Use of Contraception Among HIV-Infected Women of Reproductive Age

HIV+ women confront balancing contraception safety, effectiveness and preventing HIV transmission. Some advocate dual contraception (condoms plus) for these women. Contraceptive use in HIV+ women is understudied. Kaiser Permanente Northern California (KPNC), an integrated health maintenance organization, conducted a retrospective study on 449,181 reproductive age women in KPNC during 2006-2007. Evidence of contraception services was collected using clinical and pharmacy databases and HIV plus chronic disease registries. Comparisons were made between women with HIV (n=215), with other chronic medical conditions (OCMC) (n=24900) and without any diagnosed chronic medical condition (“healthy”, n=122921). A chart review was conducted on 240 randomly selected women without electronic evidence of contraception services. Charts reviewed showed condoms alone were used by 35% of HIV+ cohort compared to 4.4% OCMC (HIV+ vs. OCMC p<0.01) and 10% by healthy (HIV+ vs. healthy p=0.02). Abstinence was reported by 20% HIV+ cohort, vs. 15.5% OCMC and 0% healthy. In the electronic data, we found highly effective reversible contraception (progestin and copper IUD, subdermal implant) in 1.9% HIV+ group, 6.9% OCMC and 6.5% healthy (OCMC or healthy compared to HIV+ p<0.01). We found intermediate effective contraception (hormonal pill, patch, ring, or injectable) used by 9.3% HIV+ cohort compared to 16.6% OCMC and 32.9% healthy (OCMC or healthy compared to HIV+ p<0.01). Effective reversible contraception is less often utilized by women with HIV infection compared to other women of reproductive age. Less effective contraception appears utilized more reflecting HIV prevention efforts. Adequate contraception plus condom use is recommended.