Optimizing Prevention of HIV and Unplanned Pregnancy in Discordant African Couples

October 2017 - Combination Prevention

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Wall, K.M., Kilembe, W., Vwalika, B., et al. Journal of Women’s Health (2017), 26(8), doi: 10.189/jwh.2016.6169.

This study in Zambia examined predictors of dual protection for HIV and pregnancy, including condom use only (offering suboptimal pregnancy protection), and modern contraceptive use with irregular condom use (offering suboptimal HIV protection). The 3,049 participating serodiscordant couples were followed for two years. Condom use only was associated with couples with HIV-positive males; stage III‒IV HIV disease with high viral loads; women with a high number of lifetime sexual partners; baseline use of contraceptive pills, injectables, or intrauterine devices; desire to become pregnant in the next year; and being postpartum. Among these couples, 37 percent indicated some instances of unprotected sex, increasing risks of both HIV and pregnancy. Among couples who used modern contraception, irregular condom use was more likely among young men and women; those who used injectables or implants at baseline; women who wanted to become pregnant in more than one year; and couples in which the male partner was HIV-positive and circumcised. Among couples using contraception, 38 percent reported a condomless sex act, leading to increased risk of HIV, but not of pregnancy. Consistent condom use with modern contraceptive use was reported among 23–28 percent of couples across follow-ups. Although ≥50 percent of couples did not want children, 59 percent of follow-up check-ins reported condom use only. The authors recommended integrating couples voluntary counseling and testing with couples family planning services.

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