Fishing villages on Lake Victoria in Uganda have an extremely high prevalence of HIV infection—about 41 percent, compared to around 13 percent for inland communities. It’s a problem that could be eased by combining HIV care with family- planning services to prevent mother-to-child transmission; one that calls for an understanding of the family planning needs there, according to research presented November 13 at the International Conference on Family Planning.
To investigate this issue, Fredrick Makumbi, PhD, MHS, director of the statistical department of the Johns Hopkins Bloomberg School of Public Health Rakai Health Sciences Program in Uganda, used data from an ongoing annual survey of more than 7,000 women of reproductive age living in lakeside communities, far inland, or in between. That study took a wide-ranging account of the women’s reproductive health and their family planning history, including whether they were pregnant, HIV-positive or negative, had ever used contraceptives, were interested in contraceptives but not using them, or had ever deliberately terminated a pregnancy.
The researchers found that pregnancy rates were about the same among HIV-negative women in all the communities, but pregnancy rates among HIV-positive women were slightly higher among women in the lakeside communities. Women at the lakeside communities were more likely than those inland to have reported deliberately attempting to terminate a pregnancy, and were significantly less likely to use modern family-planning methods, with the exception of male condoms. Even though condom use was higher at the lakeside communities than elsewhere, women there reported the highest unmet need for family planning, suggesting that condom use was more for preventing HIV than pregnancy.
If the family planning needs of the fishing villagers were met through better reproductive health services and other intervention strategies, this could help stem HIV infections.
“HIV and family planning services need to be provided jointly,” Makumbi says. “If you aren’t looking at modern family planning, you aren’t looking at mother-to-child transmission.” —Christen Brownlee