Jessica E. Long, Methodology, Writing – original draft,#1 Gladys Waruguru, Conceptualization, Methodology, Writing – review & editing,#2 Krista Yuhas, Data curation, Formal analysis, Writing – review & editing,3 Kate S. Wilson, Methodology, Writing – review & editing,3 Linnet N. Masese, Investigation, Writing – review & editing,4 George Wanje, Investigation, Writing – review & editing,5 John Kinuthia, Investigation, Writing – review & editing,2 Walter Jaoko, Investigation, Writing – review & editing,6 Kishorchandra N. Mandaliya, Investigation, Writing – review & editing,3 and R. Scott McClelland, Conceptualization, Methodology, Supervision, Writing – review & editing1,3,5,*
Sphiwe Madiba, Editor
Affiliations
1 Department of Epidemiology, University of Washington, Seattle, WA, United States of America
2 Kenyatta National Hospital, Nairobi, Kenya
3 Department of Global Health, University of Washington, Seattle, WA, United States of America
4 Department of Medicine, University of Washington, Seattle, WA, United States of America
5 University of Nairobi Institute of Tropical and Infectious Diseases (UNITID), University of Nairobi, Nairobi, GPO, Nairobi, Kenya
6 Department of Medical Microbiology, University of Nairobi, GPO, Nairobi, Kenya
Sefako Makgatho Health Sciences University, SOUTH AFRICA
#Contributed equally.
Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: RSM receives research funding for a study of high-risk HPV collection methods, paid to the University of Washington, from Hologic Corporation. All other authors declared that no competing interests exist. We confirm that the listed competing interests do not alter our adherence to PLOS ONE data sharing policies.
* E-mail: ude.wu@llelccm
Abstract
Objectives
Female sex workers (FSWs) in sub-Saharan Africa are a key population for HIV prevention and treatment interventions, but less attention is given to their family planning needs. We evaluated the prevalence and predictors of unmet contraceptive need in HIV-positive FSWs.
Study design
This cross-sectional analysis used data from an existing longitudinal study of FSWs in Mombasa, Kenya. This analysis included women who were HIV positive, age ≥18 years, pre-menopausal, not currently pregnant or desiring pregnancy, and reported exchanging sex for cash or in-kind payment at the time of enrollment. Unmet contraceptive need was defined as non-use of modern non-barrier contraceptives and not currently trying to become pregnant. Poisson regression was used to identify factors independently associated with unmet contraceptive need.
Results
Among 346 HIV-positive FSWs, 125 (36.1%) reported modern non-barrier contraceptive use, leaving 221 (63.9%, 95%CI 58.8–68.9%) with unmet contraceptive need. Condom use was the only form of contraception for 129 (37.3%) participants. In unadjusted analyses, unmet contraceptive need was associated with physical abuse in the past year by someone other than a regular partner (PR 1.2, 95%CI 1.0–1.5), desire for (more) children (PR 1.3, 95%CI 1.1–1.5), and having 2–3 previous pregnancies compared to 0–1 prior pregnancies (PR 0.8, 95%CI 0.6–0.9). In adjusted analyses, lower number of previous pregnancies and having desire for future children remained significantly associated with a higher prevalence of unmet contraceptive need.
Conclusions
Unmet need for modern non-barrier contraception was found in two-thirds of HIV-positive FSWs who reported that they were not currently trying to become pregnant, and was higher in women with the lowest number of prior pregnancies (0–1 prior pregnancies) and in those reporting desire for (more) children in the future. These findings highlight the need for concerted efforts to identify and eliminate barriers to contraceptive use in FSWs living with HIV.
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