Contraceptive Service Uptake and Delivery Preferences in Perinatally and Horizontally Infected Female Adolescents Living with HIV: Results from a South Africa-Based Mixed-Methods Study'

  • Biodun Olagbuji
    Address correspondence to: Biodun Nelson Olagbuji, Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, Ekiti State University, Nigeria
    Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
    Search for articles by this author
  • Diane Cooper
    Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

    School of Public Health, University of the Western Cape, South Africa
    Search for articles by this author
  • Catherine Mathews
    Health Systems Research Unit, South Africa Medical Research Council, South Africa
    Search for articles by this author
  • Jennifer Moodley
    Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
    Search for articles by this author

      Study Objective

      To investigate whether contraceptive service uptake (including current contraceptive use), unmet need for contraception, unintended pregnancy, preferences for service provision, and providers among female adolescents living with HIV (ALHIV) vary with HIV-acquisition route, that is, perinatal HIV acquisition vs horizontal HIV acquisition.


      Mixed methods including exit and in-depth interviews


      Multicenter, public sector primary health care facilities, Cape Town, South Africa


      Sexually experienced female ALHIV aged 14-19 years (n = 303) including both peri/postnatally infected ALHIV (pALHIV) and horizontally infected ALHIV (hALHIV) and health care providers involved in HIV care and treatment services (n = 19)

      Main Outcome Measures

      Current contraceptive use, unintended pregnancy, and preferences for service provision and providers


      The association between HIV-acquisition route and current use of any contraceptive method (aOR = 1.23; 95% CI, 0.52-2.92) and unintended pregnancy (aOR = 1.02; 95% CI, 0.39-2.67) was not significant. In contrast, pALHIV had significantly decreased odds of receiving dual-method contraception (aOR = 0.02; 95% CI, 0.00-0.38) and significantly increased odds of preferences for younger providers (aOR = 4.45; 95% CI, 2.84-6.97), female providers (aOR = 5.11; 95% CI, 1.25-20.91), and standalone youth clinics (aOR = 7.01; 95% CI, 2.39-20.55) compared with female hALHIV. Qualitative findings indicate that provider positive attitudes, as opposed to judgmental attitudes, encourage pALHIV acceptance of care from any provider regardless of, for example, the provider's age.


      Current contraceptive use and unintended pregnancies were similar between pALHIV and hALHIV, but the 2 distinct groups of ALHIV were heterogeneous in terms of dual-method contraception and preferences for type of clinic model and providers. Promoting positive provider attitudes could improve ALHIV's contraceptive uptake.

      Key Words

      The list of abbreviations:

