Women living with HIV are still missing highly effective contraception. Results from the ANRS-Vespa2 Study, 2011, France

Background: Improvements in ART have renewed reproductive issues in women living with HIV. Among them, unintended pregnancies are still frequent and call for a better knowledge of contraceptive patterns.
Methods: Detailed contraception methods were documented among a national representative sample of HIV-positive women randomly included from 73 HIV outpatient clinics in France, using a face-to-face questionnaire. All women of reproductive age (18-49 years), sexually active in the past 12 months, not pregnant or seeking to get pregnant, not sterile or menopausal were considered at risk of unintended pregnancy. Correlates of highly effective contraception (HEC - including oral pill, IUD, implant, sterilization, injection) versus condom were studied separately among women from sub-Saharan Africa (SSA) and other women, considering age, children, education, sexual partnership, sexual satisfaction, material deprivation, employment status, health insurance coverage, visit to a gynecologist, antiretroviral treatment and cardiovascular risk.
Results: Among 932 women, 662 were of reproductive age, 327 at risk of unintended pregnancy. Among them, 44 did not use contraception, 17 used traditional methods and 256 used modern contraception. 55.7% were migrants from SSA, others were mostly French-natives. Among women using modern contraception, 25.4% of those from SSA and 26.6% of the others (p = 0.84) used HEC. Among SSA women, age under 40, having children (OR 3.75 95%IC 1.75 8.04) and being employed (OR 2.36, 95%IC 0.99-5.61) were associated with HEC use; in other women, HEC use was associated with stable partnership (OR 4.5, 95%IC 1.2-17.2) and material deprivation (OR 3.3, 95%IC 1.4-9.8). Other factors were not found associated with contraceptive methods, suggesting no accessibility barriers. Moreover, visit to a gynecologist was not found to increase the likelihood of HEC.
Conclusions: Despite consistent evidence that hormonal contraception and IUD are at no risk for women on ART and that condom is a poorly effective contraception method, condom remained the predominant contraception method, regardless of women geographical origin. The shift towards a dual protection approach as recommended by national and international guidelines has not yet occurred in a Western country like France. Promotion of dual protection should target both professionals - HIV specialists and gynecologists - and women living with HIV.

F. Lert1, B. Maraux1, N. Bajos1, R. Dray-Spira2,3, B. Spire4,5, C. Hamelin6, A. Desgrées du Lou7, Vespa Study Group
1INSERM U 1018, Centre de Recherche en Epidémiologie et Santé des Populations, Villejuif, France, 2INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Team Research in Social Epidemiology, Paris, France, 3Sorbonne Universités, UPMC Univ Paris 06, Paris, France, 4INSERM UMR 912, SESTIM, Marseilles, France, 5Aix Marseille Université, UMR_S 912, IRD, Marseilles, France, 6Université de Versailles Saint Quentin en Yvelines, Saint Quentin en Yvelines, France, 7IRD, CePED, Paris, France