Fertility Desires and Contraceptive Demand of HIV Positive Women Attending Care and Treatment Services in Nakuru, Rift Valley, Kenya

Background: HIV+ women are at risk of unintended pregnancy and lack access to family planning (FP) services. FP, however, is not typically offered at HIV care and treatment (CT) centres. This study examined fertility desires and contraceptive needs of HIV+ female CT clients; and assessed clients' and providers' attitudes toward FP/ CT integration.

Methods: A cross-sectional study was conducted at a provincial CT centre from June-December 2007. 479 HIV+ women aged 18-45 completed a survey and 16 completed in-depth interviews (IDI). 6 CT providers participated in IDIs and 1 focus group discussion.

Results: 50% of women surveyed said their last birth was unintended. Current unmet FP need was 30%. Although male condoms were the most commonly used FP method (74%), many women discussed difficulty in negotiating consistent condom use with their sexual partners, indicating unmet need may be higher.

75% women surveyed desired FP at CT. Participants said integration would reduce the time and cost of accessing both services, and believed their rapport with CT providers would allow providers to tailor FP counselling to their HIV disease progression. Providers recognized clients' contraceptive needs, and identified specific challenges to FP integration (i.e. space, staff time, client flow, provider training, etc).

Conclusion: Many HIV+ female clients support integration because CT is a trusted environment and would become a convenient ‘one-stop shop'. Provider training, structural and organizational service delivery elements must be addressed for effective integration. Any integration efforts should be evaluated for their effect on contraceptive use and CT service quality.