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Low rates of contraception use in women with HIV


 
 
 Women with HIV (WWH) have low rates of hormonal or long-acting contraceptive use. Few studies have described contraception use among WWH over time.
 
 
 
 We examined contraception (including all forms of hormonal contraception, intrauterine devices, and bilateral tubal ligations) use among cis-gender women aged 18-45 years in care at Vanderbilt's HIV clinic (Nashville, TN) from 1998-2018. Weighted annual prevalence estimates of contraception use were described. Cox proportional hazards models examined factors associated with incident contraception use and pregnancy.
 
 
 
 Of the 737 women included, median age at clinic entry was 31 years, average follow-up was 4.1 years. At clinic entry, 47 (6%) women were on contraception and 164 (22%) were pregnant. The median annual percent of time on any contraception use among non-pregnant women was 31.7% and remained stable throughout the study period. Younger age was associated with increased risk of pregnancy and contraceptive use. Psychiatric comorbidity decreased likelihood of contraception (adjusted HR [aHR] 0.52 [95%CI: 0.29-0.93]) and increased likelihood of pregnancy (aHR 1.77 [95%CI: 0.97-3.25]). While not associated with contraceptive use, more recent year of clinic entry was associated with higher pregnancy risk. Race, substance use, CD4 cell count, HIV RNA, smoking, and antiretroviral therapy were not associated with contraception use nor pregnancy.
 
 
 
 Most WWH did not use contraception at baseline nor during follow-up. Likelihood of pregnancy increased with recent clinic entry while contraception use remained stable over time. Continued efforts to ensure access to effective contraception options are needed in HIV clinics.
