Skip to main content

Advertisement

Log in

Does Integrating Family Planning into HIV Services Improve Gender Equitable Attitudes? Results from a Cluster Randomized Trial in Nyanza, Kenya

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

This study investigated whether integrating family planning (FP) services into HIV care was associated with gender equitable attitudes among HIV-positive adults in western Kenya. Surveys were conducted with 480 women and 480 men obtaining HIV services from 18 clinics 1 year after the sites were randomized to integrated FP/HIV services (N = 12) or standard referral for FP (N = 6). We used multivariable regression, with generalized estimating equations to account for clustering, to assess whether gender attitudes (range 0–12) were associated with integrated care and with contraceptive use. Men at intervention sites had stronger gender equitable attitudes than those at control sites (adjusted mean difference in scores = 0.89, 95 % CI 0.03–1.74). Among women, attitudes did not differ by study arm. Gender equitable attitudes were not associated with contraceptive use among men (AOR = 1.06, 95 % CI 0.93–1.21) or women (AOR = 1.03, 95 % CI 0.94–1.13). Further work is needed to understand how integrating FP into HIV care affects gender relations, and how improved gender equity among men might be leveraged to improve contraceptive use and other reproductive health outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Melhado L. Unmet need for contraceptives in developing world has declined, but remains high in some countries. Int Perspect Sex Reprod Health. 2013;39(3):163–4.

    Google Scholar 

  2. Darroch JE, Singh S. Trends in contraceptive need and use in developing countries in 2003, 2008, and 2012: an analysis of national surveys. Lancet. 2013;381(9879):1756–62.

    Article  PubMed  Google Scholar 

  3. Sedgh G, Singh S, Hussain R. Intended and unintended pregnancies worldwide in 2012 and recent trends. Stud Fam Plan. 2014;45(3):301–14.

    Article  Google Scholar 

  4. Schwartz SR, Rees H, Mehta S, et al. High incidence of unplanned pregnancy after antiretroviral therapy initiation: findings from a prospective cohort study in South Africa. PLoS One. 2012;7(4):e36039.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Rochat TJ, Richter LM, Doll HA, et al. Depression among pregnant rural South African women undergoing HIV testing. JAMA. 2006;295(12):1376–8.

    Article  CAS  PubMed  Google Scholar 

  6. Homsy J, Bunnell R, Moore D, et al. Reproductive intentions and outcomes among women on antiretroviral therapy in rural Uganda: a prospective cohort study. PLoS One. 2009;4(1):e4149.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Fleischman J. Integrating reproductive health and HIV/AIDS programs: strategic opportunities for PEPFAR. Washington, D.C.: Center for Strategic and International Studies; 2006.

    Google Scholar 

  8. Grossman D, Onono M, Newmann SJ, et al. Integration of family planning services into HIV care and treatment in Kenya: a cluster-randomized trial. AIDS. 2013;27(Suppl 1):S77–85.

    Article  PubMed  Google Scholar 

  9. Kosgei RJ, Lubano KM, Shen C, et al. Impact of integrated family planning and HIV care services on contraceptive use and pregnancy outcomes: a retrospective cohort study. J Acquir Immune Defic Syndr. 2011;58(5):e121–6.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Patel R, Baum S, Grossman D, et al. HIV-positive men’s experiences with integrated family planning and HIV services in western Kenya: integration fosters male involvement. AIDS Patient Care STDS. 2014;28(8):418–24.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Tao AR, Onono M, Baum S, et al. Providers’ perspectives on male involvement in family planning in the context of a cluster-randomized controlled trial evaluating integrating family planning into HIV care in Nyanza Province, Kenya. AIDS Care. 2015;27(1):31–7.

    Article  PubMed  Google Scholar 

  12. Burke HM, Ambasa-Shisanya C. Qualitative study of reasons for discontinuation of injectable contraceptives among users and salient reference groups in Kenya. Afr J Reprod Health. 2011;15(2):67–78.

    PubMed  Google Scholar 

  13. Chipeta EK, Chimwaza W, Kalilani-Phiri L. Contraceptive knowledge, beliefs and attitudes in rural Malawi: misinformation, misbeliefs and misperceptions. Malawi Med J. 2010;22(2):38–41.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wolff B, Blanc AK, Ssekamatte-Ssebuliba J. The role of couple negotiation in unmet need for contraception and the decision to stop childbearing in Uganda. Stud Fam Plann. 2000;31(2):124–37.

    Article  CAS  PubMed  Google Scholar 

  15. Eliason S, Baiden F, Quansah-Asare G, et al. Factors influencing the intention of women in rural Ghana to adopt postpartum family planning. Reprod Health. 2013;22(10):34.

    Article  Google Scholar 

  16. Imbuki K, Todd CS, Stibich MA, Shaffer DN, Sinei SK. Factors influencing contraceptive choice and discontinuation among HIV-positive women in Kericho, Kenya. Afr J Reprod Health. 2010;14(4 Spec no):98–109.

