Contraceptive use is important for women of reproductive age living with HIV both to plan and optimise safety of pregnancies. Clinicians play a vital role in counselling patients about contraceptive options and safe sexual activity. Discussion regarding relationship status, sexual activity and contraception should occur routinely and regularly. This study aims to determine the frequency and predictors of such discussions and contraceptive use.
A retrospective clinical audit of all reproductive-aged women (n = 128) treated for HIV between 2010 and 2012 at two metropolitan hospitals in Melbourne, Australia. Medical records were reviewed for documentation of discussions regarding sexual activity, relationship status, and contraception. Poisson regression modelling was performed to determine predictors. Variables included were age of patient, gender of doctor, previous pregnancy, country of birth and antiretroviral regimen.
Sexual activity status was documented for 53% (n=69) of women and contraception use was recorded for 28% (n=36) of women. 27% (n=34) of women used contraception, 10% (n=13) did not use contraception and contraceptive use was not recorded in 63% (n=81). When a discussion regarding sexual activity was documented, women were 3.63 times more likely to also have documented a discussion about contraception (p=0.01), with a trend towards this being less likely if the woman was on NNRTIs compared with protease inhibitors. Excluding women who were pregnant, women who used contraception were 2.0 times more likely to have had a discussion about contraception (p=0.03).
Discussion regarding sexual activity, relationship status and contraception between HIV positive women of reproductive age and their clinicians remains inconsistent and suboptimal. Women who had a documented discussion regarding contraception were more likely to actually use contraception, which may suggest benefit in clinician-led discussions. Mechanisms to facilitate regular discussion about sexual activity and contraception between clinicians and women with HIV, warrants further investigation.
