Academic journal article Gender & Behaviour

Dual Protection, Contraceptive Use, HIV Status and Risk among a National Sample of South African Women

Academic journal article Gender & Behaviour

Dual Protection, Contraceptive Use, HIV Status and Risk among a National Sample of South African Women

Article excerpt

The aim of this study was to investigate dual protection, contraceptive use, HIV status risk among a national sample of South African women. The final sample included only female participants (N=4675) who reported to have had sexual intercourse in the past 12 months aged 15 to 49 years. Results indicate that almost one thirds (31.7%) of the participants indicate that they were protected from both pregnancy and sexually transmitted infections the last time they had sexual intercourse, 18.6% using dual methods compared to the 6.8% who were found to use both barrier and hormonal methods and 13.1% using a condom alone; 40.9% were protected from pregnancy only through the use of a non-barrier contraceptive, while 46% of the participants used no method at all. In multivariate analysis younger age, higher education, African black, not married and high HIV risk perception were associated with dual method use. Dual method use is low in this population and the use of contraceptive methods that offer protection against pregnancy and STIs/ HIV is encouraged.

Key words: Dual protection, contraceptive use, HIV status, HIV risk, South African women

Introduction

There is an estimated 5.5 million people living with HIV in South Africa (UNAIDS, 2008). Young women are disproportionately affected, with incidence rates amongst women aged 20-29 years, 6 fold higher (5.6%) than that of males (0.9%) (Rehle, Shisana, Pillay, Zuma, Puren, 8c Parker (2007). Provincially, according to modelled data estimates among pregnant women, HIV prevalence is highest in KwaZulu-Natal (40%), Gauteng (35%) and Free State (33%). In a context where HIV prevalence increases rapidly from 4.1% among 15 year old to 26.3% among 24 year old women, high levels of sexual activity and unprotected sex are placing these young women at risk of HIV infection, as well as pregnancy (Pettifor, Rees, Steffenson, Hlongwa-Madikizela, MacPhail, Vermaak, 8c Kleinschmidt, 2004; MacPhail, Pettifor, Pascoe, 8c Rees, 2007). Researchers have identified both social and biological factors that make women vulnerable to HIV (Ackermann 8c de Klerk, 2002; Chersich 8c Rees, 2008).

Kleinschmidt, Maggwa, Smit, Beksinska and Rees (2003) analysed data from the 1998 South African Demographic and Health Survey and found that 10.5% of all sexually active women aged 1549 years used a condom at last sex and 6.3% used a condom as well as another contraceptive method; condom use was more likely among younger, more educated, more affluent, and urban women, and among women who changed partners more frequently. Findings from the 2003 South African Demographic and Health Survey (Department of Health, 2007) showed that among sexually active women aged 15-49 years 50.2% were currently using any contraceptive method, the most common contraceptive methods used were contraceptive injection (26.7%), followed by pill (9.0%), female sterilization (7.3%), (male or female) condom (6.2%), Intrauterine Device (IUD) (0.7%) and male sterilization (0.3%). Ngubane, Patel, Newell, Coovadia, Rollins, Coutsoudis, 8c Bland (2008) found in a cohort study among 1137 HIV positive and 1220 HIV negative women in KwaZulu-Natal that the most common contraceptive was the hormonal injectable; few women used condoms alone or as dual contraception, at 7-12 months 16.3%. Morroni, Smit, McFadyen, Mqhayi and Beksinska (2003) found among sexually active 15 to 49 year old women attending primary care clinics in South Africa that at last intercourse 12% of women were protected from both Sexually Transmitted Infections (STIs) and pregnancy. In multivariate analysis, higher education, being unmarried, and multiple sex partnership in the past year were predictors of dual method use, while younger age, higher education and awareness of the dual function of condoms were predictors of condom use alone (Morroni et al., 2003).

Pregnancy rates remain high among young women in South Africa (Maharaj, 2006). Encouraging the use of contraceptive services is also important for meeting HIV prevention goals. …

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