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Unmet need for contraception among HIV discordant couples

By | December 16th 2010

By Michael Oriedo

The rate of unwanted pregnancies and abortion among HIV-discordant couples is high because many do not use family planning products, finds a new study.

The Africa Population and Health Research Centre (APHRC) study reports that low use of family planning methods is fuelling unwanted pregnancies and abortion among discordant couples. "There is low use of family planning products, including condoms among HIV-discordant couples making unwanted pregnancies and abortion common," says lead researcher, Dr Chima Izugbara.

The study released recently at a forum on discordant couple surveyed family planning and condom use. In particular, the researchers explored family planning needs, practices, condom use and beliefs of the couples.

The researchers found that many couples desire to have children. "Many expressed individually and jointly that they were trying to get a baby. Only a few couples did not want another child," says Izugbara.

But despite the great desire, the research shows many couples have conflicting messages about child bearing. "Some were told not to contemplate it. Others were informed to consult doctors and others know they can go ahead if they want a child," reports the study.

Preferred method

During the study, researchers found that in instances where the woman was HIV positive, there were also children in the family who were positive.

The research reveals that many discordant couples are knowledgeable about family planning. "The methods couples are aware about include abstinence, birth control pills, intrauterine device (IUD), sterilisation, withdrawal, and male condom," says Izugbara.

But, according to the research, male condoms are the preferred method because they are accessible, easy to use and protect against both HIV and unwanted pregnancies.

On the contrary, the study says, couples rarely use female condoms.

Frequent stock outs and some health workers in mission hospitasls, who advise couples against using contraceptives, discourage couples from planning their families.

"Many couples are not aware of availability of assisted reproduction or family planning services exclusively for HIV-discordant couples," says Izugbara.

The study finds that beliefs and myths bar couples from using family planning products therefore exposing the uninfected partner to the virus. "Some couples believed that some contraceptives have side effects to women including reducing libido, causing secondary infertility and weight increase or loss," says Izugbara.

The researcher says some couples believe that having children is a way of conquering HIV. Others believe that some contraceptives do not interact well with ARV reducing their effect.

Interestingly, the research reveals that family planning related discussions are rare in the unions especially when the man is the positive. "Because of the nature of our society which is patriarchal, a man would not want to talk about his status with his partner. Some decline to use condoms therefore exposing their partners to HIV," says Izugbara.

Couples who inconsistently used condoms said they believed that they are both infected. Others believed that since their partners persistently took ARVs, they could not transmit the virus. The study found that some couples shunned condoms but used ARV immediately after having unprotected sex to prevent infection.

According to the Kenya Demographic and Health Survey of 2008, six per cent of all cohabiting couples are discordant, with 13 per cent and 11 per cent being found in Nairobi and Nyanza.



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