Skip to main content

Advertisement

SpringerLink
Log in

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

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

Abstract

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.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Joint United Nations Program on HIV/AIDS (UNAIDS). Report on the Global AIDS Epidemic. Geneva: UNAIDS; 2008.

  2. Brogly SB, Watts DH, Ylitalo N, et al. Reproductive health of adolescent girls perinatally infected with HIV. Am J Public Health. 2007;97(6):1047–52.

    Article  PubMed  Google Scholar 

  3. Myer L, Rebe K, Morroni C. Missed opportunities to address reproductive health care needs among HIV-positive women in antiretroviral therapy programmes. Trop Med Int Health. 2007;12(12):1484–9.

    Article  PubMed  Google Scholar 

  4. Shelton JD, Peterson EA. The imperative for family planning in ART therapy in Africa. Lancet. 2004;364(9449):1916–8.

    Article  PubMed  Google Scholar 

  5. Wilcher R, Cates W. Reproductive choices for women with HIV. Bull World Health Organ. 2009;87(11):833–9.

    Article  PubMed  Google Scholar 

  6. Gillespie D, Bradley H, Woldegiorgis M, Kidanu A, Karklins S. Integrating family planning into Ethiopian voluntary testing and counselling programmes. Bull World Health Organ. 2009;87(11):866–70.

    Article  PubMed  Google Scholar 

  7. Aglah O, Wohlfahrt D, Farrel BL. Integrating FP into HIV prevention and treatment services: addressing the family planning needs of HIV positive women. Abstract no. WEPE0832. In: AIDS 2006—XVI international AIDS conference, Toronto, Canada. August 16, 2006.

  8. Sedgh G, Hussain R, Bankole A, Singh S. Women with an unmet need for contraception in developing countries and their reasons for not using a method. Occasional Report No. 37. New York: Guttmacher Institute; 2007.

  9. Morroni C, Myer L, Moss M, Hoffman M. Preferences between injectable contraceptive methods among South African women. Contraception. 2006;73(6):598–601.

    Article  CAS  PubMed  Google Scholar 

  10. Debrovner CH, Winikoff B. Trends in postpartum contraceptive choice. Obstet Gynecol. 1984;63(1):65–70.

    CAS  PubMed  Google Scholar 

  11. Godecker AL, Thomson E, Bumpass LL. Union status, marital history and female contraceptive sterilization in the United States. Fam Plan Perspect. 2001;33(1):35–41, 49.

    Google Scholar 

  12. da Silva MO, Costa MM. Reason, myths and fantasies: preliminary data and reflections about the Portuguese experience with LNG-IUS-induced hypomenorrhea. Eur J Contracept Reprod Health Care. 1999;4(1):21–5.

    Article  CAS  PubMed  Google Scholar 

  13. Edelman A, Lew R, Cwiak C, Nichols M, Jensen J. Acceptability of contraceptive-induced amenorrhea in a racially diverse group of US women. Contraception. 2007;75(6):450–3.

    Article  PubMed  Google Scholar 

  14. Castle S. Factors influencing young Malians’ reluctance to use hormonal contraceptives. Stud Fam Plan. 2003;34(3):186–99.

    Article  Google Scholar 

  15. Andia I, Kaida A, Maier M, et al. Highly active antiretroviral therapy and increased use of contraceptives among HIV-positive women during expanding access to antiretroviral therapy in Mbarara, Uganda. Am J Public Health. 2009;99(2):340–7.

    Article  PubMed  Google Scholar 

  16. Laher F, Todd CS, Stibich MA, et al. A qualitative assessment of decisions affecting contraceptive utilization and fertility intentions among HIV-positive women in Soweto, South Africa. AIDS Behav. 2009;13(Suppl 1):47–54.

    Article  PubMed  Google Scholar 

  17. Nattabi B, Li J, Thompson SC, Orach CG, Earnest J. A systematic review of factors influencing fertility desires and intentions among people living with HIV/AIDS: implications for policy and service delivery. AIDS Behav. 2009;13(5):949–68.

    Article  PubMed  Google Scholar 

  18. Maier M, Andia I, Emenyonu N, et al. Antiretroviral therapy is associated with increased fertility desire, but not pregnancy or live birth, among HIV+ women in an early HIV treatment program in rural Uganda. AIDS Behav. 2009;13(Suppl 1):28–37.

    Article  PubMed  Google Scholar 

  19. Hoffman IF, Martinson FE, Powers KA, et al. The year-long effect of HIV-positive test results on pregnancy intentions, contraceptive use, and pregnancy incidence among Malawian women. J Acquir Immune Defic Syndr. 2008;47(3):477–83.

    PubMed  Google Scholar 

  20. Taulo F, Berry M, Tsui A, et al. Fertility intentions of HIV-1 infected and uninfected women in Malawi: a longitudinal study. AIDS Behav. 2009;13(Suppl 1):20–7.

