title: Factors associated with discussion of sexual activity and contraception in women with HIV.
abstract: OBJECTIVE
  Contraceptive use is important for reproductive-aged women living with HIV to plan and optimise safety of pregnancies. Clinicians play a vital role in counselling patients about contraception and safe sexual activity. This study aimed to determine the frequency and predictors of discussions regarding sexual activity and contraceptive use.
  
  
  METHODS
  Retrospective clinical study of all reproductive-aged women (n=128) treated for HIV between 2010 and 2012 at two metropolitan hospitals. Evidence of discussion between treating doctors and patients regarding sexual activity and contraception and variables including patient age, gender of doctor, time since HIV diagnosis, previous pregnancy, country of birth and antiretroviral regimen were obtained from medical records.
  
  
  RESULTS
  Sexual activity status was documented for 54% of the women and discussion regarding contraception was recorded for less than one-third of the study participants. Contraceptive use was not recorded in 63% of the medical records. In the study cohort 27% of the women used contraception, 10% did not use contraception, and when a discussion regarding sexual activity was documented, contraception was 3.7 times more likely to also be discussed (p=0.04). Excluding women who were pregnant, women who were documented as using contraception were 1.8 times as likely to have had a discussion about contraception documented (p=0.05). After adjustment for other factors, previous pregnancy, gender of doctor and age of patient were not associated with discussions regarding sexual activity or contraception.
  
  
  CONCLUSIONS
  Discussions regarding sexual activity and contraception between HIV-infected women of reproductive age and their clinicians were inconsistent and suboptimal. Mechanisms to facilitate regular discussion about sexual activity and contraception between clinicians and women with HIV warrant further investigation.
authors.affiliation: Medical Student, Monash Infectious Diseases, Monash University, Clayton, Victoria, Australia.
authors.forename: Zoe A
authors.initials: ZA
authors.lastname: Stewart
authors.affiliation: HIV Nurse, Infectious Diseases Unit, Alfred Health, Prahran, Victoria and Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia.
authors.forename: Kate
authors.initials: K
authors.lastname: Shipley
authors.affiliation: Biostatistician, Infectious Diseases Unit, Alfred Health, Prahran, Victoria, Australia.
authors.forename: Tim
authors.initials: T
authors.lastname: Spelman
authors.affiliation: Infectious Diseases Physician; Director, Infections in Pregnancy Service, Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia Deputy Director, Monash HIV, Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia Adjuct Clinical Associate Professor, Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Giles
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D001315:Australia; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage; D000069216:Contraceptive Prevalence Surveys; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D010353:Patient Education as Topic / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations; D012189:Retrospective Studies; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012747:Sexual Partners; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D003271:Contraceptive Agents, Female
keywords: counselling; education and training; hormonal contraception; human immunodeficiency virus; service delivery; sexually transmitted infections