Contraceptive use among U.S. women with HIV

Objective: To describe trends in and correlates of use of contraception and sterilization among women with the human immunodeficiency virus (HIV). Methods: This was a longitudinal cohort study of HIV-infected and uninfected women at risk for pregnancy, including structured questions on contraceptive use every 6 months. Proportions of women using contraception were calculated. Multivariate generalized estimating equation models were applied, and correlates of use were determined using logistic regression. Sterilization was assessed using a Kaplan-Meyer plot. Results: Across 26,832 visits among 2784 women from 1994 to 2005, barrier methods were used at 30.5%-36.3% of visits, sterilization at 21.8%-26.5%, hormones at <10%, and no contraception at >30%. Dual use of barrier and hormones or barrier and spermicide was uncommon. In multivariable analysis, HIV serostatus was not correlated with barrier use (OR 1.10, 95% CI 0.96-1.26, p = 0.18 compared with no method), but hormonal contraception was less likely in women with HIV (OR 0.73, 95% CI 0.60-0.89, p = 0.002). Among HIV-seropositive women, barrier use was more likely among women who had been pregnant (OR 1.37, 95% CI 1.03- 1.83, p = 0.03) and among those with higher CD4 lymphocyte counts (OR 1.10, 95% CI 1.04- 1.16, p = 0.0006), whereas hormone use was linked to higher CD4 counts (OR 1.12, 95% CI 1.03-1.23, p = 0.01). HAART use was not associated with barrier or hormone use. HIV serostatus was linked to sterilization in Cox analysis (HR 1.32, 95% CI 0.89-1.94, p = 0.17). Conclusions. Underuse of highly effective contraception and barriers leaves women with HIV at risk for unintended pregnancy and disease transmission.