1 / 20

The Need for Greater Emphasis on Married or Cohabiting Couples in Southern and East Africa

The Need for Greater Emphasis on Married or Cohabiting Couples in Southern and East Africa. John Cleland. Scope of the Presentation. Why the need for this greater emphasis? Is greater uptake of condoms by married couples feasible?

tanner
Download Presentation

The Need for Greater Emphasis on Married or Cohabiting Couples in Southern and East Africa

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The Need for Greater Emphasis on Married or Cohabiting Couples in Southern and East Africa John Cleland

  2. Scope of the Presentation • Why the need for this greater emphasis? • Is greater uptake of condoms by married couples feasible? • Is double-method protection or dual protection by condoms alone more likely? • What might be reproductive consequences of massive switching from hormonal methods to condoms?

  3. Sources • Ali, Cleland, Shah. Bulletin of World Health Organization 82(3):1-7. • Pullum, Cleland, Shah. Paper presented at annual meeting of Population Association of America, Boston 2004. • Maharaj and Cleland. Studies in Family Planning (in press June 2004) + work in progress. • Foss, Watts, Vickerman, Kumaranayake – paper on condom use, available from Charlotte.Watts@lshtm.ac.uk • Ali and Cleland. Presentation at International Conference, Mumbai, December 2003.

  4. Why the Need for Greater Emphasis • In mature generalised epidemics, about 50% of HIV infections may occur to married/cohabiting individuals, because of infidelity/spousal infection. (Less true in late-marriage societies, such as South Africa, Botswana) • Similarly, 5%-20% of couples are HIV-Discordant. • Advent of ARVs and greater uptake of VCT will vastly increase demand for protection among couples • While some positive evidence for increased uptake of condoms by sexually active single, little evidence to date of similar trends among married/cohabiting. • HIV-prevention campaigns by reinforcing association between condoms & illicit sex may have stiffened resistance to marital use

  5. Women of reproductive age in Sub-Saharan Africa: reported condom use in last sex act* *of women reporting such sex with specific partners in last 12 months Source: Macro International behavioural surveillance surveys and demographic health surveys; Measure Evaluation 1997-2002.

  6. Men of reproductive age in Sub-Saharan Africa: reported condom use in last sex act* *of men reporting such sex with specific partners in last 12 months Source: Macro International behavioural surveillance surveys and demographic health surveys; Measure Evaluation 1997-2002.

  7. Percentage of married contraceptive users relying on condoms, by stage of HIV epidemic Source: United Nations

  8. Is condom use within marriage a realistic proposition: results from WHO multi-site study (married or cohabiting women)

  9. Profile of Condom Use and Related Attitudinal Factors in Three Strata (South Africa)

  10. Profile of Condom Use and Related Attitudinal Factors in Three Strata (South Africa)Cont’d *Strata difference significant at 95% confidence level

  11. Predictors of Condom Use Reported by Wives (South Africa) Also in the model: marital status, length of relationship: fertility intentions Significant effects in red

  12. Dual-protection from condoms or double-method protection?

  13. Estimating the Reproductive Consequences of Massive Switching from High Effective Contraceptive methods to Condoms Use DHS contraceptive calendar data for 16 high use countries, linked to data on intendedness of recent births. Compare failure/discontinuation rates for pill and condom Assess consequences/sequelae of failure/discontinuation in terms of switching to another method, abortion, birth of unwanted/mistimed child. Using pooled data for all 16 countries, reverse the number of condom episodes (n=4786) and number of pill episodes (n=20875) Evaluate the expected numbers of unwanted births etc under this counterfactual reversal and compare with observed (real life) numbers

  14. Observed and hypothetical numbers of unwanted births

  15. Conclusions • The HIV-prevention needs of the married have been neglected • These needs will increase as HIV-epidemics mature and as uptake of VCT increases • The barriers to condom use within marriage are not as immutable as often assumed (though consistent use is elusive) • Women may have much more influence on condom use than often assumed • In higher contraceptive use countries, double-method protection appears more common than condom use alone • The desire to avoid pregnancy appears to reduce the chances of double-method protection. • Massive switching from hormonal FP methods to condom would have surprisingly little effect on incidence of unwanted pregnancies/abortions

More Related