Contraception uptake improves along HIV treatment cascade
Women living with HIV on antiretroviral treatment (ART) are more likely to report single and dual-method contraception use, the longer they are enrolled on HIV treatment. The findings, reported in JAIDS this week, looked at research from a rural community in KwaZulu-Natal, South Africa, and is the first of its kind to look at uptake of contraception in women as they progress along the HIV treatment cascade.
The study compared contraception use along several stages of the HIV treatment cascade. Data was collected from women who were unaware of their status; women aware of their status and/or in pre-ART care; women on ART for up to one year; women on ART for one to two years; and women on ART for four to seven years. According to the study, more than 70 percent of women living with HIV on treatment for four to seven years reported using contraception. This is compared to around 40 percent among woman living with HIV who were unaware of their status.
The type of contraception used was also recorded. Women living with HIV are recommended by the World Health Organisations (WHO) to use dual-method contraception to decrease both the risk of unwanted pregnancy and acquiring a sexually transmitted infection (STI) as well as prevent the onward transmission of HIV. In this study, they class single-method contraception use as using a condom, while dual-method referred to the use of a condom plus an additional contraceptive, such as oral contraceptives; and single contraceptive as using a contraceptive without a condom. They found that the likelihood of condom use significantly increased after women became aware of their HIV status. Use of the recommended dual-contraceptive also increased significantly as woman progressed along the cascade, and was most pronounced when on ART for four to seven years.
Progression along the HIV treatment cascade means that women are engaged with health services, and are able to access information to protect their sexual health. They are also better placed to access actual contraception methods. The researchers suggest that in order to change behaviour around contraceptive uptake and choice, HIV services need to be integrated with reproductive health services at an earlier stage so that more women may learn the benefits of dual-protection, for their own health, but also to contribute to HIV prevention overall.