title: Pregnancy prevention and condom use practices among HIV-infected women on antiretroviral therapy seeking family planning in Lilongwe, Malawi.
abstract: BACKGROUND
  Programs for integration of family planning into HIV care must recognize current practices and desires among clients to appropriately target and tailor interventions. We sought to evaluate fertility intentions, unintended pregnancy, contraceptive and condom use among a cohort of HIV-infected women seeking family planning services within an antiretroviral therapy (ART) clinic.
  
  
  METHODS
  200 women completed an interviewer-administered questionnaire during enrollment into a prospective contraceptive study at the Lighthouse Clinic, an HIV/ART clinic in Lilongwe, Malawi, between August and December 2010.
  
  
  RESULTS
  Most women (95%) did not desire future pregnancy. Prior reported unintended pregnancy rates were high (69% unplanned and 61% unhappy with timing of last pregnancy). Condom use was inconsistent, even among couples with discordant HIV status, with lack of use often attributed to partner's refusal. Higher education, older age, lower parity and having an HIV negative partner were factors associated with consistent condom usage.
  
  
  CONCLUSIONS
  High rates of unintended pregnancy among these women underscore the need for integ rating family planning, sexually transmitted infection (STI) prevention, and HIV services. Contraceptive access and use, including condoms, must be improved with specific efforts to enlist partner support. Messages regarding the importance of condom usage in conjunction with more effective modern contraceptive methods for both infection and pregnancy prevention must continue to be reinforced over the course of ongoing ART treatment.
authors: Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States of America.
authors: Lisa B
authors: LB
authors: Haddad
authors: The Lighthouse Trust, Lilongwe, Malawi; International Training and Education Center for Health (I-TECH), University of Washington, Seattle, Washington, United States of America.
authors: Caryl
authors: C
authors: Feldacker
authors: Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States of America.
authors: Denise J
authors: DJ
authors: Jamieson
authors: The Lighthouse Trust, Lilongwe, Malawi.
authors: Hannock
authors: H
authors: Tweya
authors: Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, United States of America.
authors: Carrie
authors: C
authors: Cwiak
authors: The Lighthouse Trust, Lilongwe, Malawi.
authors: Thomas
authors: T
authors: Chaweza
authors: The Lighthouse Trust, Lilongwe, Malawi.
authors: Linly
authors: L
authors: Mlundira
authors: The Lighthouse Trust, Lilongwe, Malawi.
authors: Jane
authors: J
authors: Chiwoko
authors: The Lighthouse Trust, Lilongwe, Malawi.
authors: Bernadette
authors: B
authors: Samala
authors: Reproductive Health Services, Ministry of Health, Lilongwe, Malawi.
authors: Fanny
authors: F
authors: Kachale
authors: University of North Carolina Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors: Amy G
authors: AG
authors: Bryant
authors: University of North Carolina Chapel Hill, Chapel Hill, North Carolina, United States of America; University of North Carolina Project-Malawi, Lilongwe, Malawi.
authors: Mina C
authors: MC
authors: Hosseinipour
authors: University of North Carolina Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors: Gretchen S
authors: GS
authors: Stuart
authors: University of North Carolina Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors: Irving
authors: I
authors: Hoffman
authors: The Lighthouse Trust, Lilongwe, Malawi.
authors: Sam
authors: S
authors: Phiri
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D017280:Condoms / Q000706:statistics & numerical data*; D003268:Contraception Behavior; D005193:Family Planning Services; D005260:Female; D005298:Fertility; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control*; D006801:Humans; D008295:Malawi; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D049168:Pregnancy, Unplanned