HIV/AIDS and contraceptive method choice : demographic and socio-economic correlates of contraceptive method choice among HIV-positive women practising family planning in Kenya

Introduction: As the generalized HIV epidemic in specific settings of sub-Saharan Africa continues to evolve, there is need for evidence-based response to address emerging challenges, which include enabling the large number of women living with HIV make informed choices to achieve their reproductive goals. Objectives: This paper seeks to (i) examine the effect of HIV/AIDS on contraceptive method choice among women using contraceptives in Kenya; and (ii) identify correlates of contraceptive method choice among HIV-positive women practising family planning. Material and Methods: We apply multinomial Logistic regression models to a sample of 3190 sexually-active women of reproductive age using contraceptives from the 2003 and 2008 Kenya Demographic and Health Surveys to examine the effect of HIV/AIDS on contraceptive method choice. The analysis of correlates of method choice among HIV-positive women is based on a sample of 255 HIV-positive women using contraceptives and involves bivariate cross-tabulations with Chi-Square tests. Result: Overall association between HIV status and contraceptive method choice is consistent with expected patterns, with women who are HIV-positive being more than twice as likely to use condoms rather than hormonal contraceptives, compared to their counterparts of similar characteristics who are HIV-negative (p<0.05). Among women infected with HIV, those who were previously tested for HIV were more likely to use condoms and less likely to use hormonal methods (p<0.05) than those who had never been tested. The higher use of condoms by HIV-positive women is only evident among those who had previously been tested for HIV. Significant correlates of contraceptive method choice among HIV-positive women include parity, marital status, age group, education and ethnicity. Overall trends suggest a notable shift from use of hormonal methods to condoms by HIV-positive women, but predominant use of hormonal methods (60%) and low use of condoms (23%) by HIV-positive young women aged 15-24 practising family planning is of potential concern. Conclusion: The findings have important implications for family planning policies/programs targeting young women living with HIV and underscore the need to intensify efforts towards improved HIV testing coverage to enable HIV-positive women make informed reproductive choices

Understanding the urban-rural disparity in HIV and poverty nexus: the case of Kenya

Background The relationship between HIV and poverty is complex and recent studies reveal an urban-rural divide that is not well understood. This paper examines the urban-rural disparity in the relationship between poverty and HIV infection in Kenya, with particular reference to possible explanations relating to social cohesion/capital and other moderating factors. Methods Multilevel logistic regression models are applied to nationally-representative samples of 13,094 men and women of reproductive age from recent Kenya Demographic and Health Surveys. Results The results confirm a disproportionate higher risk of HIV infection among the urban poor, despite a general negative association between poverty and HIV infection among rural residents. Estimates of intra-community correlations suggest lower social cohesion in urban than rural communities. This, combined with marked socio-economic inequalities in urban areas is likely to result in the urban poor being particularly vulnerable. The results further reveal interesting cultural variations and trends. In particular, recent declines in HIV prevalence among urban residents in Kenya have been predominantly confined to those of higher socio-economic status. Conclusion With current rapid urbanization patterns and increasing urban poverty, these trends have important implications for the future of the HIV epidemic in Kenya and similar settings across the sub-Saharan Africa region

[Accepted Manuscript] HIV/AIDS and contraceptive use: Factors associated with contraceptive use among sexually-active HIV-positive women in Kenya

With increased availability of anti-retroviral therapy and improved survival for people living with HIV, more HIV-positive women are leading full reproductive lives. However, HIV-positive women have special contraceptive needs/concerns. This paper examines the individual and community-level HIV/AIDS factors associated with contraceptive use and compares predictors of contraceptive uptake between HIV-positive and HIV-negative women in Kenya. The study is based on secondary analysis of cross-sectional data of a sample of 9132 sexually-active women of reproductive age from the Kenya Demographic and Health Surveys collected in 2003 and 2008. Multilevel logistic regression models are used to examine individual and contextual community-level factors associated with current contraceptive use. The study provides evidence of lower contraceptive uptake among women living in high HIV-prevalence communities. It further reveals striking differences in factors associated with contraceptive uptake between HIV-positive and HIV-negative women. Education and the desire to stop childbearing are strongly associated with contraceptive uptake among uninfected women, but both factors are not significant among HIV-positive women for whom wealth is the most important factor. While HIV-negative women in the richest wealth quintile are about twice as likely to use contraceptives as their counterparts of similar characteristics in the poorest quintile, this gap is about seven-fold among HIV-positive women. These findings suggest that having the desire and relevant knowledge to use contraceptives does not necessarily translate into expected contraceptive behavior for HIV-positive women in Kenya and that poor HIV-positive women may be particularly in need of increased access to contraceptive services

