HIV Sero-discordance and dual contraceptive method use among HIV-infected men and women in Lilongwe, Malawi.

BACKGROUND: Some HIV sero-discordant couples are faced with the dual challenge of preventing HIV transmission to the uninfected partner and avoiding unintended pregnancy. Therefore, we hypothesized that sero-discordance is associated with dual method use at last sex.

METHODS: We analyzed data from a cross-sectional survey of HIV-infected men and women attending 2 ART clinics in Lilongwe, Malawi. We used Fisher's exact test and Wilcoxon rank sum to assess for associations between sero-discordance, covariates, and dual method use. Multivariable logistic regression was used to estimate the adjusted odds ratio (aOR) and 95% confidence intervals (CI) of dual method use at last sex, comparing sero-discordant to sero-concordant relationships. Separate analyses were conducted for men and women.

RESULTS: We surveyed 253 HIV infected men, of which 44 (17.4%) were in a known sero-discordant relationship and 63 (24.9%) were utilizing dual methods at last sex. Likewise, among 302 HIV infected women surveyed, 57 (18.9%) were in a known sero-discordant relationship, and 80 (26.5%) were utilizing dual method at last sex. Sero-discordance was not significantly associated with dual method use at last sex for among HIV infected men (aOR = 0.62, 95% CI: 0.27-1.44) or women (aOR = 1.21, 95% CI: 0.59-2.47).

CONCLUSION: Dual method use was low among all HIV-infected individuals, irrespective of their partner's HIV status. Given these findings, we recommend greater efforts to encourage HIV providers to counsel their patients about the importance of dual method use to prevent both unintended pregnancy and sexually transmitted infections.