|Year : 2020 | Volume
| Issue : 2 | Page : 239-243
Utilization and Factors Affecting Utilization of Contraception among HIV-Positive Male Patients in Saye, Zaria
Ayandunmola F Oyegoke1, Aisha Abubakar2
1 Research & Public Health Studies, Salama Infirmary (Hospital and Maternity); Department of Community Medicine, College of Health Science, Ahmadu Bello University, Zaria, Nigeria
2 Department of Community Medicine, College of Health Science, Ahmadu Bello University, Zaria, Nigeria
|Date of Submission||10-Jan-2020|
|Date of Decision||28-Feb-2020|
|Date of Acceptance||20-Apr-2020|
|Date of Web Publication||26-Jun-2020|
Dr. Ayandunmola F Oyegoke
Salama Infirmary (Hospital and Maternity), Zaria
Source of Support: None, Conflict of Interest: None
Introduction: Sub-Saharan Africa continues to carry the full consequences of health and socioeconomic impact of HIV, with about 25.8 million and 66% of people with HIV infection living in the region. The overall prevalence of contraceptive use in Nigeria is low, especially among men; the uptake of contraception and the type of contraceptive use are heavily influenced by the male/husband dominance in the society/family. Methodology: The study was carried out among HIV-positive male patients in Saye, Zaria, using a descriptive cross-sectional study among 265 respondents. Chi-square and multivariate logistic regression were used to determine factors influencing contraceptive usage. Results: The mean age of respondents was 45.6 ± 11.7 years. Only 61.9% of the respondents have ever used contraception, out of which 56.7% are currently using contraception. The identified reason for not using contraception was because they both were HIV positive (29%). There was a significant association between age, marital status, and level of education of respondents and current use of contraception with a P value of 0.001, <0.001, and 0.004, respectively. Conclusion: There were low usage of contraception and poor acceptance of vasectomy. There should be adequate policies in place by the government to encourage male involvement in the utilization of contraception.
Keywords: Condom, contraception, HIV, National Tuberculosis and Leprosy Training Centre, tuberculosis, uptake
|How to cite this article:|
Oyegoke AF, Abubakar A. Utilization and Factors Affecting Utilization of Contraception among HIV-Positive Male Patients in Saye, Zaria. Niger J Med 2020;29:239-43
|How to cite this URL:|
Oyegoke AF, Abubakar A. Utilization and Factors Affecting Utilization of Contraception among HIV-Positive Male Patients in Saye, Zaria. Niger J Med [serial online] 2020 [cited 2020 Sep 20];29:239-43. Available from: http://www.njmonline.org/text.asp?2020/29/2/239/287927
| Introduction|| |
Sub-Saharan Africa carries the full consequences of HIV on health and socioeconomic status. Approximately 3.5 million people are living with HIV infection in Nigeria, majority of whom are in their reproductive years. Nigeria is second to South Africa in the number of people living with HIV (PLHIV)/AIDS worldwide, representing 9% of the global burden of the disease. There is a reduction in AIDS-related deaths among women (33% decrease) compared with men (15% decrease) reflecting higher treatment coverage among women than men, 52% and 41%, respectively. Furthermore, men account for 58% of adult AIDS-related deaths.
HIV is mainly transmitted through heterosexual contact, and new infections in the country heighten due to reduced perceived personal risk, multiple sexual partners, inefficient and inadequate treatment of sexually transmitted infections, and poor quality service delivery. Helping people infected with HIV achieve their family planning (FP) intentions is an essential preventive health service and has been included as one of the four prongs outlined by the United Nations to reduce the burden of pediatric AIDs.,
Keyways men can be directly involved in women reproductive health include: using contraceptive methods that require their direct participation such as condom, natural FP, vasectomy, and withdrawal; supporting their partners' use of contraception through joint decision-making about contraceptive method use and family size; and preventing the spread of sexually transmitted diseases using a condom, limiting their sexual activity to one partner, and seeking treatment. In a study done in Ondo, Nigeria, only 31.2% had ever used a condom and 15.0% reported currently using a condom.
