KENYA: Contraception concerns for HIV discordant couples

Photo: Edgar Mwakaba/IRIN
Discordant couples need advice on safe sex and family planning
NAIROBI, 13 January 2011 (PlusNews) - Cheating spouses have always caused problems for their marriages; in Kenya, a growing issue raised by extramarital sex is the phenomenon of HIV discordance - where one spouse is HIV-positive and the other negative.

Couples who find themselves in this situation need advice on safe sex and family planning options, but many HIV-discordant partners say these services are hard to access, leaving them without guidance.

Rispa Manyala and her husband Leonard have been living together for 10 years and have eight children between them. A year ago, during a routine antenatal visit, they found out that Rispa was HIV-positive but Leonard was not.

A nurse advised the couple to use a condom during every sexual encounter to avoid having more children or risk Leonard becoming infected, but they are finding it difficult.

Taking risks

"Condoms at times get finished - when you go to the dispensary you miss them," said Leonard. "At times we just have sex without a condom. I fear I might get infected or that we will get a child... but we can't help it.

"I am now even afraid to go for another HIV test because I feel I might already have it," he added.

Rispa would be interested in alternative methods of contraception, but has little knowledge and relies on friends for sometimes inaccurate information on the subject.

''When I go to the hospital, they [contraceptives] are not there and even the nurses do not give me enough information about them''
"I can't afford [the contraceptives] in the pharmacy and when I go to the hospital, they are not there and even the nurses do not give me enough information about them," she said. "I have heard from people that when you take contraceptives with ARVs, they react and make you even more sick."

A Kenyan study presented at the International AIDS Conference in Austria in 2010 found that contraceptive prevalence was low among Kenyan women - only about a quarter of HIV-positive and HIV-negative women surveyed used non-barrier contraceptive methods.

Two years into the study, through counselling and improving access, contraceptive use by HIV-positive women participating in the study increased to 38.6 percent.

Improved education, services

The authors noted that as contraception was one of the main pillars of prevention of mother-to-child HIV transmission, future programmes needed to focus on interventions to assist with fertility planning and increase contraception use among women in HIV-discordant relationships.

According to Chimaraoke Izugbara, a researcher at the Africa Population and Health Research Centre, there is a need to bolster family-planning education and increase the involvement of men in reproductive health, traditionally handled by women.

Read more
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 TB clinics boost HIV testing for couples
 Putting HIV-positive people at the centre of prevention
 Deadly consequences of inadequate HIV counselling
"The society is patriarchal and many men would not want to discuss issues like family planning with their wives and therefore they can't make the effort to even try to access these services," he told IRIN/PlusNews.

"Some even think if your partner takes ARVs then you are safe even if you have unprotected sex," he added. "There is a need to carry out education to create awareness and eradicate some of these myths."

Nicholas Muraguri, head of the Kenya National AIDS and Sexually transmitted infections Control Programme, says it is important to train health providers on the integration of family planning into health services offered to HIV discordant couples, and to counsel HIV-positive people on the need for openness with their partners.

"The government is expanding family planning services targeting discordant couples," he said. "At times the use of either condoms or contraceptives is inhibited by lack of disclosure among couples so it is not always a question of lack of these services. When couples know their status, it is easier to negotiate to either use condoms or other birth control methods."


Theme (s): Care/Treatment - PlusNews, Children, Gender Issues, HIV/AIDS (PlusNews), Prevention - PlusNews, PWAs/ASOs - PlusNews, Stigma/Human Rights/Law - PlusNews,

[This report does not necessarily reflect the views of the United Nations]

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