    Article  PubMed  Google Scholar 

  21. Cooper D, Moodley J, Zweigenthal V, Bekker LG, Shah I, Myer L. Fertility intentions and reproductive health care needs of people living with HIV in Cape Town, South Africa: implications for integrating reproductive health and HIV care services. AIDS Behav. 2009;13(Suppl 1):38–46.

    Article  PubMed  Google Scholar 

  22. 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  Google Scholar 

  23. Magalhães J, Amaral E, Giraldo PC, Simoes JA. HIV infection in women: impact on contraception. Contraception. 2002;66(2):87–91.

    Article  PubMed  Google Scholar 

  24. Peltzer K, Chao LW, Dana P. Family planning among HIV positive and negative prevention of mother to child transmission (PMTCT) clients in a resource poor setting in South Africa. AIDS Behav. 2009;13(5):973–9.

    Article  PubMed  Google Scholar 

  25. Mark KE, Meinzen-Derr J, Stephenson R, et al. Contraception among HIV concordant and discordant couples in Zambia: a randomized controlled trial. J Womens Health (Larchmt). 2007;16(8):1200–10.

    Article  Google Scholar 

  26. Stringer EM, Kaseba C, Levy J, et al. A randomized trial of the intrauterine contraceptive device vs hormonal contraception in women who are infected with the human immunodeficiency virus. Am J Obstet Gynecol. 2007;197(2):144.e1–8.

    Article  Google Scholar 

  27. Borgatti SP. Elicitation techniques for cultural domain analysis. In: Schensul J, LeCompte M, editors. The ethnographer’s toolkit, vol. 3. Walnut Creek, CA: Altamira Press; 1999.

    Google Scholar 

  28. Quinlan M. Considerations for collecting freelists in the field: examples from ethnobotany. Field Methods. 2005;17(3):219–34.

    Article  Google Scholar 

  29. Strauss RP, Sengupta S, Kegeles S, et al. Willingness to volunteer in future preventive HIV vaccine trials: issues and perspectives from three U.S. communities. J Acquir Immune Defic Syndr. 2001;26(1):63–71.

    CAS  PubMed  Google Scholar 

  30. Wilk CM, Bolton P. Local perceptions of the mental health effects of the Uganda acquired immunodeficiency syndrome epidemic. J Nerv Ment Dis. 2002;190(6):394–7.

    Article  PubMed  Google Scholar 

  31. Ministério da Saúde—Brasil [MS]. Departamento de Informática do SUS—DATASUS. Informações de saúde. Indicadores de saúde. Indicadores e dados básicos—IBD—2005. Indicadores demográficos. Taxa específica de fecundidade. 2005. http://tabnet.datasus.gov.br/cgi/idb2005/a06.htm. Accessed 25 Oct 2010.

  32. Ali MM, Cleland J. Sexual and reproductive behaviour among single women aged 15–24 in eight Latin American countries: a comparative analysis. Soc Sci Med. 2005;60(6):1175-85.

    Article  PubMed  Google Scholar 

  33. Ministerio da Saude do Brasil (Brazilian Ministry of Health), Health Surveillance Secretariat, National Programme STD and AIDS. UNGASS: Brazilian Response to the AIDS Epidemic. 2005–2007 Country Progress Report. Brasilia, Brazil: Brazilian Ministry of Health; 2008.

  34. Ministerio da Saude do Brasil (Brazilian Ministry of Health)/CEBRAP). Pesquisa Nacional de Demografia e Saude da Crianca e da Mulher (National Demographic and Health Survey), PNDS 2006. Brasilia: Ministerio da Saude; 2009. http://bvsms.saude.gov.br/bvs/pnds/atividade_sexual.php. Accessed 21 Oct 2010.

  35. Segurado AC, Paiva V. Rights of HIV positive people to sexual and reproductive health: parenthood. Reprod Health Matters. 2007;15(29 Suppl):27–45.

    Article  PubMed  Google Scholar 

  36. Paiva V, Santos N, França-Junior I, Filipe E, Ayres JR, Segurado A. Desire to have children: gender and reproductive rights of men and women living with HIV: a challenge to health care in Brazil. AIDS Patient Care STDS. 2007;21(4):268–77.

    Article  PubMed  Google Scholar 

  37. Oliveira F, Kerr L, Frota A, Nóbrega A, Bruno Z, Leitão T, Kendall C, Galvão M. HIV-positive women in northeast Brazil: tubal sterilization, medical recommendation and reproductive rights. AIDS Care. 2007;19(10):1258–65.

    Article  CAS  PubMed  Google Scholar 

  38. Santos NJ, Buchalla CM, Fillipe EV, Bugamelli L, Garcia S, Paiva V. Reproduction and sexuality in HIV-positive women, Brazil. Rev Saude Publica. 2002;36(4 Suppl):12–23.