There are overwhelming previous studies carried out to assess the utilization of contraceptive use among HIV-positive women and prevention of mother-to-child transmission of HIV in both urban and low-resource settings; however, there are few research carried out among HIV positive men. The aim of this study is to determine the uptake of contraception and factors affecting uptake among HIV-positive male patients.
| Methodology|| |
The National Tuberculosis and Leprosy Training Centre (NTBLTC), Zaria, provides training of staffs and renders medical services to patients who are made easier with the availability of the National Tuberculosis Reference Laboratory where investigations, blood work, and laboratory tests are done. The mandate of the center is as follows: training workforce for the NTBLC Program; tuberculosis (TB)/HIV and leprosy services (diagnostic, chemotherapy, etc.); and operational research relating to TB, HIV, and leprosy. The policy for the treatment of HIV is to test the patient; if positive, the antiretroviral is started immediately irrespective of CD4 count. For those starting the antiretroviral, the drugs are dispensed for 1 month to assess the level of adherence. On the second visit, it is dispensed for 2 months, and on subsequent visits, it is dispensed for 3 months. However, if the patient defaults, the interval between appointments reduces just to foster adherence.
The study was a descriptive, cross-sectional study.
The study population was HIV-positive male patients receiving treatment at the antiretroviral therapy clinic at NTBLTC, Saye, Zaria, Kaduna State, with the exclusion of HIV-positive male patients who are chronically ill on inpatient admission and HIV-positive male patients who are coinfected with TB.
Sample size determination
The sample size was determined using the formula below:
n = Minimum sample size,
z = Standard normal deviate set at a 95% confidence interval, which corresponds to 1.96,
d = Margin of sample error tolerated which is set at 5% (0.05)
p = Contraceptive prevalence was (63%) in a previous study
q = Complementary probability of q = 1 − p.
A sample size of 285 was used as the minimum sample size for this study.
A simple random sampling technique was used to collect information from an eligible participant. The patients that fulfilled the eligibility criteria during each clinic day were selected at random.
Data collection techniques
The data were collected through an android device using KoBo collect software version 1.14.0a (KoBoToolbox, Harvard Humanitarian Initiative, 14 Story St, Second floor, Cambridge, MA 02138, USA), and the questionnaire contained information on respondents' sociodemographic status, uptake of contraception, and factors influencing the use of contraception.
The questions on uptake of contraception were based on ever used, currently using, and the type of contraceptive method they are currently using. The factors affecting uptake of contraception included some sociodemographic factors, the attitude of the health workers, knowledge of contraception, and finance. The data were analyzed using STATA software version 13.0 (StataCorp LLC 4905 Lakeway Drive College Station, Texas, USA), and univariate analysis was done using proportions, measures of dispersion, measures of central tendency, and percentage while bivariate analysis which was checking the association between the religion of the respondents, level of education, and use of contraception using Chi-square was done. A confidence interval of 95% was used, and P < 0.05 was considered statistically significant; therefore, any bivariate analysis, that is, <0.05, was considered significant, and multivariate analysis was done.
Letter of introduction was written to the institution, and the principal of the NTBLTC gave the approval to carry out the study. Oral consent was obtained from each participant of the study, and confidentiality of the respondents was ensured by not asking of their name.
| Results|| |
About 8 (2.8%) questionnaires were not filled appropriately, and 9 (3.1%) questionnaires were missing. Therefore, 268 (94.0%) questionnaires from the respondents were analyzed using STATA version 13.0.
[Table 1] shows that 84 (31.3%) of the respondents were within the 38–47 age group; the mean age of respondents was 45.6 ± 11.7. Majority of the respondents (81.0%) were Muslims, 50 (18.7%) were Christians, most of the respondents were of Hausa tribe (194, 72.4%), 79% are married, 27.2% of the respondents have at least secondary education, and 20.2% have tertiary education.
In [Figure 1], out of 268 respondents, 166 (61.9%) reported that they have ever used contraception and 91 (34%) reported that their spouse had ever used contraception before while only 152 (56.7%) were currently using contraception.
In [Table 2], out of 166 respondents that reported that they had ever used contraception, 153 (92.2%) chose condom as one of the contraceptive methods that they have ever used while only 2 (1.2%) chose vasectomy. One hundred and fifty-two respondents reported that they are currently using contraception, of which condom still ranked the highest contraceptive method used at 90.8%.
|Table 2: Contraceptive methods ever used and currently using by respondents|
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Thirty percent of the respondents chose that the reason for not using contraception was because they were married, as seen in [Figure 2]; 29% said that it is because they were both HIV positive; 28% said that it reduces sexual pleasure; and 18% acknowledged that their religion does not permit the use of contraception.
