Consistent Condom Use among HIV Positive Women Attending Comprehensive Care Centre of Thika Level 5 Hospital, Kenya

Anne G. Macharia^1*, Yeri Kombe², Peter Mwaniki¹

¹Institute of Tropical Medicine and Infectious Diseases, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
²Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya.

DOI: 10.4236/wja.2015.53017                

Abstract

Background: Condoms offer protection against human immunodeficiency virus (HIV) transmission when used correctly and consistently. Many HIV infected people do not use condom regularly, thus leading to new HIV infections and reinfections. In Kenya, condom use is considered to be low and HIV prevalence is high among women aged 15 - 49 years where utilization of condoms among HIV positive women has not been studied. Objectives: The study aimed at determining the prevalence of consistent condom use among HIV positive women aged 18 - 49 years and to investigate the variables associated with it. Methods: A mixed method of study design (qualitative and quantitative approaches) was employed. A total of 422 participants were selected randomly and interviewed using a pretested structured questionnaire. Three (3) focus group discussions with 8 participants in each group were conducted. Chi-square test (p < 0.05) and odds ratio with corresponding 95% confidence interval were computed to establish the association between consistent condom use and independent variables. Binary logistic regression model was used to identify variables independently associated with consistent condom use. Qualitative data were transcribed and coded and then analysed thematically. Results: Consistent condom use among sexually active HIV positive women was found to be 57.4% (95%CI: 52.7% - 62.1%). The stepwise logistic regression revealed that attending tertiary education [aOR = 2.54; 95%CI = 1.30 - 4.95; P = 0.006], disclosing HIV status [aOR = 2.27; 95%CI = 1.27 - 4.06; P = 0.005], having an HIV negative partner [aOR = 4.23; 95%CI = 1.99 - 8.98; P < 0.001], not taking alcohol [aOR = 1.72; 95%CI = 1.10 - 2.69; P = 0.017], never encountered resistance to use condom by partners [aOR = 1.87; 95%CI = 1.15 - 3.03; P = 0.011] and perceived risk of contracting STIs [aOR = 2.11; 95%CI = 1.12 - 3.97; P = 0.021] as factors independently associated with consistent condom use. Conclusion: This study shows that there is still low prevalence of consistent condom use among HIV positive women. More education, campaigning and sensitization should be tailored among HIV positive women during counseling so as to avoid re-infection and transmission of infections.