    PubMed  Google Scholar 

  39. Ministerio da Saude do Brasil (Brazilian Ministry of Health)/CEBRAP). Pesquisa Nacional de Demografia e Saude da Crianca e da Mulher (National Demographic and Health Survey), PNDS 2006. Brasilia: Ministerio da Saude; 2009. http://bvsms.saude.gov.br/bvs/pnds/fecundidade.php. Accessed 21 Oct 2010.

  40. Relatório Final da Comissão Nacional sobre Determinantes Sociais da Saúde (CNDSS). As Causas Sociais das Iniquidades em Saude no Brasil. Oswaldo Cruz Foundation, Rio de Janeiro, Brazil. 2008.

  41. Minamisava R, Nouer SS, Neto OL, Melo LK, Andrade AL. Spatial clusters of violent deaths in a newly urbanized region of Brazil: highlighting the social disparities. Int J Health Geogr. 2009;8:66.

    Article  PubMed  Google Scholar 

  42. Sateren WB, Foglia G, Renzullo PO, et al. Epidemiology of HIV-1 infection in agricultural plantation residents in Kericho, Kenya: preparation for vaccine feasibility studies. J Acquir Immune Defic Syndr. 2006;43(1):102–6.

    Article  PubMed  Google Scholar 

  43. Foglia G, Sateren WB, Renzullo PO, et al. High prevalence of HIV infection among rural tea plantation residents in Kericho, Kenya. Epidemiol Infect. 2008;136(5):694–702.

    Article  CAS  PubMed  Google Scholar 

  44. Kenya National AIDS and STI Control Program (NASCOP), Kenya National AIDS Control Council (NACC), Kenya National Bureau of Statistics (KNBS), National Public Health Laboratory Services (NPHLS), Kenya Medical Research Institute (KEMRI), and the National Coordinating Agency for Population and Development (NCAPD). Kenya AIDS Indicator Survey 2007. Ministry of Public Health & Sanitation, Republic of Kenya. Nairobi, Kenya. 2009.

  45. Kenya Central Bureau of Statistics. Demographic and Health Survey. Nairobi, Kenya: Department of Health; 2003.

  46. Analysis, Information Management and Communication Activity (AIM) Project. USAID Country Health Statistical Report: Kenya. USAID, Washington, DC. 2009.

  47. Westoff CF, Cross AR. The stall in the fertility transition in Kenya. In: Paper presented at the international union for the Scientific Study of Population XXV international population conference, Tours, France, July 18–23, 2005.

  48. Koome P, Nturibi D, Kichamu G. The effect of declining family planning IEC efforts on contraceptive behaviour: working paper. National Coordinating Agency for Population and Development, Nairobi, Kenya. 2005.

  49. Mburugu EK, Adams BN. Families in Kenya. In: Adams BN, Trost J, editors. Handbook of world families. Thousand Oaks, CA: Sage Press; 2005.

    Google Scholar 

  50. National Department of Health, South Africa. National HIV and Syphilis Prevalence Survey, South Africa, 2007. Pretoria, South Africa: Department of Health; 2008.

  51. Barker PM, Venter F. Setting district-based annual targets for HAART and PMTCT a first step in planning effective intervention for the HIV/AIDS epidemic. SAMJ. 2007;97:916–7.

    PubMed  Google Scholar 

  52. Health Systems Trust. Health Statistics—reproductive health. http://www.hst.org.za/healthstats/index.php?indtype_id=003006002. Accessed 25 Oct 2010.

  53. Buchmann EJ, Mensah K, Pillay P. Legal termination of pregnancy among teenagers and older women in Soweto, 1999–2001. S Afr Med J. 2002;92(9):729–31.

    CAS  PubMed  Google Scholar 

  54. Laher F, Lephoto C, Forrest J, Cheyip M, Mohapi L. The impact of parallel HAART and contraception service provision on elective terminations of pregnancy in Soweto, South Africa. In: Abstract #75. 4th South African AIDS conference. Durban, South Africa; 2009.

  55. Mbirimtengerenji ND. Is HIV/AIDS epidemic outcome of poverty in Sub-Saharan Africa? Croat Med J. 2007;48(5):605–17.

    PubMed  Google Scholar 

  56. Vincent L. Virginity testing in South Africa: re-traditioning the postcolony. Cult Health Sex. 2006;8(1):17–30.

    Article  PubMed  Google Scholar 

  57. Nduna M, Farlane L. Women living with HIV in South Africa and their concerns about Fertility. AIDS Behav. 2009;12(Suppl1):S62–5.

    Article  Google Scholar 

  58. Kaida A, Laher F, Money D, Janssen PA, Strathdee SA, Hogg RS, Gray G. Fertility intentions of women of reproductive age in Soweto, South Africa: the influence of expanded access to HAART in an HIV hyper-endemic setting. Am J Public Health, 2010; [Epub ahead of print].

