Contraceptive Choice and Use of Dual Protection Among Women Living with HIV in Canada: Priorities for Integrated Care
Preventing unintended pregnancy and HIV transmission is important for women with HIV, but little is known about their contraceptive use, particularly under current antiretroviral therapy (ART) recommendations for treatment and prevention.
The prevalence of contraceptive use and of dual protection was examined among 453 sexually active women with HIV aged 16–49 and enrolled in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study in 2013–2015; multivariable logistic regression was used to identify correlates of use. Two definitions of dual protection were assessed: the World Health Organization (WHO) definition (consistent condom use alongside another effective method) and an expanded definition (consistent condom use or a suppressed HIV viral load alongside an effective method).
Overall, 73% of women used effective contraceptives, primarily male condoms (45%) or tubal ligation (19%). Eighteen percent practiced WHO-defined dual protection, and 40% practiced dual protection according to the expanded definition. Characteristics positively associated with contraceptive use were younger age, having been pregnant, being heterosexual, being unaware of ART's HIV prevention benefits and having had partners of unknown HIV status (odds ratios, 1.1–6.7). Younger age and perceived inability to become pregnant were positively associated with both definitions of dual protection (1.04–3.3); additionally, WHO-defined dual protection was associated with perceiving HIV care to be women-centered and having had partners of unknown HIV status (2.0–4.1), and dual protection under the expanded definition was related to having been pregnant (2.7).
Future research should explore how sustained ART and broader contraceptive options can support women's sexual and reproductive health care needs.
Angela Kaida is associate professor, Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada. Sophie Patterson and Allison Carter are Ph.D. candidates, Faculty of Health Sciences, Simon Fraser University; and research assistants, British Columbia Centre for Excellence in HIV/AIDS, Vancouver. Mona Loutfy is associate professor and physician scientist, Women’s College Research Institute, Women’s College Hospital, and Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto. Erin Ding is a statistician, and Paul Sereda is a data analyst, both at British Columbia Centre for Excellence in HIV/AIDS. Kath Webster is peer research associate and community representative, National Management Team of the CHIWOS study, Vancouver. Neora Pick is medical director, Oak Tree Clinic, British Columbia Women’s Health Centre, and associate professor, Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver. Mary Kestler is clinical assistant professor, Oak Tree Clinic and Division of Infectious Diseases, Department of Medicine, University of British Columbia. Alexandra de Pokomandy is assistant professor and physician scientist, Chronic Viral Illness Service, McGill University Health Centre, and Department of Family Medicine, McGill University, Montreal.