title: Trends in contraceptive use among women with human immunodeficiency virus.
abstract: OBJECTIVE
  To estimate trends in contraceptive use, especially long-acting reversible contraceptives (LARCs) and condoms, among human immunodeficiency virus (HIV)-seropositive and HIV-seronegative women.
  
  
  METHODS
  Human immunodeficiency virus-seropositive and HIV-seronegative women in a multicenter longitudinal cohort were interviewed semiannually between 1998 and 2010 about sexual behaviors and contraceptive use. Trends in contraceptive use by women aged 18-45 years who were at risk for unintended pregnancy but not trying to conceive were analyzed using generalized estimating equations.
  
  
  RESULTS
  Condoms were the dominant form of contraception for HIV-seropositive women and showed little change across time. Less than 15% of these women used no contraception. Between 1998 and 2010, LARC use increased among HIV-seronegative women from 4.8% (6 of 126) to 13.5% (19 of 141, P=.02), but not significantly among seropositive women (0.9% [4 of 438] to 2.8% [6 of 213], P=.09). Use of highly effective contraceptives, including pills, patches, rings, injectable progestin, implants, and intrauterine devices, ranged from 15.2% (53 of 348) in 1998 to 17.4% (37 of 213) in 2010 (P=.55). Human immunodeficiency virus-seronegative but not HIV-seropositive LARC users were less likely than nonusers to use condoms consistently (hazard ratio 0.51, 95% confidence interval [CI] 0.32-0.81, P=.004 for seronegative women; hazard ratio 1.09, 95% CI 0.96-1.23 for seropositive women).
  
  
  CONCLUSIONS
  Although most HIV-seropositive women use contraception, they rely primarily on condoms and have not experienced the increase in LARC use seen among seronegative women. Strategies to improve simultaneous use of condoms and LARC are needed to minimize risk of unintended pregnancy as well as HIV transmission and acquisition of sexually transmitted infections.
  
  
  METHODS
  II.
authors.affiliation: Division of Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri 63110, USA.
authors.forename: Mengyang
authors.initials: M
authors.lastname: Sun
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Peipert
authors.forename: Qiuhong
authors.initials: Q
authors.lastname: Zhao
authors.forename: Tracey E
authors.initials: TE
authors.lastname: Wilson
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Weber
authors.forename: Lorraine
authors.initials: L
authors.lastname: Sanchez-Keeland
authors.forename: Gypsyamber
authors.initials: G
authors.lastname: DʼSouza
authors.forename: Mary
authors.initials: M
authors.lastname: Young
authors.forename: D Heather
authors.initials: DH
authors.lastname: Watts
authors.forename: Marla J
authors.initials: MJ
authors.lastname: Keller
authors.forename: Deborah
authors.initials: D
authors.lastname: Cohan
authors.forename: L Stewart
authors.initials: LS
authors.lastname: Massad
mesh_terms: D000293:Adolescent; D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data* / Q000639:trends; D003267:Contraception / Q000379:methods / Q000706:statistics & numerical data* / Q000639:trends; D003271:Contraceptive Agents, Female; D003274:Contraceptive Devices, Female / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D015658:HIV Infections; D018023:HIV Seronegativity; D006679:HIV Seropositivity; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D015233:Models, Statistical; D057566:Self Report; D014481:United States; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female