In [Table 3], there was a significant association between age of respondents, marital status, level of education, and current use of contraception, with a P value of 0.001, <0.001, and 0.004, respectively.
|Table 3: Relationship between sociodemographic characteristics and use of contraception|
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This analysis in [Table 4] showed that the odds of good contraceptive usage is four times higher in those that are married (odds ratio [OR] = 4.25, 95% confidence interval [CI] =2.19–8.26) and two times higher in those with formal education (OR = 2.23, 95% CI = 1.26–3.94). This means that education and marital status are the main predictors of contraceptive usage.
|Table 4: Multivariate logistic regression model on the usage of contraception and sociodemographic characteristics|
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| Discussion|| |
This study shows that 61.9% of the respondents reported that they have ever used contraception which is almost synonymous with a study done in Nairobi, Kenya, where 58.8% of the male respondents had used contraception, but it is, however, low compared to a study done in Zimbabwe where 80.6% of the respondents had ever used a contraceptive method and a study done in Uganda where 87% of the respondents had ever used FP. Only 34% of the respondents reported that their spouse has ever used contraception before, and this is in contrast to a study done in Nigeria where the results showed that 63% of men reported that they or their wives had previously used at least one modern or traditional method. The disparities may be due to the environment where the study was done, as there is no high importance placed on contraception.
Fifty-six percent of the respondents are currently using contraception which is almost similar to a study done in Bangladesh where the current contraceptive use rate was 63% and in Uganda Rhoda where 68% of men are currently using an FP method. However, it is in contrast to a study done in India where 96% of men are currently using a contraceptive method. In a study done in Northern Nigeria, it showed that 67% of the current users of contraceptives are between the ages of 26 and 40 years and only 24% are between the ages of 41–59 years; this is, however, in contrast to this study where 72.6% and 53.9% of the current users of contraception are within the ages of 38–47 years and 48–57 years, respectively. This may be due to misinterpretation of the information transmitted to the respondents, and some might not want to use contraception because of the felt need to reproduce.
In this study, condom ranked the highest contraceptive method used at 90.8% and only 2% used male sterilization; this is similar to a study done in India where a condom was the most commonly reported contraceptive method used by married PLHIV. It is similar to a study done in Nairobi, Kenya, where it was also noted that condom was one most common method of the contraceptive use and men with HIV/AIDS reported a higher condom use. This study is, however, in contrast to a study done in Uganda Rhoda where although the most commonly used FP method was male condoms as chosen by 62% of the men. However, the preference for vasectomy and female sterilization was at 14% and 16%, respectively. The condom is the most available contraceptive, and the high rate of use might be due to the dual effects it has; most of the respondents are opposed to vasectomy because they feel that it affects erection and libido.
This study discovered that contraceptive use was higher among respondents who are married and of high educational level which is also similar to a study done in Nairobi, Kenya, where contraceptive use was higher among married individuals with HIV/AIDS and increased with age and education level. It is also synonymous with a study done in Ilorin, Nigeria, where the ever use of contraception ranges from 6% in those with no education to 53% with those with postsecondary education.
The factors responsible for uptake of contraception are: marital status; seroconcordant couple; religion; side effects of contraception; cost; and reduction of pleasure. This is in line with a study done in India where the researcher identified the barriers as lack of discussion by health-care providers about contraceptives other than condoms, lack of acceptability of contraceptives due to misconceptions about and overestimation of their side effects, and lack of involvement of husbands in FP counseling, placing the burden for contraception on women. Similarly, in a study at Osogbo, Nigeria, the identified barriers were long waiting time at FP center, the attitude of health workers, and finance.
| Conclusion|| |
The study carried out in NTBLTC, Saye, to determine the usage contraception among HIV-positive male patients showed that the uptake of contraception was fair because the population of the respondents who have ever used contraception was not up to those who are currently using contraception and even less reported that their spouses have ever used contraception. Very few of the respondents were currently using vasectomy as most opted for a condom. Furthermore, some of the respondents are not using contraception because they think that it is not necessary since their spouse is also HIV positive. There was also a significant relationship between the level of education and marital status with current use of contraception. The assessment carried out reveled that marital status, seroconcordant couple, disapproval by religion, side effects of contraception and attitude of health workers were factors that affect uptake of contraception. Therefore, this study showed that there were low usage of contraception and poor acceptance of vasectomy.