Keywords

Consistent Condom Use, HIV Positive Women, HIV Status

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Stammers, T. (2005) As Easy as ABC? Primary Prevention of Sexually Transmitted Infections. Postgraduate Medical Journal, 81, 273-275. http://dx.doi.org/10.1136/pgmj.2004.027722
[2]	Weller, S. and Davis, K. (2003) Condom Effectiveness in Reducing Heterosexual HIV Transmission. Oxford. The Cochrane Library, Issue 2.
[3]	Macaluso, M., Lawson, M.L., Hortin, G., Duerr, A., Hammond, K.R., Blackwell, R. and Bloom, A. (2003) Efficacy of the Female Condom as a Barrier to Semen during Intercourse. American Journal of Epidemiology, 157, 289-297. http://dx.doi.org/10.1093/aje/kwf212
[4]	Versteeg, M. and Murray, M. (2008) Condom Use as Part of the wider HIV Prevention Strategy: Experiences from Communities in the North West Province, South Africa. Journal of Social Aspects of HIV/AIDS, 5, 83-93. http://dx.doi.org/10.1080/17290376.2008.9724905
[5]	Joint United Nations Programme on HIV/AIDS (UNAIDS) (2008) Report on the Global AIDS Epidemic. Geneva.
[6]	WHO (2010) Scaling up Priority HIV/AIDS Interventions in the Health Sector. http://whqlibdoc.who.int/publications/2010/97892415 00395_eng.pdf
[7]	Kenya AIDS Indicator Survey (2007) Prevalence of HIV in Kenya. 44-46.
[8]	World Bank (2008) Country Classifications: Country Groups.
[9]	Dore, G.J. and Cooper, D.A. (2006) HAART’s First Decade: Successbrings Further Challenges. Lancet, 368, 427-428. http://dx.doi.org/10.1016/S0140-6736(06)69128-9
[10]	Chen, S.Y., Gibson, S., Katz, M.H., Klausner, J.D., Dilley, J.W., Schwarez, S.K., Kellogg, T.A. and McFarland, W. (2002) Continuing Increases in Sexual Risk Behaviour and Sexually Transmitted Diseases among Men Who Have Sex with Men. American Journal of Public Health, 92, 1387-1388. http://dx.doi.org/10.2105/AJPH.92.9.1387-a
[11]	Stolte, I.G., Dukers, N.H., de Wit, J.B., Fennema, J.S. and Coutinho, R.A. (2001) Increase in Sexually Transmitted Infections among Homosexual Men in Amsterdam in Relation to HAART. Sexually Transmitted Infections, 77, 184-186. http://dx.doi.org/10.1136/sti.77.3.184
[12]	Donnell, D., Baeten, J.M., Kiarie, J., Thomas, K.K., Stevens, W., Cohen, C.R., et al. (2010) Heterosexual HIV-1 Transmission after Initiation of Antiretroviral Therapy: A Prospective Cohort Analysis. The Lancet, 375, 2092-2098.http://dx.doi.org/10.1016/S0140-6736(10)60705-2
[13]	Cohen, M.S., Chen, Y.Q., McCauley, M., Gamble, T., Hosseinipour, M.C., Kumarasamy, N., et al. (2011) Prevention of HIV-1 Infection with Early Antiretroviral Therapy. The New England Journal of Medicine, 365, 493-505.http://dx.doi.org/10.1056/NEJMoa1105243
[14]	National AIDS/STI Contol Programme (NASCOP) Kenya (2007) Kenya AIDS Indicator Survey. http://www.aidskenya.org
[15]	Alene, K.A. (2014) Consistent Condom Use among Sexually Active HIV-Positive Women in Amhara Region, Ethiopia. Open Access Journal of Contraception, 5, 85-90. http://dx.doi.org/10.2147/OAJC.S72683
[16]	Bateganya, M., Colfax, G., Shafer, L.A., Kityo, C., Mugyenyi, P., Serwadda, D., et al. (2005) Antiretroviral Therapy and Sexual Behavior: A Comparative Study between Antiretroviral-Naive and -Experienced Patients at an Urban HIV/ AIDS Care and Research Center in Kampala, Uganda. AIDS Patient Care STDS, 19, 760-768.http://dx.doi.org/10.1089/apc.2005.19.760
[17]	Cicconi, P., d’Arminio Monforte, A., Castagna, A., Quirino, T., Alessandrini, A., Gargiulo, M., et al. (2013) Inconsistent Condom Use among HIV-Positive Women in the “Treatment as Prevention Era”: Data from the Italian DIDI Study. Journal of the International AIDS Society, 16, Article ID: 18591. http://dx.doi.org/10.7448/IAS.16.1.18591
[18]	Avina, S., Gupta, I., Pujari, S., Sengar, A.K., Garg, R. and Weiss, E. (2006) Examining Adherence and Sexual Behaviour among Patients on Antiretroviral Therapy in India. Horizons Final Report, Population Council, Washington DC.
[19]	Wilson, T.E., Gore, M.E., Greenblatt, R., Cohen, M., Minkoff, H., Silver, S., et al. (2004) Changes in Sexual Behaviour among HIV-Infected Women after Initiation of HAART. American Journal of Public Health, 94, 1141-1146. http://dx.doi.org/10.2105/AJPH.94.7.1141
