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Race, Culture, and Identity

Use of Effective Family Planning Methods and Frequency of Sex among HIV-infected and HIV-uninfected African Women

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Background: Frequency of sex, contraceptive use and HIV infection are key determinants of fertility. Use of an
effective family planning (EFP) method (injectable, oral, intra-uterine contraceptive device (IUCD), or Norplant)
potentially eliminates women’s concerns of unintended pregnancy. We report the association between EFP and
frequency of sex among HIV-infected and HIV-uninfected non-pregnant African women.

Methods: Prospective fertility intentions study nested within a phase 3 randomized double-masked placebo-controlled
trial (2003-2005) to treat genital tract infections in HIV-infected and HIV-uninfected non-pregnant women. Enrollment of
study participants was stratified by HIV infection status. Data on demographics, family planning and sexual history were
obtained at baseline and at 3, 6, 9 and 12 months. Chi square and Wilcoxon Rank-Sum tests were used to compare
categorical and continuous variables, respectively. Generalized Estimating Equations method was used to estimate
relative risk (RR) of frequent sex (≥ 2 acts/week) among users of different EFP methods (injectable, oral, implant or
intra-uterine contraceptive device).

Results: After adjusting for age, current health status, and fertility intentions, EFP use was significantly associated with
frequent sex among HIV-infected women (RR 1.32; 95% Confidence Interval [CI] 1.14-1.52); this association was not
statistically significant among HIV-uninfected women (RR 1.10; 95% CI 0.96-1.24). Fertility intentions among HIV-infected,
and education among HIV-uninfected womenwere independent predictors of sex frequency.

Conclusion: These data suggest that the association between EFP use and frequency of sex among women varies by
HIV infection status. Service-delivery of diverse EFP methods should be integrated within HIV counseling, testing and
treatment facilities.

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English
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Subject(s)
Sex
Contraception
HIV-uninfected African women
HIV/AIDS
Sub-Saharan Africa
Sexual behavior
Family planning
HIV-infected
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Article
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