title: Factors associated with the use of irreversible contraception and continuous use of reversible contraception in a cohort of HIV-positive women.
abstract: BACKGROUND
  Effective contraception can be lifesaving by reducing maternal mortality linked to childbirth and unsafe abortion and by reducing vertical and horizontal transmission of HIV, in the case of an HIV-positive woman.
  
  
  METHODS
  This study is a secondary analysis of a prospective cohort study. We assessed factors associated with the use of irreversible contraception and the continuous use of reversible contraception in HIV-positive Thai women. We used descriptive statistics to present baseline characteristics and logistic regression to assess the association between contraceptive use and factors in the study.
  
  
  RESULTS
  Of 196 women included in the analysis, 87% self-reported always using male condoms and 56% continuously using another effective contraceptive method during the period of the study (12-18 months). The choice of effective contraceptive methods was suboptimal--42% were sterilized, 14% used hormonal contraception and no participant reported the use of an intrauterine device. Sexual activity and past contraceptive use were factors associated positively with current continuous contraceptive use. Live births and lower levels of education were additional factors associated positively with sterilization.
  
  
  CONCLUSIONS
  Despite high contraceptive use, there are still uncovered contraceptive needs among HIV-positive women in Thailand. HIV-positive women need established specialized family planning services, offering an optimal variety of contraceptive choices and tailored to their individual needs. As sterilization is an irreversible choice, it cannot be a viable alternative for every woman. Due to the positive trend between current and past contraceptive use, we consider that it may be possible to improve family planning programs if they start as early as possible in a woman's life and are continued throughout her sexually active and reproductive years.
authors.affiliation: The HIV Netherlands Australia Thailand Research Collaboration, Bangkok, Thailand. nadia.kl@hivnat.org
authors.forename: Nadia
authors.initials: N
authors.lastname: Kancheva Landolt
authors.forename: Reshmie Ashmanie
authors.initials: RA
authors.lastname: Ramautarsing
authors.forename: Nittaya
authors.initials: N
authors.lastname: Phanuphak
authors.forename: Nipat
authors.initials: N
authors.lastname: Teeratakulpisarn
authors.forename: Suteeraporn
authors.initials: S
authors.lastname: Pinyakorn
authors.forename: Piyanee
authors.initials: P
authors.lastname: Rodbamrung
authors.forename: Surasith
authors.initials: S
authors.lastname: Chaithongwongwatthana
authors.forename: Jintanat
authors.initials: J
authors.lastname: Ananworanich
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D017280:Condoms; D003268:Contraception Behavior; D003278:Contraceptives, Oral, Hormonal; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission; D006679:HIV Seropositivity; D006801:Humans; D059012:Lost to Follow-Up; D008875:Middle Aged; D011446:Prospective Studies; D017584:Reproductive History; D057566:Self Report; D012725:Sexual Behavior; D013245:Sterilization, Reproductive; D013785:Thailand; D055815:Young Adult
chemical_list: D003278:Contraceptives, Oral, Hormonal