Keywords

1 Introduction

Nigeria is second to South Africa in the number of people living with HIV/AIDS worldwide, representing 9% of the global burden of the disease [1] while men account for 58% of adult AIDS related deaths [2]. HIV is mainly transmitted through heterosexual contact and new infections in the country heighten due to reduced perceived personal risk, multiple sexual partners, inefficient and inadequate treatment of sexually transmitted infections (STIs) and poor quality service delivery [1].

In Nigeria, the total contraceptive prevalence rate (CPR) indicates wide state variations, ranging from 0.3% in Jigawa to 41.6% in Lagos state, as well as zonal variations ranging from 2.7% in the North West to 28.5% in the South West [3]. In a study done in 2003 among monogamous men in Ondo State Nigeria, the study revealed that 81.0% of the respondents knew of condom, only 31.2% had ever used a condom and 15.0% reported currently using condoms at the time of interview [4]. This trend was also seen in a study done in 2006 on male knowledge, attitudes, and family planning practices in northern Nigeria where the results suggested that there is high knowledge of contraceptives and consequently low rates of contraceptive use [5] of which the reasons might range from cultural to religious misconceptions about men using contraception. There are overwhelming previous studies carried out to assess the uptake, utilization and factors affecting contraceptive use among HIV positive women and prevention of mother to child transmission of HIV (PMTCT) in both urban and low resource settings. However, research carried out to evaluate the perception and utilization of HIV positive men are few [5, 6] although it is the men that are usually the decision makers on important household issues like household purchase, family size, health of household members and timing of pregnancy in this country [7]. The uptake of contraceptives and the type of contraceptive use is heavily influenced by the male/husband dominance in the society/family. Therefore, there is a need to integrate and involve the male in the contraception policies [8].

In this study, we evaluated the knowledge, perception and uptake of contraception among HIV positive male patients in Nigeria. We majorly focused our study on patients attending ART clinic of National Tuberculosis and Leprosy Training Center (NTBLTC) Saye-Zaria. So, we provided answers to the following questions: (1) What is the knowledge of contraception among HIV positive male patients? (2) What is the perception of contraception use among HIV positive male patients? (3) What is the use of contraception among HIV positive male patients? (4) What are the factors influencing contraceptive uptake among HIV positive male patients?

2 Methodology

The study was a descriptive, Cross-sectional study collecting both qualitative and quantitative data. The study population was HIV positive male patients receiving treatment at the ART clinic at NTBLTC Saye-Zaria, Nigeria. Inclusion criteria was all HIV positive male patients attending ART clinic, HIV positive male patients who are ≥18 years and HIV positive male patients who are taking ART at the time of the interview. The sample size was determined using the formula [9]

$$ n = \frac{Z^2 pq}{{d^2 }} $$
(1)

A sample size of 285 was used as the minimum sample size for this study. A simple random sampling technique was used to collect information from eligible participants. The data was collected using adapted, semi-structured and pre-coded questionnaires which were collected via an android device using KoBo kollect software and were administered to each respondent. The questionnaire contained information on respondent’s sociodemographic status, knowledge of contraception, perception of contraception use, uptake of contraception and factors influencing the use of contraception. The knowledge of contraception was based on those that have ever heard of contraception before. The perception on contraception was scored on a 2-point perception scale for each question, positive perception was 2 point, negative perception was 0 points and undecided was 1 point. Those that score less than or equal to one (≤1) point had negative perception and those that score greater than one (>1) point had positive perception. The quantitative data collected was entered and analyzed using STATA, univariate analysis was done using proportions, measures of dispersion, measures of central tendency and percentage while bivariate analysis using chi square was done. A confidence interval of 95% was used and a p value of <0.05 was considered statistically significant.

3 Results and Discussion

3.1 Socio-Demographic Characteristics

The study (in Fig. 1) showed that 84 (31.3%) of the respondents were within the 38–47 age group, the mean age of respondents was 45.6 ± 11.7. Majority of the respondents (81.0%) were Muslims, 50 (18.7%) were Christians, most of the respondents were of Hausa tribe 194 (72.4%), Fulani/Ibo (7.8%), Yoruba/Others (6%). Although, 79.1% of the respondents were married, 147 (69.3%) are monogamous and 30.0% have more than one sexual partner.

Fig. 1.
figure 1

The socio-demographic characteristics of respondents.

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Some (27.2%) of the respondents have at least secondary education, 25% have Quranic education, 20.2% have tertiary education, 14.9% post-secondary and 3% have no formal education. 57 (21.3%) of the respondents are traders and self-employed, 54 (20.2%) are civil servants, 47 (17.5%) were farmers and only 6 (2.2%) are unemployed. More than half of the respondents 146 (54.5%) reside in urban areas while 122 (45.5%) reside in rural areas.

3.2 Knowledge of Contraception Among HIV Positive Male Patients

Majority 228 (85.1%) of the respondents have heard about contraception before which showed that there is good knowledge about contraception and almost all 206 (90.4%) of the respondents knew that condoms are a type of contraception, as shown in Fig. 2. It is also similar to a study done in Uganda Rhoda and a study done in Zimbabwe where more than 98% of the men reported that they have heard of at least one method of contraception [10, 11]. However, it is in contrast to a study done in Osogbo-Nigeria on male involvement in family planning where only 57.0% had a good knowledge of FP [3].

Fig. 2.
figure 2

Knowledge of respondents about contraception.

