Socio-demographic Characteristics of respondents
A total of 415 participants were included in the study making the response rate 100%. Of all respondents, 362(87.2%) were from urban. The age distribution of the respondents showed that, 152(36.6%) of the respondents were in the age group of 25-34 years. Three hundred eighty one (91.8%) of women were Orthodox in religion; while Muslim constituted 24(5.8%). Majority 404 (97.3%) of the study participants were Amhara in ethnicity. Education level of respondents showed that 140 (33.7%) had primary education. Regarding the marital status of the respondents, the majority 274(66.0%) of women were married whereas 69(16.6%), 53(12.5), and 19(4.6) were widowed, divorced and single respectively. One hundred seventy seven (42.7%) of the study participants were merchants while 144(34.7%), 71(7.5%) and 24(5.8%) were housewives, government employee and private employee respectively. Majority 319(76.9%) of the study participants had monthly income of less than 3000 birr (Table 1).
Knowledge about modern contraceptives
All (100%) of the study participant had ever heard about modern family planning. The most commonly mentioned sources of information were health professionals 188(45.3%), Television 147(35.4%), and Radio 129(31.0%), respectively (Figure: 1). All participants were heard injectables and pills. The other contraceptive methods heard were implant, condom and IUCD which accounts 91.3 %, 89.9% and 72.1% respectively (Figure:2).
Utilization of modern contraceptive methods
Three hundred eighty six (93%) of participants ever used modern contraceptive. Around 328(85.0%) of participants ever used contraception after being HIV positive. One hundred thirty seven (41.8%) of the women who participated in the study were currently using at least one method of modern contraceptive. Among the current contraceptive users (137), the most frequently used method of contraception was injectables (48.9%) followed by pills and condom only which accounts 24.1% and 11.7% respectively. The other least frequently used methods by women were dual contraceptive (8%), Implant (5.8%) and IUCD (1.5%) as a method of contraception. Out of the dual or condom only users 12(44.4%) reported consistent use of condom.
Majority of the respondent’s reasons for condom use were to prevent unwanted pregnancy 19(70.4%). The other reasons were health worker advice 7(25.9%), fear of other STI 4 (14.8%) and partner being HIV negative 3(11.1%). Women in the study who had heard of emergency contraception were found to be 275 (66.3%). Forty two (15.3%) of the women who have heard emergency contraception had ever used it. Among non users (233), only one in five women (19.9%) had a desire to use emergency contraceptives in the future. One hundred ninety one (58.2%) of women were not currently utilizing any modern contraceptive methods. Two third 94(66.6%) of women were not using modern contraceptives since they were not married or in a relationship. The other reasons were the need to get pregnant 87(45.5%), infertility 23(12%), partner disapproval 16(8.4%) and other reasons 7(3.7%). Out of non users, 58 (34.6%) of respondent had desire to use modern FP in the future (Table: 2).
Client/patient related characteristics of women living with HIV/AIDS
Four hundred four (97.3%) of respondents explained that their sero status did not affect their use of modern contraceptives. Half of the respondents 211(50.8%) had peer support to use modern contraceptives. Three hundred ninety eight (95.9%) of women participated in the study reported that their religion did not affect their use of modern contraceptives. Out of 211 women in the study who were discussed about modern contraceptive methods with their partners, 200(94.8%) were supported by their partner to use contraceptives (Table: 3).
Service delivery related factors
Out of the total respondents, 377 (90.8%) received counseling about modern FP in the ART unit. Two hundred eighty three (68.2%) of women reported that availability of ART & PMTCT service did not affect their pregnancy desires. Out of ever users (386) of modern contraceptive methods, 369(95.6%) had access to modern FP methods whenever they needed, 377 (97.7%) of women explained that the hospital met their need for modern FP and 267 (69.2%) of them explained that side effects of modern FP methods could not influence their choice of modern FP method (Table: 4).