Onset of sexual activity among adolescents in HIV/AIDS affected households in sub-Saharan Africa

This paper examines the effect of orphanhood and HIV status of adults in a household on onset of sexual activity among adolescent girls and boys aged 15-17 years in sub-Saharan Africa (SSA). We apply multilevel logistic models to pooled Demographic and Health Surveys data from19 countries of SSA where HIV test data were collected during 2003-2008 from nationally representative samples of men and women of reproductive age. The results highlight increased vulnerability among adolescent boys and girls living in households where an adult is infected with HIV, and adolescent boys who are paternal orphans. On average, adolescent boys and girls living in households where at least one adult is HIV-positive have about 25 percent higher odds of having initiated sexual activity compared to their counterparts of similar characteristics in households where no adult is HIV-positive. Furthermore, adolescent boys who are paternal orphans have about 25 percent higher odds of having initiated sexual activity than their non-orphan counterparts of similar individual characteristics. Further analysis reveals that household circumstances relating to living arrangements and poverty are important pathways through which household HIV/AIDS status is linked to adolescent sexual debut. The findings underscore the importance of international efforts in the SSA region to address the plight of other children in HIV/AIDS affected households, beyond orphans

A multilevel analysis of the determinants of HIV testing in Zimbabwe: evidence from the demographic and health surveys

Introduction Zimbabwe is still burdened with HIV epidemic and the government has an ambitious aim in the post-2015 era to end the AIDS epidemic by 2030. To achieve this, the government has set up the 90-90-90 strategic milestones to be achieved by 2020. It is daunting task to increase HIV testing uptake from current estimate of 56%to 90% to meet these targets. The current government’s initiative requires an understanding of determinants of HIV testing. Objectives The specific objectives of this study are to: (i) identify the individual and community-level determinants of HIV testing, focussing on predisposing, enabling and perceived need factors (PREP); and (ii) establish gender differences. Material and Methods We applied multilevel logistic regression models to nationally-representative samples of 17,797women and 14,587 men from the 2005/6 and 2010/11 Zimbabwe Demographic and Health Surveys to examine the determinants of HIV testing. Results HIV testing uptake increased significantly between 2005/6 and 2010/11, especially for women (females OR=5.60; males OR=2.57). Most PREP factors associated with HIV testing are largely consistent with patterns in Southern Africa (e.g. higher uptake by women and those who are wealthier), but unique patterns have also emerged. In particular, results reveal important gender differences: rural residence is associated with lower uptake of HIV testing for women (OR=0.74) but higher for men (OR=1.16); community wealth is a more important factor in enabling HIV testing than household wealth for women, but the converse is true for men; and individual-level, rather than community-level stigma is important for women, while for men, it is community-level stigma that is important. Conclusion Observed gender disparities in determinants of HIV testing calls for gender specific response. Couple-oriented HIV counselling and testing services where men accompany their spouse to HIV screening during pregnancy may help increase HIV testing uptake for males and reduce gender disparities

The inequality of maternal health in urban sub-Saharan Africa

Numerous studies document the urban poor disadvantage in child health conditions in African cities. This study uses DHS data from 23 countries in sub-Saharan Africa to examine whether the urban poor experience comparable disadvantages in maternal health. The results show that although the urban poor on average receive better antenatal and delivery care than rural residents, they consistently have poorer maternal health indicators than the urban non-poor. Further analyses based on a multilevel approach reveal significant variations in urban maternal health inequalities across countries of sub-Saharan Africa. The urban poor disadvantage is more pronounced in countries with better average maternal health indicators, where the urban poor tend to be even worse off than rural residents