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Other types of contraception identified by the respondents were Pills 48 (21.1%), Injectable 41(18%), Withdrawal 24 (10.5%), only 15 (6.6%) and 10 (4.4%) of the respondents knew Male sterilization and Female sterilization respectively. The least known methods were Foam or Jelly (0.4%), Emergency contraception (0.4%), LAM 2 (0.9%), Diaphragm 3 (1.3%), IUD 6(2.6%) and Traditional method 8 (3.5%). Mostly half of the respondents knew that contraception is used for Prevention of pregnancy and Preventing the transmission of HIV/STIs, while 28 (12.3%) of the respondents think that contraception is neither useful for both.

Half (50.4%) of the respondents in this study got their information about contraception from ART clinic/Hospital, while 30.7% got their information from radio. This is followed by 7% of respondents that got their information from television and friends/family.

3.3 Perception of Contraception Among HIV Positive Male Patients

The overall mean perception score (in Table 1) of the respondents was 1.38 ± 0.52 and most of the respondents 192 (72%) had good perception while 76 (28%) had poor perception. 22.0% were of the perception that it is only promiscuous women that use contraception without their husband’s consent, 23.5% of the respondents were of the perception that they will not allow their spouse to use contraception, the perception of 15.7% of the respondents was that it is only women that are meant to use contraception and not the men.

Table 1. Perception of respondents on contraception.
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About 16.4% and 22.0% perceived that there is no need for HIV positive men to use contraception and contraception should not be promoted among people living with HIV, while the perception of 19.4% of the respondents was that men should not assist their women in obtaining contraception this is in contrast with the study done at secondary health facility in North-Central Nigeria where 97.8% of the respondents said condom use should be promoted among people living with HIV/AIDS [12].

3.4 Uptake of Contraception Among HIV Positive Male Patients

Out of the 268 respondents (in Table 2), many of the respondents 166 (61.9%) reported that they have ever used contraception and 91 (34%) reported that their spouse has ever used contraception before while only 152 (56.7%) are currently using contraception which is almost synonymous to a study done in Nairobi, Kenya where 58.8% of the male respondents had used contraception [13].

Out of 166 respondents that reported that they had ever used contraception, 153 (92.2%) chose condom as one of the contraceptive methods that they have ever used, 17 (10.2%) withdrawal method, 7 (4.2%) abstinence, 4 (2.4%) traditional method, 3 (1.8%) chose pills while only 2 (1.2%) chose male sterilization. 152 respondents reported that they are currently using contraception of which condom still ranked highest contraceptive method used at 138 (90.8%), the second was withdrawal 14 (9.2%), followed by injectable at 8 (5.3%) and male sterilization at 3 (2.0%). None of the respondents chose IUD, LAM, foam/jelly, diaphragm and emergency contraception as a method they have used or currently using.

Table 2. Contraceptive methods ever used and currently using by respondents.
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About 65 (39%) of the 166 respondents that have ever used contraception reported that the reason for their contraceptive use was to prevent pregnancy, 59 (36%) stated prevention of re-infection as the reason while 42 (25%) stated prevention of re-infection and pregnancy as the reason for contraceptive use.

3.5 Factors Affecting Uptake of Contraception Among HIV Positive Male Patient

30% of the respondents choose that the reason for not using contraception was because they were married, 29% said it is because they were both HIV positive, 28% said it reduces sexual pleasure, 18% acknowledge that their religion does not permit them to use it also that they don’t know where to obtain contraception from and lack of discussion by their health care provider. 15% reported that it was because of the side effects, 14% due to the attitude of the health workers, 7% reported that it was because contraception is too expensive. Out of 10% of the respondents that were not using contraception because of other reasons, most (13) of the respondents reported that it was because they are not married.

Table 3. Relationship between sociodemographic characteristics and other studied criteria.
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3.6 Sociodemographic Characteristics, Knowledge, Perception and Uptake of Contraception Relationship

The relationship between the demographic characteristics and the knowledge, perception and uptake of the patients were evaluated as shown in Table 3. Findings from the study indicated all demographic characteristics were found to be insignificant except for marital status which shows good relation with the knowledge (P < 0.001) and uptake (P < 0.001); including other characteristic like Level of education which was shows a significant relationship with their perception (P = 0.005) and uptake (P = 0.004) while age was found to have shown as significant influence (P = 0.001) on their use of contraception.

The study further indicates that the most influential demographic characteristic which significantly contributes to the level of the patients’ perception, knowledge and uptake of contraception was found to be marital status, education level and age. Which were found to be evident in the nature of the responses where the married class and aged class of people (from 38 years and above) were found to have shown significant knowledge of contraception compared to other categories. The influence of education was equally seen to have enabled the patients’ gain better perception of the contraception use compared to the class of uneducated patients.

4 Conclusion and Recommendations

The study carried out in NTBLTC Saye-Zaria to determine the knowledge of contraception among HIV positive male patients showed that there was high knowledge of contraception among HIV positive men, good perception, low usage of contraception and poor acceptance of contraception due to religious reasons. Marital status, level of education, and age were socio-demographic characteristics that affected the uptake perception and knowledge of contraception. Therefore, it is necessary for religious organization to enlighten men on importance of contraception. The Government should put in place adequate policies to encourage male involvement in the utilization of contraception as some respondents in the study thought contraception is basically a problem the women have to deal with alone.