Women living with HIV still lack highly effective contraception: results from the ANRS VESPA2 study, France, 2011.
OBJECTIVE
Advances in antiretroviral treatment (ART) have led to improvements in reproductive health for women living with HIV. This paper aims to investigate the pattern of contraceptive use among women living with HIV in France.


METHODS
Data were drawn from the ANRS VESPA2 study, which included a representative sample of HIV-positive people. Contraception methods were documented, including condoms, highly effective contraception methods (HEC) and traditional methods. We measured the frequency of not using any modern contraception (neither condoms nor HEC) and of HEC use and studied their correlates (i.e., geographic origin, age, parity, partnership status, education level, material deprivation, employment status, health insurance, visits to a gynecologist, being on ART, cardiovascular risk) among women at risk of an unintended pregnancy.


RESULTS
Of the 662 women of reproductive age, 327 were in need of contraception. Overall, 20.5% used HEC, 58.8% used condoms and 20.7% used traditional or no methods, with no difference according to geographic origin [sub-Saharan African (SSA) women vs. French and other migrant women]. Among SSA women, being <30years old [odds ratio (OR) 16.39, 95% confidence interval (95%CI) 2.77-97.01], having had at least one child (OR 3.75, 95%CI 1.75-8.04) and being employed (OR 2.36, 95%CI 0.99-5.61) were associated with HEC use; among French and other migrant women, HEC use was associated with being in a stable partnership (OR 4.5, 95%CI 1.2-17.2) and material deprivation (OR 3.3 95%CI 1.4-9.8). Gynecologist visits, health insurance status and cardiovascular risk were not associated with HEC use.


CONCLUSIONS
Condoms remained the predominant contraceptive method despite the absence of restrictions on hormonal contraception and intrauterine device use for HIV-positive women. The recent recommendations about dual method protection should be actively promoted, targeting HIV-positive women, HIV specialists and gynecologists to overcome the barriers to effective contraception.


CONCLUSIONS
The information provided in this study constitutes a major contribution to comprehensively inform the scientific community on contraception practices among women living with HIV in France in the early 2010s. Our results show that the therapeutic advances since the late 1990s and the removal of restrictions on hormonal contraception use have not led to the expected shift in contraception patterns. There is an urgent need to promote dual method protection, as condom use may decrease in the future in the context of the preventive effect of ART.
INSERM U1018, Centre de Recherche en Epidémiologie et Santé des Populations, Villejuif, France. Electronic address: barbara.maraux@gmail.com.
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Maraux
INSERM U1018, Centre de Recherche en Epidémiologie et Santé des Populations, Villejuif, France; Université de Versailles Saint-Quentin en Yvelines, Villejuif, France.
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Hamelin
INSERM U1018, Centre de Recherche en Epidémiologie et Santé des Populations, Villejuif, France; INED, Paris, France; Université Paris Sud, Le Kremlin-Bicêtre, France.
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Bajos
INSERM, UMRS 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Équipe de Recherche en Épidémiologie Sociale, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR-S 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Équipe de Recherche en Épidémiologie Sociale, Paris, France.
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Dray-Spira
INSERM UMRS 912 (SESSTIM), Marseille, France; Aix Marseille Université, UMRS 912, IRD, Marseille, France; ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte-D'azur, Marseille, France.
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Spire
INSERM U1018, Centre de Recherche en Epidémiologie et Santé des Populations, Villejuif, France; Université de Versailles Saint-Quentin en Yvelines, Villejuif, France.
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Lert
D000328:Adult; D017954:Africa South of the Sahara / Q000208:ethnology; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D017280:Condoms; D003268:Contraception Behavior / Q000208:ethnology; D003271:Contraceptive Agents, Female / Q000008:administration & dosage; D000069216:Contraceptive Prevalence Surveys; D005260:Female; D005602:France; D015658:HIV Infections / Q000188:drug therapy* / Q000208:ethnology; D006801:Humans; D010349:Patient Compliance / Q000208:ethnology; D017410:Practice Guidelines as Topic; D012747:Sexual Partners; D012959:Socioeconomic Factors; D014171:Transients and Migrants; D055815:Young Adult
D044966:Anti-Retroviral Agents; D003271:Contraceptive Agents, Female
Contraception; Dual method protection; France; HIV; Women