Postnatal contraceptive choices among women living with HIV: a decade of experience in a community-based integrated sexual health clinic.

BACKGROUND Establishing effective postnatal contraception is essential for HIV-seropositive women to avoid the risk of unwanted pregnancy and minimise HIV transmission to HIV-seronegative partners. The authors describe their experience of providing postnatal contraception to HIV-seropositive women who attend a community-based integrated sexual health clinic. METHODS The authors performed a retrospective case note review of all women who received care for HIV in pregnancy to term at their clinic from September 2000 to October 2010. RESULTS A total of 107 pregnancies among 95 women were eligible for review. Attendance for contraceptive advice within 4 weeks of delivery occurred in 82/107 (77%) pregnancies. Depo-Provera® was prescribed in 21 (21/82, 26%) cases; an intrauterine contraceptive was arranged in 22/82 (27%) cases and sterilisation had occurred as part of a Caesarean delivery in 10/82 (12%) cases. In seven women who discontinued antiretroviral therapy at delivery one subdermal implant was fitted and the combined contraceptive pill was prescribed six times. In 17/82 (21%) cases women opted to use condoms alone. Attendance for postpartum contraceptive advice was missed following 21/107 (20%) pregnancies. CONCLUSIONS Uptake of a second contraceptive method in addition to condoms is high among women who attend clinic for contraceptive advice in the immediate postnatal period. However, 20% of women did not attend and their contraceptive choices remain unknown. These women are at risk of unwanted pregnancy and transmission of HIV to seronegative partners if appropriate contraceptive methods are not re-established postpartum.