Women who are living with HIV use IUDs at a lower rate than the general population, and it is unclear whether health care providers’ misconceptions about IUD safety contribute to this disparity.
A 2013–2014 nationwide survey of 1,998 U.S. family planning providers assessed perceptions of IUD safety for women with HIV or other medical conditions. Multivariable logistic regression was used to examine associations between provider characteristics and whether individuals believed IUDs were safe for HIV‐positive women. Data from public‐sector providers and office‐based physicians were analyzed separately.
Seven in 10 providers considered IUDs safe for women with HIV, and there were no differences by provider type. Among public‐sector providers, some of the characteristics associated with believing that IUDs were unsafe for seropositive women were working at a clinic without Title X funding (odds ratio, 1.5), not being trained in IUD insertion (2.1) and not using the U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) for clinical guidance (1.8). Office‐based physicians who did not use the guidelines also had an increased likelihood of believing that IUDs were unsafe for women with HIV (2.9), and physicians who had completed training 25 or more years ago were more likely than those who had done so less than five years ago to consider IUDs unsafe (3.3).
Greater use of evidence‐based contraceptive guidance such as the U.S. MEC may help inform provider perceptions of IUD safety and hence contribute to increased contraceptive choice for women with HIV.
Katharine B. Simmons is obstetrician-gynecologist, Permanente Medical Group, San Leandro, CA. Lauren Zapata is senior research scientist, and Kathryn M. Curtis is health scientist, both at the Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta.