title: Clinicians' perceptions and provision of hormonal contraceptives for HIV-positive and at-risk women in Southern Africa: an original research article.
abstract: OBJECTIVE
  To assess clinician provision of hormonal contraception for HIV-positive and at-risk women in Southern Africa.
  
  
  METHODS
  We conducted a nationally representative survey of clinicians (n=1444) in HIV-prevalent settings in South Africa and Zimbabwe to evaluate evidence-based contraceptive care and clinician views of hormonal contraceptives for HIV-positive and at-risk women. Multivariable logistic regression was used to analyze differences in contraceptive provision by professional training and practice setting.
  
  
  RESULTS
  Most providers offered oral contraceptives (85%), but only a small minority considered them appropriate for women at risk of HIV (27%) or HIV-positive women (25%). A higher proportion of clinicians considered injections appropriate for women at risk of HIV (42%) or HIV-positive women (46%). Very few considered emergency contraceptives appropriate (13%). Multivariable results showed that family planning training and clinic as compared to hospital practices were associated with evidence-based attitudes about contraception for HIV-positive or at-risk women and greater provision. There were no differences, however, between physicians and nurses or by HIV training.
  
  
  CONCLUSIONS
  These findings emphasize the need to improve clinicians' awareness of evidence-based guidelines for hormonal contraception for women at high risk of HIV and HIV-positive women. Evidence-based information that oral contraception and injections are appropriate is essential. Contraceptive education should be integrated into HIV training to reach at-risk populations.
authors.affiliation: Ibis Reproductive Health, Cambridge, MA 02138 USA. Electronic address: kblanchard@ibisreproductivehealth.org.
authors.forename: Kelly
authors.initials: K
authors.lastname: Blanchard
authors.affiliation: University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
authors.forename: Tsungai
authors.initials: T
authors.lastname: Chipato
authors.affiliation: HIV Research Unit, Medical Research Council, Westville, 3630, South Africa.
authors.forename: Gita
authors.initials: G
authors.lastname: Ramjee
authors.affiliation: University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
authors.forename: Tzadzaa
authors.initials: T
authors.lastname: Nhemachena
authors.affiliation: University of California, San Francisco, Department of Obstetrics, Gynecology & Reproductive Sciences, San Francisco, CA, USA 94143-0744.
authors.forename: Cynthia C
authors.initials: CC
authors.lastname: Harper
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003276:Contraceptives, Oral; D003282:Contraceptives, Postcoital, Hormonal; D037001:Directive Counseling; D019317:Evidence-Based Medicine; D005193:Family Planning Services / Q000193:education; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology*; D019538:Health Care Surveys; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage; D008875:Middle Aged; D009640:Norethindrone / Q000008:administration & dosage / Q000031:analogs & derivatives; D057184:Practice Patterns, Nurses' / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology
chemical_list: D003276:Contraceptives, Oral; D003282:Contraceptives, Postcoital, Hormonal; D017258:Medroxyprogesterone Acetate; C024319:norethindrone enanthate; D009640:Norethindrone
keywords: Contraception; Family planning; HIV; Southern Africa