Long-acting reversible contraception knowledge, attitudes, and use among HIV-infected and uninfected women and their providers.

Abstract

OBJECTIVE(S)\nTo describe differences in contraceptive knowledge, attitudes and use among HIV-infected and HIV-uninfected women served by an academic medical center in New York City, and to describe gaps in knowledge and practice of gynecologic (GYN) and HIV clinicians providing care at the same clinic sites where patients completed surveys.\n\n\nSTUDY DESIGN\nWe conducted a survey comparing contraceptive knowledge, attitudes, reproductive histories and long acting reversible contraception (LARC) use in HIV-infected and uninfected women. We also conducted a survey to elicit clinician demographic characteristics and education, contraceptive practice patterns and their knowledge of current contraceptive guidelines. We surveyed clinicians and patients at five ambulatory sites.\n\n\nRESULTS\nWe screened 90% of patients approached. All 257 women who were eligible completed a survey. These included 107 (42%) HIV-infected women and 150 (58%) HIV-uninfected women. HIV-infected women were older, more likely to be black/African-American, less likely to be Latina, more likely to receive public assistance, and with lower educational attainment. HIV-infected women reported lower lifetime LARC use (12% vs. 28%) and higher recent condom use (58% vs. 25%) than HIV-uninfected women. Both groups reported similar attitudes towards intrauterine devices (IUD) and implants. HIV clinicians were less likely to have had training in or discuss LARC methods with their patients.\n\n\nCONCLUSIONS\nHIV-infected women were less likely to be current (last 30days) or ever-LARC users, despite having similar attitudes towards IUDs and implants, compared to HIV-uninfected women. HIV providers had lower levels of knowledge of HIV-specific contraceptive guidelines compared with gynecology practitioners.\n\n\nIMPLICATIONS\nHIV-infected women and their providers share a knowledge gap regarding LARC. Increased interdisciplinary collaboration may help mitigate the resulting disparities in access to highly effective contraception in HIV-infected women. Knowledge of HIV-specific contraceptive guidelines and ability to place contraceptive implants were low among all surveyed providers, suggesting need for additional training.