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Lert F , Maraux B, Bajos N, Dray.Spira R, Spire B, Annabel Desgrées du Loû , Hamelin C

Women living with HIV are still missing highly effective contraception Results from the ANRS-Vespa2 Study , 2011 . Lert F , Maraux B, Bajos N, Dray.Spira R, Spire B, Annabel Desgrées du Loû , Hamelin C and the Vespa2 study group. Context.

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Lert F , Maraux B, Bajos N, Dray.Spira R, Spire B, Annabel Desgrées du Loû , Hamelin C

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  1. Women living with HIV are stillmissinghighly effective contraception Resultsfrom the ANRS-Vespa2 Study, 2011 LertF , Maraux B, BajosN, Dray.SpiraR, Spire B, Annabel Desgrées du Loû, Hamelin C and the Vespa2 study group

  2. Context • In Western Europe, increase of life expectancy, normalisation of life expectations includingsexual life and parental expectations Renewedneedsregardingfamily planning • Among new diagnoses, • More thanhalfin women of childbearingage • Large proportion in migrant womenfromSubSaharanAfrica (UNAIDS 2013) • Contraception amongwomen living with HIV • Still large dominance of condom as contraceptive method(Heard 2004, Massad 2007, Sun 2012) • No effect of hormonal contraception on the responseto ART (Robinson 2012) • Safety of intrauterinedevice(Curtis 2009) • Unmetneed for contraception • High rates of unintendedpregnancieswith proportions rangingfrom 50% to 85% (Loufty2013) • Overall, scarcity of information on the contraceptive profile of women living with HIV (Haberl 2013, Sutton 2014)

  3. Objectives

  4. Methods

  5. Variables of interest

  6. Distribution of women of childbearing age according to the need of contraception

  7. Characteristics of women concerned by contraception according to country of birth

  8. Methods of contraception

  9. Correlates of highly effective methods vs. condoms among women on contraception No statistical association withhealthinsurance, visitto a gynaecologist, cardiovascularrisk.

  10. Discussion(1/3)Contraceptive patterns of women living with HIV • One in five women is not using any modern contraceptive method : muchhigherthan in the general population (9%, Bajos, 2012) • Amongwomen on contraception, condom has remained the mostused contraceptive method (# 75%) • No significantdifferencebetweenmigrant womenfromsub-SaharanAfrica and otherwomenregarding the use of contraceptive method

  11. Discussion(2/3)Correlates of highly effective contraception methods • Difference in correlates of highly effective contraception methods between Sub-Saharanwomen and otherwomen (French native and other migrants) • Among migrant womenfromsub-Saharanafrica • Children : Afterdelivery, heathprofessionalsmightoffer a broader range of contraceptive methods in maternityhospitals • Employment : a possible acculturation pathway • AmongFrench and other migrant women • Casualpartnershipassociatedwith more condom : lowsexualactivity(29% withsexual intercourse in the last 4 weeks) • Low use of highly effective method : not an accessibility issue • No association withhealthinsurance, 80% of womenwith a gynecologistvisit in the 12 monthperiod • Physicians’ attitudes ? Do theyprovidewomen living with HIV withthe full range of contraceptive options ?

  12. Discussion (3/3)Strengths and limitations of the Vespa2 study • Vespa2 questionnaire did not documentedunintentedpregancies and history of abortions. • Not enoughstatistical power to perform a stratifiedmultivariatelogisticregression of correlates of contraception methods.

  13. Conclusion

  14. Acknowledgements • The VESPA2 survey was sponsored and funded by the French National Agency for Research on Aids and Viral Hepatitis (ANRS). We thank all PLWHIV who agreed to participate in the ANRS VESPA2 survey, all medical staff members in the participating hospitals, as well as the community-based organisations AIDES and Act-Up Paris who supported the survey. • The ANRS VESPA2 Study Group: France Lert and Bruno Spire (scientific coordinators), PatriziaCarrieri, Rosemary Dray-Spira, Christine Hamelin, Nicolas Lorente, Marie Préau and Marie Suzan-Monti, with the collaboration of Marion Mora. • Methodological and ground support: Yann Le Strat (InVS, Saint-Maurice), LiseCuzin (HôpitalPurpan, Toulouse), Laurence Meyer (Cesp, Inserm, Le Kremlin Bicêtre), Daniela Rojas-Castro (Aides, Pantin) and Hugues Fischer (Act-Up Paris). • Data collection: The ClinSearch firm and the social research institute Ipsos. • Participatinghospitals and investigators

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