Journal Article

Use of female-controlled dual protection methods among adolescent girls and young women living with HIV in Northern Uganda: A convergent mixed-methods study

Kabiri, Lydia, Kumakech, Edward, Benyumiza, Deo, Ogwal-Okeng, Jasper Watson, Inzama, Wilfred, Musinguzi, Marvin, Ebong, Doryn, Okello, James

2025

Overview

Adolescent girls and young women living with HIV (AGYWLHIV) in Uganda face dual risks of HIV transmission to male partners and unintended pregnancies. Male condoms require male partner cooperation. Female-controlled dual protection methods (FCDPM) offer a potential solution by enabling AGYWLHIV to independently manage their sexual and reproductive health. This study assessed the prevalence of dual protection methods (DPMs), identified factors influencing their use, and explored reasons for non-use among AGYWLHIV in northern Uganda. A parallel convergent mixed-methods study was conducted among the AGYWLHIV attending antiretroviral therapy services at six public health facilities in Lira City and Lira District between November 2022 and April 2023. Participants were asked about the methods they were using to simultaneously prevent unintended pregnancy and HIV transmission. If not using any dual protection method, why not? Quantitative data on DPM prevalence and associated factors were analysed using descriptive statistics and chi-square tests, while qualitative data on non-use reasons were thematically analysed. Among the 423 participants (median age 22 years), no one reported using the FCDPM, while only 1.2% used any form of DPM. Male condoms alone were used by 29.3% of the participants. The few who used the DPM combined the use of the male condoms with oral contraceptive pills, emergency contraceptive pills, IUD or implants. Factors positively influencing the DPM use included marital status, prior condom use, and knowledge of safer conception methods. Barriers included personal or partner disapproval of the modern contraceptives, lack of contraceptive knowledge or misconceptions, fear of contraceptive side effects or stigma, desire to conceive, and sole reliance on the male condoms. The findings highlight a critical gap in FCDPM uptake and the low prevalence of DPM use among AGYWLHIV. Strengthening health education on modern contraception, addressing misconceptions, and reducing fears about contraceptive side effects or stigma could improve DPM acceptance and uptake in this population.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adolescent / Adolescents / Adult / Antiretroviral agents / Antiretroviral drugs / Antiretroviral therapy / Biology and Life Sciences / Birth control / Chi-square test / Condoms / Condoms - statistics & numerical data / Contraception / Contraception - methods / Contraception Behavior - statistics & numerical data / Contraceptives / Cooperation / Cross-sectional studies / Demographic aspects / Disease prevention / Disease transmission / Education / Female / Females / Girls / Health aspects / Health care facilities / Health Knowledge, Attitudes, Practice / HIV / HIV infection / HIV Infections - epidemiology / HIV Infections - prevention & control / HIV Infections - transmission / Human immunodeficiency virus / Humans / Intrauterine devices / IUD / Knowledge management / Male / Medicine and Health Sciences / Methods / Oral contraceptives / Pregnancy / Pregnancy, Unplanned / Prevention / Public health / Qualitative analysis / Reproductive health / Risk factors / Safety and security measures / Sexual Behavior / Sexual health / Sexual intercourse / Sexual Partners / Sexually transmitted diseases / Side effects / Statistical tests / STD / Teenage girls / Teenagers / Uganda - epidemiology / Women / Womens health / Young Adult / Young women