Knowledge, Attitudes, and Experiences with Contraception Among Young Women Living with HIV in Moshi, Tanzania

Abstract

Gendered differences in HIV infection disproportionately impact adolescent girls and young women (AGYW), where adolescent girls are about six times more likely to become infected with HIV than adolescent boys in sub-Saharan Africa, and young people living with HIV are more likely to have adverse HIV and mental health outcomes compared to older individuals living with HIV. Furthermore, about half of adolescent pregnancies annually are unintended, and adolescent pregnancies are often rooted in similar structural causes of HIV, resulting in adverse health outcomes for AGYW and exacerbating adverse HIV-related health outcomes. To understand how to best support AGYW living with HIV (LWH) in fulfilling their intended goals, the aim of this study was to examine family planning knowledge, preference, and barriers and facilitators to obtaining preferred contraception among young women living with HIV (YWLWH) in the Kilimanjaro and Arusha Regions of Tanzania. Qualitative interviews, a focus group discussion, and a list ranking activity were conducted among 16 YWLWH. Individuals were purposely sampled into two groups: those who had a pregnancy experience (PE, n = 13) and those with no pregnancy experiences (NPE, n = 3) to compare the knowledge about, attitudes and norms around, perceptions of, preferences for, and experiences with family planning to better understand barriers and facilitators to engagement with desired family planning services. Analysis included inductive and deductive coding and memo writing. Seven of 13 participants experienced an unplanned first pregnancy, and male condoms (8/16) and the calendar method (7/16) were the most common contraceptives ever used by participants. No participants used a hormonal contraceptive method prior to their first pregnancy. Attitudes and perceived social norms around individuals who are perceived as appropriate users of family planning services, perceived side effects of contraceptives, along with an expressed lack of knowledge about contraceptives emerged as the most prevalent barriers to engagement with family planning services. Known and perceived benefits of contraceptive were the most salient facilitators of family planning engagement. The most prevalent barriers to desired engagement with family planning services could be addressed through education, a desire resoundingly expressed by participants. Possible avenues to increase potential impact of delivered educational interventions include leveraging close relationships and social networks to normalize adolescent engagement with clinical family planning services and deliver evidence-based education about contraception.