title: Contraceptive use among U.S. women with HIV.
abstract: OBJECTIVE
  To describe trends in and correlates of use of contraception and sterilization among women with the human immunodeficiency virus (HIV).
  
  
  METHODS
  This was a longitudinal cohort study of HIV-infected and uninfected women at risk for pregnancy, including structured questions on contraceptive use every 6 months. Proportions of women using contraception were calculated. Multivariate generalized estimating equation models were applied, and correlates of use were determined using logistic regression. Sterilization was assessed using a Kaplan-Meyer plot.
  
  
  RESULTS
  Across 26,832 visits among 2784 women from 1994 to 2005, barrier methods were used at 30.5%-36.3% of visits, sterilization at 21.8%-26.5%, hormones at <10%, and no contraception at >30%. Dual use of barrier and hormones or barrier and spermicide was uncommon. In multivariable analysis, HIV serostatus was not correlated with barrier use (OR 1.10, 95% CI 0.96-1.26, p = 0.18 compared with no method), but hormonal contraception was less likely in women with HIV (OR 0.73, 95% CI 0.60-0.89, p = 0.002). Among HIV-seropositive women, barrier use was more likely among women who had been pregnant (OR 1.37, 95% CI 1.03- 1.83, p = 0.03) and among those with higher CD4 lymphocyte counts (OR 1.10, 95% CI 1.04- 1.16, p = 0.0006), whereas hormone use was linked to higher CD4 counts (OR 1.12, 95% CI 1.03-1.23, p = 0.01). HAART use was not associated with barrier or hormone use. HIV serostatus was linked to sterilization in Cox analysis (HR 1.32, 95% CI 0.89-1.94, p = 0.17). CONCLUSIONS. Underuse of highly effective contraception and barriers leaves women with HIV at risk for unintended pregnancy and disease transmission.
authors.affiliation: Southern Illinois University School of Medicine, Springfield, Illinois 62794-9640, USA. LSMASSAD@ameritech.net
authors.forename: L Stewart
authors.initials: LS
authors.lastname: Massad
authors.forename: Charlesnika T
authors.initials: CT
authors.lastname: Evans
authors.forename: Tracey E
authors.initials: TE
authors.lastname: Wilson
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Golub
authors.forename: Lorraine
authors.initials: L
authors.lastname: Sanchez-Keeland
authors.forename: Howard
authors.initials: H
authors.lastname: Minkoff
authors.forename: Kathleen
authors.initials: K
authors.lastname: Weber
authors.forename: D Heather
authors.initials: DH
authors.lastname: Watts
mesh_terms: D000328:Adult; D015331:Cohort Studies; D016001:Confidence Intervals; D003267:Contraception / Q000706:statistics & numerical data*; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000517:prevention & control*; D021841:Safe Sex / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D047568:Unsafe Sex / Q000706:statistics & numerical data