    PubMed  Google Scholar 

  17. Sternberg P, Hubley J. Evaluating men’s involvement as a strategy in sexual and reproductive health promotion. Health Promot Int. 2004;19(3):389–96.

    Article  PubMed  Google Scholar 

  18. Shattuck D, Kerner B, Gilles K, Hartmann M, Ng’ombe T, Guest G. Encouraging contraceptive uptake by motivating men to communicate about FP: the Malawi Male Motivator Project. Am J Public Health. 2011;101(6):1089–95.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Adongo PB, Tapsoba P, Phillips JF, et al. The role of community-based health planning and services strategy in involving males in the provision of family planning services: a qualitative study in southern Ghana. Reprod Health. 2013;26(10):36.

    Article  Google Scholar 

  20. Lindegren ML, Kennedy CE, Bain-Brickley D, et al. Integration of HIV/AIDS services with maternal, neonatal and child health, nutrition, and family planning services. Cochrane Database Syst Rev. 2012;. doi:10.1002/14651858.CD010119.

    PubMed  Google Scholar 

  21. Bawah AA, Akweongo P, Simmons R, Phillips JF. Women’s fears and men’s anxieties: the impact of family planning on gender relations in northern Ghana. Stud Fam Plan. 1999;30(1):54–66.

    Article  CAS  Google Scholar 

  22. Onyango MA, Owoko S, Oguttu M. Factors that influence male involvement in sexual and reproductive health in western Kenya: a qualitative study. Afr J Reprod Health. 2010;14(4 Spec no):32–42.

    PubMed  Google Scholar 

  23. Hartmann M, Gilles K, Shattuck D, Kerner B, Guest G. Changes in couples’ communication as a result of a male-involvement family planning intervention. J Health Commun. 2012;17(7):802–19.

    Article  PubMed  Google Scholar 

  24. Stephenson R, Bartel D, Rubardt M. Constructs of power and equity and their association with contraceptive use among men and women in rural Ethiopia and Kenya. Glob Public Health. 2012;7(6):618–34.

    Article  PubMed  Google Scholar 

  25. Pulerwitz J, Martin S, Mehta M, et al. Promoting gender equity for HIV and violence prevention: results from the Male Norms Initiative evaluation in Ethiopia. Washington, D.C.: PATH; 2010.

    Google Scholar 

  26. Shattuck D, Burke H, Ramirez C, et al. Using the inequitable gender norms scale and associated HIV risk behaviors among men at high risk for HIV in Ghana and Tanzania. Men Masc. 2013;16(5):540–59.

    Article  Google Scholar 

  27. Kenya National Bureau of Statistics (KNBS), ICF Macro. Kenya demographic and health survey 2008–2009. Calverton (MD): KNBS, ICF Macro; 2010.

  28. Kenya Ministry of Health. Kenya AIDS indicator survey 2012. Nairobi: Kenya Ministry of Health; 2013.

  29. Harrington EK, Newmann SJ, Onono M, et al. Fertility intentions and interest in integrated family planning services among women living with HIV in Nyanza Province, Kenya: a qualitative study. Infect Dis Obstet Gynecol. 2012;2012:809682.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Newmann SJ, Mishra K, Onono M, et al. Providers’ perspectives on provision of family planning to HIV-positive individuals in HIV care in Nyanza Province, Kenya. AIDS Res Treat. 2013;2013:915923.

    PubMed  PubMed Central  Google Scholar 

  31. Newmann SJ, Grossman D, Blat C, et al. Does integrating family planning into HIV care and treatment impact intention to use contraception? Patient perspectives from HIV-infected individuals in Nyanza Province, Kenya. Int J Gynaecol Obstet. 2013;123(Suppl 1):e16–23.

    Article  PubMed  Google Scholar 

  32. Lewis Kulzer J, Penner JA, Marima R, et al. Family model of HIV care and treatment: a retrospective study in Kenya. J Int AIDS Soc. 2012;15(1):8.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Onono M, Blat C, Miles S, et al. Impact of family planning health talks by lay health workers on contraceptive knowledge and attitudes among HIV-infected patients in rural Kenya. Patient Educ Couns. 2014;94(3):438–41.

    Article  PubMed  Google Scholar 

  34. Onono M, Guzé MA, Grossman D, et al. Integrating family planning and HIV services in western Kenya: the impact on HIV-infected patients’ knowledge of family planning and male attitudes toward family planning. AIDS Care. 2015;27(6):743–52.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Pulerwitz J, Barker G. Measuring attitudes toward gender norms among young men in Brazil: development and psychometric evaluation of the GEM scale. Men Masc. 2008;10(3):322–38.

    Article  Google Scholar 

  36. Barker G, Contreras JM, Heilman B, Singh AK, Verma RK, Nascimento M. Evolving men: initial results from the International Men and Gender Equality Survey (IMAGES). Washington, D.C.: International Center for Research on Women; 2011. Joint publication of Instituto Promundo, Rio de Janeiro.