  59. Todd CS, Stibich MA, Stanekzai MR, et al. 2006–2007 A qualitative assessment of injection drug use and harm reduction programmes in Kabul, Afghanistan. Int J Drug Policy. 2009;20(2):111–20.

    Article  PubMed  Google Scholar 

  60. Weller SC, Romney AK. Systematic data collection. Thousand Oaks, CA: Sage Publications; 1988.

    Google Scholar 

  61. Bernard HR. Social research methods: qualitative and quantitative approaches. Thousand Oaks, CA: Sage Publications, Inc.; 2000.

    Google Scholar 

  62. Borgatti SP. ANTHROPAC 4.0. Natick, MA: Analytic Technologies; 1996.

    Google Scholar 

  63. Smith JJ. Using ANTHROPAC 3.5 and a spreadsheet to compute a freelist salience index. Field Methods. 1993;5(3):1–3. http://fmx.sagepub.com/content/5/3.toc.

  64. Schraiber LB, D’Oliveira AF, França Junior I; Grupo de Estudos em População, Sexualidade e Aids. Intimate partner sexual violence among men and women in urban Brazil, 2005. Rev Saude Publica. 2008;42(Suppl 1):127–37.

  65. Jewkes R, Dunkle K, Nduna M, Levin J, Jama N, Khuzwayo N, Koss M, Puren A, Duvvury N. Factors associated with HIV sero-status in young rural South African women: connections between intimate partner violence and HIV. Int J Epidemiol. 2006;35(6):1461–8.

    Article  CAS  PubMed  Google Scholar 

  66. Kiarie JN, Farquhar C, Richardson BA, Kabura MN, John FN, Nduati RW, John-Stewart GC. Domestic violence and prevention of mother-to-child transmission of HIV-1. AIDS. 2006;20(13):1763–9.

    Article  PubMed  Google Scholar 

  67. Alio AP, Daley EM, Nana PN, Duan J, Salihu HM. Intimate partner violence and contraception use among women in Sub-Saharan Africa. Int J Gynaecol Obstet. 2009;107(1):35–8.

    Article  PubMed  Google Scholar 

  68. Matthews LT, Mukherjee JS. Strategies for harm reduction among HIV-affected couples who want to conceive. AIDS Behav. 2009;13(Suppl 1):5–11.

    Article  PubMed  Google Scholar 

  69. Watts DH, Park JG, Cohn SE, et al. Safety and tolerability of depot medroxyprogesterone acetate among HIV-positive women on antiretroviral therapy: ACTG A5093. Contraception. 2008;77(2):84–90.

    Article  CAS  PubMed  Google Scholar 

  70. Kaida A, Gray G, Bastos FI, et al. The relationship between HAART use and sexual activity among HIV-positive women of reproductive age in Brazil, South Africa, and Uganda. AIDS Care. 2008;20(1):21–5.

    Article  CAS  PubMed  Google Scholar 

  71. Harrison A. Hidden love: sexual ideologies and relationship ideals among rural South African adolescents in the context of HIV/AIDS. Cult Health Sex. 2008;10(2):175–89.

    Article  PubMed  Google Scholar 

  72. Piccinino LJ, Mosher WD. Trends in contraceptive use in the United States: 1982–1995. Fam Plan Perspect. 1998;30(1):4–10, 46.

    Google Scholar 

Download references

Acknowledgments

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).

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Columbia University, 622 West 168th Street, New York, NY, 10032, USA

    Catherine S. Todd

  2. Lacuna Projects, Houston, TX, USA

    Mark A. Stibich

  3. Perinatal HIV Research Unit, University of Witwatersrand, Soweto, South Africa

    Fatima Laher & Glenda E. Gray

  4. Oswaldo Cruz Foundation, Rio de Janeiro, Brazil

    Monica S. Malta & Francisco I. Bastos

  5. CAPES/Fulbright Visiting Scholar Program, Brown University, Providence, RI, USA

    Francisco I. Bastos

  6. Walter Reed Project, Kericho, Kenya

    Kennedy Imbuki, Douglas N. Shaffer & Samuel K. Sinei

Authors
  1. Catherine S. Todd
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark A. Stibich
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fatima Laher
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Monica S. Malta
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Francisco I. Bastos
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kennedy Imbuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Douglas N. Shaffer
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Samuel K. Sinei
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Glenda E. Gray
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Catherine S. Todd.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Todd, C.S., Stibich, M.A., Laher, F. et al. Influence of Culture on Contraceptive Utilization Among HIV-Positive Women in Brazil, Kenya, and South Africa. AIDS Behav 15, 454–468 (2011). https://doi.org/10.1007/s10461-010-9848-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-010-9848-z

Keywords

Search

Navigation