title: Attitudes toward family planning among HIV-positive pregnant women enrolled in a prevention of mother-to-child transmission study in Kisumu, Kenya.
abstract: BACKGROUND
  Preventing unintended pregnancies among HIV-positive women through family planning (FP) reduces pregnancy-related morbidity and mortality, decreases the number of pediatric HIV infections, and has also proven to be a cost-effective way to prevent mother-to-child HIV transmission. A key element of a comprehensive HIV prevention agenda, aimed at avoiding unintended pregnancies, is recognizing the attitudes towards FP among HIV-positive women and their spouse or partner. In this study, we analyze FP attitudes among HIV-infected pregnant women enrolled in a PMTCT clinical trial in Western Kenya.
  
  
  RESULTS
  Baseline data were collected on 522 HIV-positive pregnant women using structured questionnaires. Associations between demographic variables and the future intention to use FP were examined using Fisher's exact tests and permutation tests. Most participants (87%) indicated that they intended to use FP. However, only 8% indicated condoms as a preferred FP method, and 59% of current pregnancies were unintended. Factors associated with positive intentions to use FP were: marital status (p = 0.04), having talked to their spouse or partner about FP (p<0.001), perceived spouse or partner approval of FP (p<0.001), previous use of a FP method (p = 0.006), attitude toward the current pregnancy (p = 0.02), disclosure of a sexually transmitted infection (STI) diagnosis (p = 0.03) and ethnic group (p = 0.03).
  
  
  CONCLUSIONS
  A significant gap exists between future FP intentions and current FP practices. Support and approval by the spouse or partner are key elements of FP intentions. Counseling services should be offered to both members of a couple to increase FP use, especially given the high number of unplanned pregnancies among HIV-positive women. Condoms should be promoted as part of a dual use method for HIV and STI prevention and for contraception. Integration of individual and couple FP services into routine HIV care, treatment and support services is needed in order to avoid unintended pregnancies and to prevent mother-to-child HIV transmission.
authors.affiliation: Kenya Medical Research Institute, Kisumu, Kenya ; Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Victor
authors.initials: V
authors.lastname: Akelo
authors.forename: Sonali
authors.initials: S
authors.lastname: Girde
authors.forename: Craig B
authors.initials: CB
authors.lastname: Borkowf
authors.forename: Frank
authors.initials: F
authors.lastname: Angira
authors.forename: Kevin
authors.initials: K
authors.lastname: Achola
authors.forename: Richard
authors.initials: R
authors.lastname: Lando
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Mills
authors.forename: Timothy K
authors.initials: TK
authors.lastname: Thomas
authors.forename: Shirley
authors.initials: S
authors.lastname: Lee Lecher
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D017280:Condoms; D003267:Contraception / Q000706:statistics & numerical data; D003268:Contraception Behavior; D005193:Family Planning Services; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology*; D006679:HIV Seropositivity / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007630:Kenya / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D049168:Pregnancy, Unplanned; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D055815:Young Adult