Factors associated with utilization of modern contraceptives
The table (Table 5) illustrates the association between modern contraceptive use and selected variables in the study area. It shows that there is significant association (p-value<0.05) between the modern contraceptive use among women living with HIV/AIDS to their educational status (X2 =33.9, p-value=0.000), knowledge of modern contraceptive (X2=236, p-value=0.000), spouse approval of contraceptive use(X2 =58.3, p-value=0.000) and receive counseling about modern contraceptives(X2=184, p-value=0.000) (Table: 5).
The study tried to assess utilization of modern contraceptive utilization among women living with HIV/AIDS in Debre Tabor Referral Hospital. Modern contraceptive use was assessed; the study indicated that 93% of respondents ever used at least one modern contraceptive method. However, the utilization of modern contraceptive after they knew their HIV status and during the course of this study has dropped to 85% and 41.8% respectively. This finding is line with study done in Gimbi town, west Ethiopia (85.1%) ever modern contraceptives and (56.7%) currently using contraceptives (15).
In this study 130 (41.8%) of respondents were currently using modern contraceptive methods. The most frequent family planning methods used among HIV positive women were injectable and pills. This is comparable with the study done in Tigray, Ethiopia (46.3%) (16). This is lower than another studies done in, Gimbie town, West Ethiopia (56.7%), East Gojjam Zone, Ethiopia (53.6%) and Addis Ababa, Ethiopia (53.5%) (15,17,18).This variation could be because of difference in socio demographic characteristics including educational background , more than half of respondents in this study were achieved only primary school or below this and this possibly have effect on their awareness and utilization of contraceptives.
On the other hand, a study finding indicated that HIV-positive women currently using modern contraceptive in Soweto South Africa, (84%) and Mbarara, Uganda (85%) (19,20). These findings were higher than our study finding which may be due to socio-demographic difference, different health care system and treatment conditions under which the populations go through. Out of the dual or condom only users 44.4% of respondents were utilizing condom consistently, which is relatively lower than studies done in Lusaka, Zambia (73.5%), Tigray, Northern Ethiopia (70%) and Soweto, South Africa (64%) (16,19,21). The possible explanation for this discrepancy might be due to low prevalence of discordant rate and low educational status in this study. Modern FP methods other than condom use were very low, the result showed dual contraceptives (8%), implant (5.8%) and IUCD (1.5%), this is comparable with study from Tigray Ethiopia. The majority of the respondent reasons for condom use were to prevent unwanted pregnancy 19(70.4%) and health workers advice 7(25.9%), this is in line with study done in Lusaka Zambia (16).
Factor associated with utilization of modern contraceptive identified in this study was respondent’s educational status. Women’s’ educational status is statistically associated with their use modern FP methods. This finding was also in line with study done in Tigray Ethiopia, Lusaka Zambia, East Gojam zone, Ethiopia (16,18,21). On contrary study done in Addis Ababa, Ethiopia and Gimbi town, west Ethiopia result indicated that educational status had no effect on modern contraceptive use (15,17). Possible explanation for this finding is those women attending primary and above level of education had knowledge of modern contraceptive methods, (89.9%) and knowledge of risk of mother to child transmission of HIV/AIDS (96.6%) in this study. Women who had knowledge about contraceptives were more likely to use modern contraceptive, and also women who had spouse approval and who received counseling about modern contraceptives were more likely to use modern contraceptive. This finding was consistent with study from Gondar town, Northwest Ethiopia, and Makerere University Uganda irrespective of their HIV status (22,23).
In the chi square test of live children and peer support were found to be not significantly associated with the use of modern contraceptive. This finding is in line with study result done in Southwestern, Uganda, Gimbie town, West Ethiopia and Asella Hospital, Ethiopia (15,24,25). In this study even though 100% of study participant have ever heard about modern contraceptives, currently only 41.8% of them were using any of modern contraceptive, and the emergency contraception ever use was still low (46%).