Neglect of attention to reproductive health in women with HIV infection: contraceptive use and unintended pregnancies in the Swiss HIV Cohort Study. HIV Medicine
Aebi-Popp et al. aimed to assess the rates of contraceptive use and the types of methods used according to the type of combination antiretroviral therapy (cART), dual contraception use, and the number of unintended pregnancies among women participating in the SHCS. The study was a cross-sectional multicentre survey including all 18 to 46 years old women from the SHCS with at least one follow-up visit after January 2012. Women were asked to complete a self-report anonymous questionnaire on contraceptive methods, adherence to them, and unintended pregnancies.
Of 462 women included, 164 (35.5%) reported not using any contraception. Among these, 65 (39.6%) reported being sexually active, although 29 (44.6%) were not planning a pregnancy. Of 298 women using contraception, the following methods were reported: condoms, 219 (73.5%); oral hormonal contraception, 32 (10.7%); and intrauterine devices, 28 (9.4%). Among all women on contraception, 32 (10.7%) reported using more than one contraceptive method and 48 (16%) had an unintended pregnancy while on contraception (18, condoms; 16, oral contraception; 4, other methods). Of these, 68.1% terminated the pregnancy and almost half (43.7%) continued using the same contraceptive method after the event.
In conclusion, the use of effective contraception is challenging in HIV-positive women of reproductive age. HIV care physicians should be attentive both to women’s choices and to their needs for contraception. In Switzerland, condoms remained the predominant reported contraceptive method, with a high rate of unintended pregnancies, despite clear contraindications/restrictions on hormonal contraception and IUDs for HIV-positive women. Health care providers should discuss all available possibilities, with a particular emphasis on prescribing oral and long-acting reversible contraceptives with low interactions with cART.