Trends and determinants of contraceptive method choice in Kenya

This paper uses data from the 1989, 1993 and 1998 Kenya Demographic and Health Surveys to examine trends and determinants of contraceptive method choice. The analysis, based on two-level multinomial regression models, shows that, across years, use of modern contraceptive methods, especially long-term methods is higher in the urban than rural areas, while the pattern is reversed for traditional methods. Use of barrier methods among unmarried women is steadily rising, but the levels remain disappointingly low, particularly in view of the HIV/AIDS epidemic in Kenya. One striking result from this analysis is the dramatic rise in the use of injectables. Of particular program relevance is the notably higher levels of injectables use among rural women, women whose partners disapprove of family planning, uneducated women and those less exposed to family planning media messages, compared to their counterparts with better service accessibility and family planning information exposure

Pathways of the determinants of unfavourable birth outcomes in Kenya

This paper explores the pathways of the determinants of unfavourable birth outcomes, such as premature birth, the size of the baby at birth, and Caesarean section deliveries in Kenya, using graphical loglinear chain models. The results show that a number of factors which do not have direct associations with unfavourable birth outcomes contribute to these outcomes indirectly through intermediate factors. Marital status, the desirability of a pregnancy, the use of family planning, and access to health facilities have no direct associations with poor birth outcomes, such as premature births and the small size of the baby at birth, but are linked to these outcomes through antenatal care. Antenatal care is identified as a central link between various socio- demographic or reproductive factors and birth outcomes

Household and community HIV/AIDS status and child malnutrition in sub-Saharan Africa: Evidence from the demographic and health surveys

This paper examines the extent to which under five children in households or communities adversely affected by HIV/AIDS are disadvantaged, in comparison with other children in less affected households/communities. The study is based on secondary analysis of the Demographic and Health Survey (DHS) data collected during 2003–2008 from 18 countries in sub-Saharan Africa, where the DHS has included HIV test data for adults of reproductive age. We apply multilevel logistic regression models that take into account the effect of contextual community/country level HIV/AIDS factors on child malnutrition. The outcome variable of interest is child undernutrition: stunting, wasting and underweight. The results suggest that across countries in sub-Saharan Africa, children whose mothers are infected with HIV are significantly more likely to be stunted, wasted or underweight compared to their counterparts of similar demographic and socio-economic background whose mothers are not infected. However, the nutritional status of children who are paternal orphans or in households where other adults are HIV positive are not significantly different from non-orphaned children or those in households where no adult is infected with HIV. Other adult household members being HIV positive is, however, associated with higher malnutrition among younger children below the age of one. Further analysis reveals that the effect of mothers’ HIV status on child nutritional status (underweight) varies significantly across communities within countries, the effect being lower in communities with generally higher levels of malnutrition. Overall, the findings have important implications for policy and programme efforts towards improved integration of HIV/AIDS and child nutrition services in affected communities and other sub-groups of the population made vulnerable by HIV/AIDS. In particular, children whose mothers are infected with HIV deserve special attention

Perception and implementation of sustainable/green design in India

Profound effects of global warming, species extinction, pollution of air and water, resource depletion, and population growth demand that India, the second most populated country in the world, address the need for ecological responsibility. This phenomenological study explored awareness and perceptions of green/sustainable (G/S) design in India’s design community. Architects in the five geographic regions were interviewed. All were familiar with S/G design and said knowledge was “very important.” However, none felt “well-versed.” They believed lack of client awareness (49%) and materials (28%) were the major problems encountered. Although the vast majority was willing to promote S/G design, none had actually promoted it. All felt there were inadequate government incentives to persuade the design community to practice and promote S/G design. The study revealed an urgent need in India for education and promotion of ecological responsibility at a micro level through green design and at a macro level through sustainable development