Diya Surie, Methodology, Writing – original draft, Writing – review & editing,¹ Krista Yuhas, Data curation, Formal analysis, Methodology, Software, Validation, Writing – review & editing,² Kate Wilson, Conceptualization, Writing – review & editing,² Linnet N. Masese, Investigation, Project administration, Writing – review & editing,¹ Juma Shafi, Conceptualization, Investigation, Methodology, Project administration, Writing – review & editing,³ John Kinuthia, Conceptualization, Investigation, Writing – review & editing,⁴ Walter Jaoko, Conceptualization, Investigation, Project administration, Writing – review & editing,⁵ and R. Scott McClelland, Conceptualization, Funding acquisition, Investigation, Methodology, Project administration, Supervision, Validation, Writing – original draft, Writing – review & editing^1,2,3,6,*

Caroline Mitchell, Editor

Affiliations

¹ Department of Medicine, University of Washington, Seattle, United States of America

² Department of Global Health, University of Washington, Seattle, United States of America

³ Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya

⁴ Departments of Research and Programs, Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya

⁵ Kenya AIDS Vaccine Initiative Institute, University of Nairobi, Nairobi, Kenya

⁶ Department of Epidemiology, University of Washington, Seattle, United States of America

Massachusetts General Hospital, UNITED STATES

Competing Interests: Dr. McClelland receives research funding, paid to the University of Washington, from Hologic Corporation. All other authors report no conflict of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

* E-mail: ude.wu@llelccm

Associated Data

Supplementary Materials

S1 File: Mombasa cohort enrollment questionnaire. (PDF)

pone.0187444.s001.pdf (125K)

GUID: 10C17D15-3424-4FA4-B599-663FF16F21CF

S2 File: Lifecourse enrollment questionnaire. (PDF)

pone.0187444.s002.pdf (280K)

GUID: F3415C6C-3B29-455E-9C80-76B7A4F30688

S3 File: Lifecourse general monthly follow up questionnaire. (PDF)

pone.0187444.s003.pdf (63K)

GUID: 46B6BA5B-0C46-4CE6-A03D-DD96C8A1DA96

Data Availability Statement

The Kenyatta National Hospital/University of Nairobi Ethics and Research Committee requires that we release data from Kenyan studies (including de-identified data) only after they have provided their written approval for additional analyses. They do not feel that analyses that may be outside the scope of the current scientific and ethical approval should be conducted without their prior review. The Principal Investigator on the approved protocol is considered to be the custodian of the data. Data are available from the authors upon request, with written approval for the proposed analysis from the Kenyatta National Hospital/University of Nairobi Ethics and Research Committee (KNH/UON ERC). Their application forms and guidelines can be accessed at http://erc.uonbi.ac.ke/. Additionally, data requests may be sent to the following representatives of the data access committee: Vrasha Chohan Research Scientist University of Washington Dept of Medicine/Allergy and Infectious Diseases 325 Ninth Avenue Box 359909 Seattle WA 98104 Email: ude.wu@nahohcv Prof. Anastasia Guantai Chair of the Kenyatta National Hospital Ethics Research Committee Email: ek.ca.ibnou@iatnaugna.

Abstract

Background

As access to antiretroviral therapy in sub-Saharan Africa continues to expand, more women with HIV can expect to survive through their reproductive years. Modern contraceptives can help women choose the timing and spacing of childbearing. However, concerns remain that women with HIV who use non-barrier forms of modern contraception may engage in more condomless sex because of their decreased risk of unintended pregnancy. We examined whether non-barrier modern contraceptive use by HIV-positive female sex workers was associated with increased frequency of recent condomless sex, measured by detection of prostate-specific antigen (PSA) in vaginal secretions.

Methods

Women who were HIV-positive and reported transactional sex were included in this analysis. Pregnant and post-menopausal follow-up time was excluded, as were visits at which women reported trying to get pregnant. At enrollment and quarterly follow-up visits, a pelvic speculum examination with collection of vaginal secretions was conducted for detection of PSA. In addition, women completed a structured face-to-face interview about their current contraceptive methods and sexual risk behavior at enrollment and monthly follow-up visits. Log-binomial generalized estimating equations regression was used to test for associations between non-barrier modern contraceptive use and detection of PSA in vaginal secretions and self-reported condomless sex. Data from October 2012 through September 2014 were included in this analysis.

Results

Overall, 314 women contributed 1,583 quarterly examination visits. There was minimal difference in PSA detection at contraceptive-exposed versus contraceptive-unexposed visits (adjusted relative risk [aRR] 1.28, 95% confidence interval [95% CI] 0.93–1.76). There was a higher rate of self-reported condomless sex at visits where women reported using modern contraceptives, but this difference was not statistically significant after adjustment for potential confounding factors (aRR 1.59, 95% CI 0.98–2.58).

Conclusion

Non-barrier methods of modern contraception were not associated with increased risk of objective evidence of condomless sex.

Link

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5703462/