title: Role of menstruation in contraceptive choice among HIV-infected women in Soweto, South Africa.
abstract: BACKGROUND
  Contraceptive preferences of HIV-infected women must be considered in efforts to integrate HIV and reproductive health services. In South Africa, contraception is often discontinued due to bleeding pattern changes. It is unknown whether HIV-infected women are more sensitive to menstrual changes and how this affects contraceptive choice. This study describes perceptions toward menses and contraceptive-induced amenorrhea among HIV-infected women.
  
  
  METHODS
  A convenience sample of 42 HIV-infected women aged 15 to 45 years was purposively recruited for three focus groups and 15 in-depth qualitative interviews which were conducted at the Perinatal HIV Research Unit, South Africa. Transcripts were coded and emergent themes grouped.
  
  
  RESULTS
  One third of women reported HIV-related menstrual changes, unchanged by antiretroviral use. Menstruation was believed to purge the body of "dirty blood." Women perceived that menstruation had a negative effect on male partner sexual desire, with concern about higher HIV transmission during menstruation. Ninety-six percent of injectable contraceptive users experienced amenorrhea, regarded as troublesome and a reason for discontinuation.
  
  
  CONCLUSIONS
  In Soweto, HIV diagnosis may accentuate linking menstruation with health, leading to avoidance or discontinuation of methods causing amenorrhea. Providers should intensify education on the safety of contraceptive-induced oligo/amenorrhea.
authors.affiliation: Perinatal HIV Research Unit, Soweto, Johannesburg, Gauteng Province, South Africa. laherf@phru.co.za
authors.forename: Fatima
authors.initials: F
authors.lastname: Laher
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Todd
authors.forename: Mark A
authors.initials: MA
authors.lastname: Stibich
authors.forename: Rebecca
authors.initials: R
authors.lastname: Phofa
authors.forename: Xoliswa
authors.initials: X
authors.lastname: Behane
authors.forename: Lerato
authors.initials: L
authors.lastname: Mohapi
authors.forename: Neil
authors.initials: N
authors.lastname: Martinson
authors.forename: Glenda
authors.initials: G
authors.lastname: Gray
mesh_terms: D000293:Adolescent; D000328:Adult; D000568:Amenorrhea / Q000139:chemically induced / Q000523:psychology; D003268:Contraception Behavior / Q000523:psychology*; D003271:Contraceptive Agents, Female / Q000009:adverse effects; D003430:Cross-Sectional Studies; D003469:Culture; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000523:psychology* / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008598:Menstruation / Q000187:drug effects / Q000523:psychology*; D008599:Menstruation Disturbances / Q000139:chemically induced / Q000523:psychology*; D008875:Middle Aged; D057240:Patient Preference; D012725:Sexual Behavior / Q000523:psychology; D012747:Sexual Partners / Q000523:psychology; D013019:South Africa; D016312:Treatment Refusal / Q000523:psychology; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female