[20]	Clark, R.A., Kissinger, P., Bedimo, A.L., Dunn, P. and Albertin, H. (1997) Determination of Factors Associated with Condom Use among Women Infected with Human Immunodeficiency Virus. International Journal of STD and AIDS, 8, 229-233. http://dx.doi.org/10.1258/0956462971919976
[21]	Dessie, Y., Gerbaba, M., Bedru, A. and Davey, G. (2011) Risky Sexual Practices and Related Factors among ART Attendees in Addis Ababa Public Hospitals, Ethiopia: A Cross-Sectional Study. BMC Public Health, 11, 422.http://dx.doi.org/10.1186/1471-2458-11-422
[22]	Ncube, N.M., Akunna, J., Babatunde, F., Nyarko, A., Yatich, N.J., Ellis, W., et al. (2012) Sexual Risk Behaviour among HIV-Positive Persons in Kumasi, Ghana. Ghana Medical Journal, 46, 27-33.
[23]	Sayles, J.N., Pettifor, A., Wong, M.D., MacPhail, C., Lee, S.J., Hendriksen, E., et al. (2006) Factors Associated with Self-Efficacy for Condom Use and Sexual Negotiation among South African Youth. JAIDS: Journal of Acquired Immune Deficiency Syndromes, 43, 226-233. http://dx.doi.org/10.1097/01.qai.0000230527.17459.5c
[24]	Weller, S.C. (1993) A Meta-Analysis of Condom Effectiveness in Reducing Sexually Transmitted HIV. Social Science & Medicine, 36, 1635-1644. http://dx.doi.org/10.1016/0277-9536(93)90352-5
[25]	Peretti-Watel, P., Spire, B., Obadia, Y. and Moatti, J.P. (2007) Discriminations against HIV-Infected People and the Spread of HIV: Some Evidence from France. PLoS ONE, 2, e411. http://dx.doi.org/10.1371/journal.pone.0000411
[26]	Wolitski, R.J., Pals, S.L., Kidder, D.P., Courtenay-Quirk, C. and Holtgrave, D.R. (2009) The Effects of HIV Stigma on Health, Disclosure of HIV Status, and Risk Behavior of Homeless and Unstably Housed Persons. AIDS and Behavior, 13, 1222-1232. http://dx.doi.org/10.1007/s10461-008-9455-4
[27]	Varni, S.E., Miller, C.T. and Solomon, S.E. (2012) Sexual Behavior as a Function of Stigma and Coping with Stigma among People with HIV/AIDS in Rural New England. AIDS and Behavior, 16, 2330-2339. http://dx.doi.org/10.1007/s10461-012-0239-5
[28]	Przybyla, S.M., Golin, C.E., Widman, L., Grodensky, C.A., Earp, J.A. and Suchindran, C. (2013) Serostatus Disclosure to Sexual Partners among People Living with HIV: Examining the Roles of Partner Characteristics and Stigma. AIDS Care, 25, 566-572. http://dx.doi.org/10.1080/09540121.2012.722601
[29]	Heard, I., Potard, V., Costagliola, D. and Kazatchkine, M.D. (2004) Contraceptive Use in HIV-Positive Women. Journal of Acquired Immune Deficiency Syndrome, 36, 714-720. http://dx.doi.org/10.1097/00126334-200406010-00008
[30]	Conserve, D., Sevilla, L., Younge, S., Mbwambo, J. and King, G. (2012) Condom Use among HIV-Positive Sexually Active Adults and Partner’s HIV Status in Dares Salaam, Tanzania. Journal of Health Care for the Poor and Underserved, 23, 191-203. http://dx.doi.org/10.1353/hpu.2012.0010
[31]	Shuper, P.A., Joharchi, N., Irving, H. and Rehm, J. (2009) Alcohol as a Correlate of Unprotected Sexual Behavior among People Living with HIV/AIDS: Review and Meta-Analysis. AIDS and Behavior, 13, 1021-1036.http://dx.doi.org/10.1007/s10461-009-9589-z
[32]	Crepaz, N., Hart, T.A. and Marks, G. (2004) Highly Active Antiretroviral Therapy and Sexual Risk Behaviour: A Meta-Analytic Review. Journal of American Medical Association, 292, 224-236. http://dx.doi.org/10.1001/jama.292.2.224
[33]	Van Devanter, N., Duncan, A., Birnbaum, J., Burrell-Piggott, T. and Siegel, K. (2011) Gender Power Inequality and Continued Sexual Risk Behavior among Racial/Ethnic Minority Adolescent and Young Adult Women Living with HIV. Journal of AIDS & Clinical Research, S1, pii:003. http://dx.doi.org/10.4172/2155-6113.S1-003
[34]	Awusabo-Asare, K., Anarfi, J.K. and Agyeman, D.K. (1993) Women’s Control over Their Sexuality and the Spread of STDs and HIV/AIDS in Ghana. Health Transition Review, 3, 69-83.
[35]	Dixon-Mueller, R. (1993) The Sexuality Connection in Reproductive Health. Studies in Family Planning, 24, 269-282.http://dx.doi.org/10.2307/2939221