Influence of culture on contraceptive utilization among HIV-positive women in Brazil, Kenya, and South Africa.
Contraceptive choice and discontinuation are poorly understood among HIV-positive women, and HIV disease and culture may influence decisions. We assessed factors influencing contraceptive decision-making among HIV-positive women in three countries. This qualitative assessment of 108 HIV-positive women (36/site, selected by age and parity strata) was conducted in Rio de Janeiro, Brazil; Kericho, Kenya; and Soweto, South Africa. Freelist interviews assessed knowledge and attitudes towards contraception and were analyzed enumerating frequency and saliency of mentions. There was intersite consensus around list items but priority and themes varied. Site-specific factors influencing contraceptive choice were male partner wishes and fertility desire (Brazil), side-effects (South Africa), and impact on health and HIV progression (Kenya). Age, parity, and taking antiretroviral therapy (ART) impacted some themes. Contraceptive use among HIV-positive women is substantially influenced by culture and other factors. Counseling efforts should consider individual factors in method selection and offer method variety to accommodate changing needs.
Department of Obstetrics and Gynecology, Columbia University, 622 West 168th Street, New York, NY 10032, USA. cst2121@columbia.edu
Catherine S
CS
Todd
Mark A
MA
Stibich
Fatima
F
Laher
Monica S
MS
Malta
Francisco I
FI
Bastos
Kennedy
K
Imbuki
Douglas N
DN
Shaffer
Samuel K
SK
Sinei
Glenda E
GE
Gray
D000293:Adolescent; D000328:Adult; D001938:Brazil; D003267:Contraception / Q000706:statistics & numerical data*; D003268:Contraception Behavior / Q000208:ethnology / Q000523:psychology*; D003431:Cross-Cultural Comparison; D003469:Culture; D005260:Female; D005298:Fertility; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D007630:Kenya; D008297:Male; D008598:Menstruation / Q000523:psychology; D008875:Middle Aged; D011247:Pregnancy; D036301:Qualitative Research; D012747:Sexual Partners; D013019:South Africa; D055815:Young Adult