Family planning among people living with HIV in post-conflict Northern Uganda: A mixed methods study

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2011

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Nattabi Barbara , Li Jianghong , Orach , Earnest , Earnest Jaya , Thompson

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Northern Uganda experienced severe civil conflict for over 20 years and is also a region of high HIV prevalence. This study examined knowledge of, access to, and factors associated with use of family planning services among people living with HIV (PLHIV) in this region. Methods Between February and May 2009, a total of 476 HIV clinic attendees from three health facilities in Gulu, Northern Uganda, were interviewed using a structured questionnaire. Semi-structured interviews were conducted with another 26 participants. Factors associated with use of family planning methods were examined using logistic regression methods, while qualitative data was analyzed within a social-ecological framework using thematic analysis. Results There was a high level of knowledge about family planning methods among the PLHIV surveyed (96%). However, there were a significantly higher proportion of males (52%) than females (25%) who reported using contraception. Factors significantly associated with the use of contraception were having ever gone to school [adjusted odds ratio (AOR) = 4.32, 95% confidence interval (CI): 1.33-14.07; p = .015], discussion of family planning with a health worker (AOR = 2.08, 95% CI: 1.01-4.27; p = .046), or with one's spouse (AOR = 5.13, 95% CI: 2.35-11.16; p = .000), not attending the Catholic-run clinic (AOR = 3.67, 95% CI: 1.79-7.54; p = .000), and spouses' non-desire for children (AOR = 2.19, 95% CI: 1.10-4.36; p = .025). Qualitative data revealed six major factors influencing contraception use among PLHIV in Gulu including personal and structural barriers to contraceptive use, perceptions of family planning, decision making, covert use of family planning methods and targeting of women for family planning services. Conclusions Multilevel, context-specific health interventions including an integration of family planning services into HIV clinics could help overcome some of the individual and structural barriers to accessing family planning services among PLHIV in Gulu. The integration also has the potential to reduce HIV incidence in this post-conflict region.

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biomed

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01 janvier 2011

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English

AIDS Contraception

Nattabiet al.Conflict and Health2011,5:18 http://www.conflictandhealth.com/content/5/1/18

R E S E A R C HOpen Access Family planning among people living with HIV in postconflict Northern Uganda: A mixed methods study 1,2* 3,41,2 51 Barbara Nattabi, Jianghong Li, Sandra C Thompson, Christopher G Orachand Jaya Earnest

Abstract Background:Northern Uganda experienced severe civil conflict for over 20 years and is also a region of high HIV prevalence. This study examined knowledge of, access to, and factors associated with use of family planning services among people living with HIV (PLHIV) in this region. Methods:Between February and May 2009, a total of 476 HIV clinic attendees from three health facilities in Gulu, Northern Uganda, were interviewed using a structured questionnaire. Semistructured interviews were conducted with another 26 participants. Factors associated with use of family planning methods were examined using logistic regression methods, while qualitative data was analyzed within a socialecological framework using thematic analysis. Results:There was a high level of knowledge about family planning methods among the PLHIV surveyed (96%). However, there were a significantly higher proportion of males (52%) than females (25%) who reported using contraception. Factors significantly associated with the use of contraception were having ever gone to school [adjusted odds ratio (AOR) = 4.32, 95% confidence interval (CI): 1.3314.07; p = .015], discussion of family planning with a health worker (AOR = 2.08, 95% CI: 1.014.27; p = .046), or with one’s spouse (AOR = 5.13, 95% CI: 2.3511.16; p = .000), not attending the Catholicrun clinic (AOR = 3.67, 95% CI: 1.797.54; p = .000), and spouses’nondesire for children (AOR = 2.19, 95% CI: 1.104.36; p = .025). Qualitative data revealed six major factors influencing contraception use among PLHIV in Gulu including personal and structural barriers to contraceptive use, perceptions of family planning, decision making, covert use of family planning methods and targeting of women for family planning services. Conclusions:Multilevel, contextspecific health interventions including an integration of family planning services into HIV clinics could help overcome some of the individual and structural barriers to accessing family planning services among PLHIV in Gulu. The integration also has the potential to reduce HIV incidence in this postconflict region. Keywords:HIV/AIDS, contraception, mixed methods, Northern Uganda

Background Between 1987 and 2007, Northern Uganda was affected by civil conflict resulting in a complex humanitarian emergency, characterized by a displacement of over 1.5 million people from their homes into overcrowded internally displaced persons (IDP) camps. The region experienced an increase in transmission of infectious diseases and increased mortality rates [1]. In 2006 Northern Uganda had the highest infant mortality rates

* Correspondence: barbara.nattabi@cucrh.uwa.edu.au 1 Centre for International Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia Full list of author information is available at the end of the article

(106 deaths per 1,000 live births) and underfive mortal ity (177 deaths per 1,000 live births) in all of Uganda, with even higher rates in the IDP camps at 123 and 200, respectively [2]. During the insurgency, disruptions to the health care system and social infrastructure, and migration of skilled health workers to more stable parts of the country led to limited availability of, and access to, quality health services among the IDPs [1]. Consequent to the insurgency, Gulu District had the highest percentage of its population (58.1%) in the low est quintile of wealth in Uganda, and only 0.9% of females and 3.0% of males had completed secondary education [2]. Northern Uganda also had the lowest use

© 2011 Nattabi et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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