title: Contraceptive method and self-reported HIV status among women in Malawi.
abstract: OBJECTIVE
  We aimed to describe contraceptive methods used by women in Malawi and determine whether contraceptive use differed by self-reported HIV status. Effective contraception is a primary method of preventing mother-to-child transmission of HIV.
  
  
  METHODS
  Analysis is based on 12,658 nonpregnant, sexually debuted women ages 15-49 years in the 2010 Malawi Demographic and Health Survey. Analysis was restricted to respondents with contraceptive need (i.e., fecund and did not want a child in the next 12 months) who reported their last HIV test result. We accounted for the two-stage cluster sampling design by applying cluster, stratum and sample weights. We assessed differences in contraceptive method use by HIV status with χ2tests and multivariable logistic regression.
  
  
  RESULTS
  A total of 893 (7.0%) of respondents reported being HIV positive. Use of long-acting reversible contraception (LARC) was low and did not differ between HIV-positive (1.4%) and HIV-negative (1.9%) women [adjusted odds ratio (aOR)=0.7, 95% confidence interval (CI), 0.4-1.4]. HIV-positive women (15.6%) were less likely than HIV-negative women (30.4%) to use progestin-only injectable contraception (aOR, 0.7; 95% CI, 0.5-0.8). Prevalence of female sterilization was higher among HIV-positive women (17.9%) compared to HIV-negative women (9.2%; aOR=1.7; 95% CI, 1.2-2.3).
  
  
  CONCLUSIONS
  LARC use was low among adult women with contraceptive need in Malawi. HIV-positive women were less likely to report progestin-only injectable use but more likely to report having undergone female sterilization compared to their HIV-negative counterparts. Noncoercive interventions that provide highly effective methods of contraception to HIV-positive women with contraceptive need are valuable methods of vertical transmission prevention in Malawi.
  
  
  CONCLUSIONS
  Contraceptive use differed by self-reported HIV status among adult women with contraceptive need in Malawi. Female sterilization was significantly higher, and use of progestin-only injectables was significantly lower, among HIV-positive women compared to their HIV-negative counterparts. Use of long-acting reversible contraception was low among both HIV-positive and HIV-negative women.
authors.affiliation: Division of Epidemiology, College of Public Health, The Ohio State University, 324 Cunz Hall, 1841 Neil Ave., Columbus, OH. Electronic address: luster.24@osu.edu.
authors.forename: Jamie E
authors.initials: JE
authors.lastname: Luster
authors.affiliation: Division of Infectious Diseases, College of Medicine, The Ohio State University, N1144 Doan Hall, 410 W. 10th Ave., Columbus, OH.
authors.forename: Abigail Norris
authors.initials: AN
authors.lastname: Turner
authors.affiliation: Division of Epidemiology, College of Public Health, The Ohio State University, 324 Cunz Hall, 1841 Neil Ave., Columbus, OH.
authors.forename: Duna
authors.initials: D
authors.lastname: Alkhalaileh
authors.affiliation: Division of Epidemiology, College of Public Health, The Ohio State University, 324 Cunz Hall, 1841 Neil Ave., Columbus, OH.
authors.forename: Maria F
authors.initials: MF
authors.lastname: Gallo
mesh_terms: D000293:Adolescent; D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data; D003267:Contraception / Q000379:methods*; D003268:Contraception Behavior / Q000706:statistics & numerical data; D003271:Contraceptive Agents, Female / Q000008:administration & dosage; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D006679:HIV Seropositivity / Q000453:epidemiology; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008295:Malawi; D008875:Middle Aged; D016017:Odds Ratio; D012424:Rural Population; D057566:Self Report; D013245:Sterilization, Reproductive / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female
keywords: Contraception; HIV; Long-acting reversible contraception; Malawi; Sterilization; Vertical transmission