  37. Pulerwitz J, Michaelis A, Verma R, Weiss E. Addressing gender dynamics and engaging men in HIV programs: lessons learned from Horizons Research. Public Health Rep. 2010;125(2):282–92.

    PubMed  PubMed Central  Google Scholar 

  38. De Boeck P, Wilson M, editors. Explanatory item response models: a generalized linear and nonlinear approach. New York: Springer; 2004.

    Google Scholar 

  39. Smith D, Stephenson R, Rubardt M et al. Assessing understanding of questions from gender and power norm scales in Siaya, Kenya. 2011 Annual Meeting of the Population Association of America—PAA 2011; 2011 Mar 31–Apr 2; Washington, DC.

  40. Withers M, Dworkin SL, Onono M, et al. Men’s perspectives on their role in family planning in Nyanza Province, Kenya. Stud Fam Plan. 2015;46(2):201–15.

    Article  Google Scholar 

  41. Withers M, Dworkin SL, Zakaras JM, et al. ‘Women now wear trousers’: men’s perceptions of family planning in the context of changing gender relations in western Kenya. Cult Health Sex. 2015;17(9):1132–46.

    Article  PubMed  Google Scholar 

  42. Wambui T, Ek AC, Alehagen S. Perceptions of family planning among low-income men in western Kenya. Int Nurs Rev. 2009;56(3):340–5.

    Article  CAS  PubMed  Google Scholar 

  43. Scott J, Hacker M, Averbach S, et al. Influences of sex, age and education on attitudes towards gender inequitable norms and practices in South Sudan. Glob Public Health. 2014;9(7):773–86.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Nanda G, Schuler SR, Lenzi R. The influence of gender attitudes on contraceptive use in Tanzania: new evidence using husbands’ and wives’ survey data. J Biosoc Sci. 2013;45(3):331–44.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Biddlecom AE, Fapohunda BM. Covert contraceptive use: prevalence, motivations, and consequences. Stud Fam Plann. 1998;29(4):360–72.

    Article  CAS  PubMed  Google Scholar 

  46. Koffi AK, Adjiwanou VD, Becker S, et al. Correlates of and couples’ concordance in reports of recent sexual behavior and contraceptive use. Stud Fam Plan. 2012;43(1):33–42.

    Article  Google Scholar 

  47. Peterson SA. Marriage structure and contraception in Niger. J Biosoc Sci. 1999;31(1):93–104.

    Article  CAS  PubMed  Google Scholar 

  48. Agadjanian V, Ezeh AC. Polygyny, gender relations, and reproduction in Ghana. J Comp Fam Stud. 2000;31(4):427–41.

    Google Scholar 

  49. Baschieri A, Cleland J, Floyd S, et al. Reproductive preferences and contraceptive use: a comparison of monogamous and polygamous couples in northern Malawi. J Biosoc Sci. 2013;45(2):145–66.

    Article  CAS  PubMed  Google Scholar 

  50. Ezeh AC. Polygyny and reproductive behavior in sub-Saharan Africa: a contextual analysis. Demography. 1997;34(3):355–68.

    Article  CAS  PubMed  Google Scholar 

  51. Magadi MA, Curtis SL. Trends and determinants of contraceptive method choice in Kenya. Stud Fam Plan. 2003;34(3):149–59.

    Article  Google Scholar 

  52. Irani L, Speizer IS, Fotso JC. Couple characteristics and contraceptive use among women and their partners in urban Kenya. Int Perspect Sex Reprod Health. 2014;40(1):11–20.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Pulerwitz J, Gortmaker SL, DeJong W. Measuring sexual relationship power in HIV/STD research. Int J Mens Health. 2000;42(7/8):637–60.

    Google Scholar 

  54. Barker G, Das A. Men and sexual and reproductive health: the social revolution. Int J Mens Health. 2004;3(3):147–54.

    Article  Google Scholar 

  55. Verma RK, Pulerwitz J, Mahendra V, et al. Challenging and changing gender attitudes among young men in Mumbai, India. Reprod Health Matters. 2006;14(28):135–43.

    Article  PubMed  Google Scholar 

  56. Jejeebhoy SJ. Convergence and divergence in spouses’ perspectives on women’s autonomy in rural India. Stud Fam Plann. 2002;33(4):299–308.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank the Kenyan women and men who participated in the study. We acknowledge the important logistical support of the KEMRI-UCSF Collaborative Group and especially Family AIDS Care and Education Services (FACES). We gratefully acknowledge the Director of KEMRI, the Director of KEMRI’s Centre for Microbiology Research, and the Nyanza Provincial Ministries of Health and the provincial and district reproductive health coordinators for their support in conducting this research.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sara J. Newmann.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Newmann, S.J., Rocca, C.H., Zakaras, J.M. et al. Does Integrating Family Planning into HIV Services Improve Gender Equitable Attitudes? Results from a Cluster Randomized Trial in Nyanza, Kenya. AIDS Behav 20, 1883–1892 (2016). https://doi.org/10.1007/s10461-015-1279-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-015-1279-4

Keywords

Navigation