Contraceptive methods should be made available and easily accessible at the center and also sexual and reproductive health facilities should be incorporated extensively into the services provided, and involvement of males in this process will increase the utilization of contraception significantly. The government should put in place adequate policies to encourage male involvement in the utilization of contraception as some respondents in the study thought that contraception is basically a problem the women who have to deal with it alone. The uptake of contraception and the type of contraceptive use are heavily influenced by the male/husband dominance in the society/family; therefore, there is a need to integrate and involve the male in the contraception policies.
The corresponding author wants to appreciate Engr. Oyegoke Toyese for his immense support in editing and proof-reading the manuscript meticulously and the Ministry of Education (Federal Government Scholarship Board) for their sponsorship and also to IFRA-Nigeria and French Embassy in Nigeria for the research grant award.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
UNAIDS. Global AIDS Update. Switzerland: UNAIDS; 2016.
Shehu A, Joshua I, Umar Z. Knowledge of contraception and contraceptive choices among human immunodeficiency virus-positive women attending antiretroviral clinics in Zaria, Nigeria. Sub Saharan African J Med 2016;3:84-90.
Nigeria Demographic and Health Survey, 2013. Abuja, Nigeria and Rockville. Maryland USA: NPC and ICF International; 2013.
Hancock NL, Chibwesha CJ, Bosomprah S, Newman J, Mubiana-Mbewe M, Sitali ES, et al
. Contraceptive use among HIV-infected women and men receiving antiretroviral therapy in Lusaka, Zambia: A cross-sectional survey. BMC Public Health 2016;16:392.
Wells E. Involving men in reproductive health. Outlook 1997;14:1-7.
Oyediran KA. Determinants of condom use among monogamous men in Ondo State, Nigeria. J Health Popul Nutr 2003;21:358-66.
Federal Ministry of Health of Nigeria – Department of Public Health. National Tuberculosis and Leprosy Control Program (NTBLCP) Workers' Manual. 5th
ed. Abuja: Federal Ministry of Health; 2010.
Oyediran KA, Ishola GP, Feyisetan BJ. Factors affecting ever-married men's contraceptive knowledge and use in Nigeria. J Biosoc Sci 2002;34:497-510.
Wekesa E, Coast E. Contraceptive need and use among individuals with HIV/AIDS living in the slums of Nairobi, Kenya. Int J Gynaecol Obstet 2015;130 Suppl 3:E31-6.
Mbizvo MT, Adamchak DJ. Family planning knowledge, attitudes, and practices of men in Zimbabwe. Stud Fam Plann 1991;22:31-8.
Wanyenze RK, Tumwesigye NM, Kindyomunda R, Beyeza-Kashesya J, Atuyambe L, Kansiime A, et al
. Uptake of family planning methods and unplanned pregnancies among HIV-infected individuals: A cross-sectional survey among clients at HIV clinics in Uganda. J Int AIDS Soc 2011;14:35.
Shahjahan M, Mumu SJ, Afroz A, Chowdhury HA, Kabir R, Ahmed K. Determinants of male participation in reproductive healthcare services: A cross-sectional study. Bio Med Cent 2013;10:27.
Chakrapani V, Kershaw T, Shunmugam M, Newman PA, Cornman DH, Dubrow R. Prevalence of and barriers to dual-contraceptive methods use among married men and women living with HIV in India. Infect Dis Obstet Gynecol 2011;2011:376432.
Duze MC, Mohammed IZ. Male knowledge, attitudes, and family planning practices in northern Nigeria. Afr J Reprod Health 2006;10:53-65.
Oni GA, McCarthy J. Family planning knowledge, attitudes and practices of males in Ilorin, Nigeria. Int Fam Plan Perspect 1991;17:50-64.
Adelekan A, Omoregie P, Elizabeth E. Male involvement in family planning: Challenges and way forward. Int J Popul Res 2003;9:1-16.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]