AIDS and Behavior

, Volume 15, Issue 2, pp 454–468 | Cite as

Influence of Culture on Contraceptive Utilization Among HIV-Positive Women in Brazil, Kenya, and South Africa

  • Catherine S. ToddEmail author
  • Mark A. Stibich
  • Fatima Laher
  • Monica S. Malta
  • Francisco I. Bastos
  • Kennedy Imbuki
  • Douglas N. Shaffer
  • Samuel K. Sinei
  • Glenda E. Gray
Original Paper


Contraceptive choice and discontinuation are poorly understood among HIV-positive women, and HIV disease and culture may influence decisions. We assessed factors influencing contraceptive decision-making among HIV-positive women in three countries. This qualitative assessment of 108 HIV-positive women (36/site, selected by age and parity strata) was conducted in Rio de Janeiro, Brazil; Kericho, Kenya; and Soweto, South Africa. Freelist interviews assessed knowledge and attitudes towards contraception and were analyzed enumerating frequency and saliency of mentions. There was intersite consensus around list items but priority and themes varied. Site-specific factors influencing contraceptive choice were male partner wishes and fertility desire (Brazil), side-effects (South Africa), and impact on health and HIV progression (Kenya). Age, parity, and taking antiretroviral therapy (ART) impacted some themes. Contraceptive use among HIV-positive women is substantially influenced by culture and other factors. Counseling efforts should consider individual factors in method selection and offer method variety to accommodate changing needs.


HIV Fertility desire Contraception Menstruation Future fertility Condom use 



A portion of this study was funded by the Walter Reed Army Institute of Research. The opinions and assertions made by the authors do not reflect the official position or opinion of the U.S. Department of the Navy or Army, or of the respective in-country National HIV/AIDS Control Programs and other Non-Governmental Organizations (NGOs). The authors thank the participants for their time and constructive comments. Financial support was received from the Morris S. Smith Foundation, the Doris Duke Charitable Foundation, the U.S. Military HIV Research Program (Kenya), and from the Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization (Brazil).


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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Catherine S. Todd
    • 1
    Email author
  • Mark A. Stibich
    • 2
  • Fatima Laher
    • 3
  • Monica S. Malta
    • 4
  • Francisco I. Bastos
    • 4
    • 5
  • Kennedy Imbuki
    • 6
  • Douglas N. Shaffer
    • 6
  • Samuel K. Sinei
    • 6
  • Glenda E. Gray
    • 3
  1. 1.Department of Obstetrics and GynecologyColumbia UniversityNew YorkUSA
  2. 2.Lacuna ProjectsHoustonUSA
  3. 3.Perinatal HIV Research UnitUniversity of WitwatersrandSowetoSouth Africa
  4. 4.Oswaldo Cruz FoundationRio de JaneiroBrazil
  5. 5.CAPES/Fulbright Visiting Scholar ProgramBrown UniversityProvidenceUSA
  6. 6.Walter Reed ProjectKerichoKenya

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