title: Does Integrating Family Planning into HIV Services Improve Gender Equitable Attitudes? Results from a Cluster Randomized Trial in Nyanza, Kenya.
abstract: This study investigated whether integrating family planning (FP) services into HIV care was associated with gender equitable attitudes among HIV-positive adults in western Kenya. Surveys were conducted with 480 women and 480 men obtaining HIV services from 18 clinics 1 year after the sites were randomized to integrated FP/HIV services (N = 12) or standard referral for FP (N = 6). We used multivariable regression, with generalized estimating equations to account for clustering, to assess whether gender attitudes (range 0-12) were associated with integrated care and with contraceptive use. Men at intervention sites had stronger gender equitable attitudes than those at control sites (adjusted mean difference in scores = 0.89, 95 % CI 0.03-1.74). Among women, attitudes did not differ by study arm. Gender equitable attitudes were not associated with contraceptive use among men (AOR = 1.06, 95 % CI 0.93-1.21) or women (AOR = 1.03, 95 % CI 0.94-1.13). Further work is needed to understand how integrating FP into HIV care affects gender relations, and how improved gender equity among men might be leveraged to improve contraceptive use and other reproductive health outcomes.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, USA. sara.newmann@ucsf.edu.|Ibis Reproductive Health, Oakland, CA, USA. sara.newmann@ucsf.edu.|Department of Obstetrics, Gynecology & Reproductive Sciences, San Francisco General Hospital, 1001 Potrero Avenue, Unit 6D-14, San Francisco, CA, 94110, USA. sara.newmann@ucsf.edu.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Newmann
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Corinne H
authors.initials: CH
authors.lastname: Rocca
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Zakaras
authors.affiliation: Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Maricianah
authors.initials: M
authors.lastname: Onono
authors.affiliation: Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, USA.|Ibis Reproductive Health, Oakland, CA, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Grossman
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D016000:Cluster Analysis; D003267:Contraception / Q000706:statistics & numerical data*; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003376:Counseling / Q000379:methods*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005193:Family Planning Services / Q000458:organization & administration*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000628:therapy; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007630:Kenya; D008297:Male; D012737:Sex Factors; D012747:Sexual Partners; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: Family planning; Gender equity; HIV; Integrated services; Sub-Saharan Africa
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