Although global community is working to end HIV/AIDS epidemic by 2030, it remains a major global epidemic in post millennium development era. It remains the leading cause of morbidity and mortality throughout the world. Since the start of the epidemic, around 76.1 million peoples infected and 35 million people died from AIDS (Acquired Immunodeficiency Syndrome) related illness[1]. Globally in 2017, there were 36.9 million people living with HIV; 18.2 million women of reproductive age group and 1.8 million were children under 15 years old. There were also a total of 1.8 million new infection and 940,000 AIDS related death in the same year. [2].
Eastern and southern Africa including Ethiopia remains the region most affected by the HIV epidemic, accounting for 45% of the world’s HIV infection and 53% of people living HIV globally. Adolescent girls and young women continue to face disproportionately high risk of HIV in the region[2].Sub-Saharan Africa (SSA) contributed 76% of total of HIV-infected people,76% of a total of new HIV infection and 75% of a total of HIV/AIDS related deaths in 2015[3].
As one of the sub-Saharan country, the scenario in Ethiopia is similar. In Ethiopia, the HIV epidemic has remained a major public health problem, largely affecting women of reproductive age group[4]. At the end of 2017, there were an estimated total 722,248 people infected with HIV, 22,827 new HIV infection and 14,872 annual AIDS related deaths. In the same year, an estimated HIV prevalence in the general population was at 1.5 percent[5].
The epidemic is well established in the urban areas of the country .According to Ethiopian population-based HIV impact assessment (EPHIA2017-2018), the annual incidence of HIV among adult age groups (15–64) years in urban Ethiopia is 0.06%. Prevalence of HIV among adult age 15–64 years in urban Ethiopia is 3.0%; 4.1% among women and 1.9% among men. Prevalence of HIV among children ages 0–14 years in urban Ethiopia is 0.3%, the same among both sexes. Viral load suppression among HIV-positive adults ages 15–64 years in urban Ethiopia is 70.1%: 71.7% among women and 66.8% among men[6].
Voluntary family planning a key intervention for health and development by enabling women and couples to decide number, timing and spacing of births. Sexually active women can do this by using different contraceptive methods. Reducing maternal mortality, child mortality, abortion and transmission of HIV from mother to child are some of the health benefits of family [7, 8]. Universal access for family planning and reproductive health is not the only path to sustainable development, but without addressing these issues achievement of other sustainable goals will be challenging [7].
Contraceptive is a cost-effective intervention for preventing mother to child HIV transmission [7]. The United Nations PMTCT strategy outlines four approaches necessary to cut mother-to-child transmission. Preventing unintended pregnancy in HIV infected woman is one of the recommended PMTCT strategy[9]. Study from U.S.-based Johns Hopkins University and the World Health Organization have found that only moderate reductions in unintended pregnancy rates among HIV-infected women would cut rates of HIV-positive births [9].
Ethiopia is the most populous country next to Nigeria with an estimated population of more than 100 million[4]. It has one of the highest fertility rate in Africa, with 45% of its population under-15 years old. Ethiopia’s strong investment in health sector have contributed to a significant progress over the last 10 years in increasing contraceptive use and reducing fertility rates. However, fertility and population growth rates remains high, at 4.1 and 2.6 percent [10].
Ethiopian health sector transformation plan has planned to increase proportion of contraceptive use from 42–55%, to decrease total fertility rate from 4 to 3 percent, unmet need for family planning from 24–10% and adolescent age pregnancy rate from 12–3% [11].However, the 2016 Ethiopian Demographics and Health Survey estimated only 36% of married women were using any of contraception which is lower than the HSPD II target [12].
Preventing unintended pregnancy among sexually active HIV positive women is cost effective approach to primary prevention of mother to child transmission of HIV. It is also a global public health priority for addressing the distracted state of maternal and child health in high HIV endemic areas like Ethiopia[13]. Every year, Meeting all unmet needs for modern contraceptive methods could avert 52 million untended pregnancies in developing region [14].
Meeting the family planning goals of women living with HIV through proper counseling and contraceptives services could optimize health outcomes for women, cut the potential HIV transmission to their children and help achieve an HIV free generation by 2020 [15, 16].Therefore, the aim of this study was to assess contraceptive use and associated factors among sexually active HIV positive women at ART clinic in Felege Hiwot Referral Hospital, Northwest Ethiopia, 2018.