      ALHIV (adolescents living with HIV), aOR (adjusted odds ratio), HIV (human immunodeficiency virus), hALHIV (adolescents who acquired HIV via a horizontal transmission), pALHIV (adolescents who acquired HIV via a perinatal transmission), PHC (primary health care clinic), TX (Texas), UNAIDS (Joint United Nations Programme on HIV/AIDS), SRH (sexual and reproductive health), STATA (Software for Statistics and Data Science)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric and Adolescent Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • UN Joint Programme on HIV/AIDS (UNAIDS)
        UNAIDS Estimates.
        • UN Joint Programme on HIV/AIDS (UNAIDS)
        UNAIDS Estimates. 2018. UN Joint Programme On HIV/AIDS (UNAIDS).
        • Slogrove AL
        • Sohn A.H.:
        The global epidemiology of adolescents living with HIV: time for more granular data to improve adolescent health outcomes.
        Curr Opin HIV AIDS. 2018; 13: 170-178
        • Carter MW
        • Kraft JM
        • Hatfield-Timajchy K
        • et al.
        The reproductive health behaviors of HIV-infected young women in the United States: a literature review.
        AIDS Patient Care STDs. 2013; 27: 669-680
      1. Adolescent Friendly Health Services for Adolescents Living With HIV: From Theory to Practice.
        World Health Organization, Technical Brief. Geneva, Switzerland2019 (WHO/CDS/HIV/19.39). Licence: CC BY-NC-SA 3.0 IGO
      2. UNICEF: HIV treatment, care, and support for adolescents living with HIV in Eastern and Southern Africa.
        A review of interventions for scale. 2021;
        • Koenig LJ
        • Pals SL
        • Chandwani S
        • et al.
        Sexual transmission risk behavior of adolescents with HIV acquired perinatally or through risky behaviors.
        J Acquir Immune Defic Syndr. 2010; 55: 380-390
        • Atrio J
        • Graham K
        • Vora H
        • et al.
        Contraceptive use in adolescents with perinatally and behaviourally acquired human immunodeficiencyvirus infection seen in a public Los Angeles County Clinic.
        J AIDS Clin Res. 2013; 4: 244
        • Poudel AN
        • Newlands D
        • Simkhada P:
        Issues and problems in conducting sensitive research: a case of HIV/AIDS in Nepal.
        Health Prospect. 2016; 15: 5-10
        • Department of Health
        South Africa Demographic and Health Survey 2003.
        PretoriaDepartment of Health,, Republic of South Africa,2007
        • Shisana O
        • Rehle T
        • Simbayi LC
        • et al.
        South African National HIV Prevalence Incidence and Communication Survey 2008: A Turning Tide Among Teenagers?.
        Human Sciences Research Council (HSRC) Press,, Cape Town2009
        • Chesney MA
        • Ickovics JR
        • Chambers DB
        • et al.
        Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. Patient Care Committee & Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical Trials Group (AACTG).
        AIDS Care. 2000; 12: 255-266
        • Levinson RA:
        Contraceptive self-efficacy: a perspective on teenage girls' contraceptive behavior.
        J Sex Res. 1986; 22: 347-369
        • Olagbuji B
        • Cooper D
        • Mathews C
        • et al.
        Adolescents living with HIV: contraceptive services and uptake in general primary healthcare clinics and stand-alone youth clinics.
        J Pediatr Adolesc Gynecol. 2021; (S1083-3188(21)00190-X)
        • Bradley SE
        • Croft TN
        • Fishel JD
        • et al.
        Revising unmet need for family planning.
        DHS Analytical Studies. 2012; (25)
        • Westoff C:
        New Estimates of Unmet Need and the Demand for Family Planning.
        Macro International Inc,, Calverton, Maryland2006 (DHS Comparative Reports No.14)
        • Braun V
        • Clarke V
        Using thematic analysis in psychology.
        Qual Res Psychol. 2006; 3: 77-101
        • Birungi H
        • Obare F
        • van der Kwaak A
        • et al.
        Maternal health care utilization among HIV-positive female adolescents in Kenya.
        Int Perspect Sex Reprod Health. 2011; 37: 143-149
        • Elgalib A
        • Hegazi A
        • Samarawickrama A
        • et al.
        Pregnancy in HIV-infected teenagers in London.
        HIV Med. 2011; 12: 118-123
        • Kenny J
        • Williams B
        • Prime K
        • et al.
        Pregnancy outcomes in adolescents in the UK and Ireland growing up with HIV.
        HIV Med. 2012; 13: 304-308
        • Koenig LJ
        • Espinoza L
        • Hodge K
        • et al.
        Young, seropositive, and pregnant: epidemiologic and psychosocial perspectives on pregnant adolescents with human immunodeficiency virus infection.
        Am J Obstet Gynecol. 2007; 197 (S123-S131)
      3. Obare F, van der Kwaak A, Adieri B, et al: HIV-positive adolescents in Kenya: access to sexual and reproductive health services. 2010.

        • Obare F
        • van der Kwaak A
        • Birungi H:
        Factors associated with unintended pregnancy, poor birth outcomes and post-partum contraceptive use among HIV-positive female adolescents in Kenya.
        BMC Womens Health. 2012; 12: 34
        • Matthews LT
        • Milford C
        • Kaida A
        • et al.
        Lost opportunities to reduce periconception HIV transmission.
        J Acquir Immune Defic Syndr. 2014; 67: S210-S217
        • Landolt NK
        • Phanuphak N
        • Pinyakorn S
        • et al.
        Sexual life, options for contraception and intention for conception in HIV-positive people on successful antiretroviral therapy in Thailand.
        AIDS Care. 2012; 24: 897-904
        • Mbalinda SC
        • Kaye DK
        • Nyasharu M
        • et al.
        Using Andersen's behavioral model of health care utilization to assess contraceptive use among sexually active perinatally hiv-infected adolescents in Uganda.
        Int J Reprod Med. 2020; 20208016483
        • Koenig LJ
        • Nesheim S
        • Abramowitz S:
        Adolescents with perinatally acquired HIV: emerging behavioral and health needs for long-term survivors.
        Curr Opin Obstet Gynecol. 2011; 23: 321-327