Background: Women of reproductive age are at the highest risk of both HIV infection and unintended pregnancy in sub-Saharan Africa. Highly effective contraceptives (HECs) such as hormonal injectable and implants are widely used in this region. HECs are effective for preventing pregnancies. However, unlike condoms, HECs offer no protection against HIV. Dual-method use, or the use of condoms with HECs, is an ideal option to reduce HIV risk but is infrequently practiced. Rather, women tend not to use condoms when they use HECs and increase their HIV risk from their sexual partners. However, it remains unknown whether HIV status affects such tendency. Given the increasing popularity of HECs in sub-Saharan Africa, this study examined the association between the use of HECs and condom use among HIV-positive and negative women. Methods: A cross-sectional study was conducted among 833 sexually active women aged 18-49 years, recruited from six clinics in Siaya county, Kenya. From March to May 2017, female research assistants interviewed the women using a structured questionnaire. Multiple logistic regression analysis was conducted to examine the association between HEC use and consistent condom use in the past 90 days, adjusting for potential confounders. It was also examined with regular partners (husbands or live-in partners) and non-regular partners, separately. In addition, a sub-sample analysis of HIV-negative or unknown women was conducted. Results: In total, 735 women were available for the analysis. Among the women, 231 (31.4%) were HIV-positive. HIV-positive women were more likely to use HECs than HIV-negative or status unknown women (70.1% vs. 61.7%, p=0.027). HEC use was significantly associated with decreased condom use with a regular partner (adjusted odds ratio (AOR)=0.25; 95% CI 0.15-0.43, p<0.001) and a non-regular partner (AOR=0.25; 95% CI 0.11-0.58, p=0.001). However, compared with HIV-negative or status unknown women, HIV-positive women were more likely to use HECs and condoms consistently with a regular partner (AOR=6.54, 95% CI 2.15-20.00, p=0.001). Other factors significantly associated with consistent condom use included partner’s positive attitude toward contraception, partner’s HIV-positive status, high HIV risk perception, and desire for children in the future. Conclusion: Dual-method use was limited among HIV-negative women and women who had HIV-negative partners due to inconsistent condom use. The use of HECs was significantly associated with decreased condom use, regardless of partner type and their HIV status. Due to this inverse association, HIV-negative women may increase their HIV risk from their sexual partners. Therefore, interventions should be strengthened to reduce their dual risks of HIV infection and unintended pregnancy by promoting dual-method use. Family planning services should strengthen counseling on the possible risk of HIV infection from their sexual partners and target not only women but also their partners, who may play a key role in condom use.

Survey data on consistent condom use among highly effective contraceptive users in rural Kenya

A health facility-based cross-sectional study was conducted in Siaya county in Kenya. To recruit a sufficient number of participants for this study, 73 health facilities were selected from across Siaya county, which received more than 500 outpatients per month on average in 2015, based on records in the District Health Information System. Then, they were clustered into the six sub-counties (Ugenya, Ugunja, Alego-Usonga, Gem, Bondo, and Rarieda), and one facility was randomly selected per sub-county. Each of the six facilities was allocated a sample size proportional to the number of women of reproductive age who lived in each sub-county in 2009. Study participants were sexually active women aged 18 to 49 who reported having had sexual intercourse at least once within 30 days prior to the interview. However, pregnant women and women who were sterilized were excluded because they were expected to have different reproductive characteristics from other women.

PLOS_ONE_Data.dta