While doctors and HIV experts have been pleading with HIV positive partners to use a condom and other forms of contraceptives when having unprotected sex, the message seems not to be making major inroads.

Two recent studies done in the country indicate that HIV positive women are not using condoms or any other form of contraceptive when having sex either with their HIV positive or negative partners.

Study conducted at Kenyatta National Hospital’s (KNH) Comprehensive Care Centre and published in a recent East African Medical Journal shows that of the 94 HIV positive women who were interviewed, 55.8 percent were not using contraceptives.

And of the 44 percent who were using contraceptives, only 10.5 percent were on female condoms, with the majority (81.5 percent) turning to male condoms. Aggressive advertisement of males condoms compared to other contraceptives is blamed for this high preference.

Similarly, the use of long-term contraceptives methods was low among many women, says the study, Contraceptive Use Among HIV Infected Women Attending Comprehensive Care Centre. Norplant was the only long-term method used by about 3 percent of the women.

More worrying was about 60 percent of the women interviewed said they had regular sexual partners, which exposed them to unplanned pregnancies.

“These women are at risk of conception unless they are on effective contraception while their sexual partners are at high risk of HIV acquisition,” say the authors of the KNH study.

The findings of the 2008 Kenya AIDS Indicator Survey (KAIS) released recently sent a similar warning that HIV positive women and men are not using condoms, even after being counseled and encouraged to do so.  

This practice is now being blamed not only for rising HIV prevalence, but also for increasing in the number of children born with HIV, a development likely to strain further resources required to manage these children and their parents.

HIV experts have been pushing for use of contraceptives in scenarios where both partners are HIV positive or where they are discordant – one HIV positive and the other HIV negative- for two main reasons. One is to help the infected person to avoid re-infections or infecting other negative partners.

The other is to prevent pregnancy, especially in cases where the woman or the partners do not have access to interventions or lack the financial means to help them get the best technologies known to significantly reduce the chances of the mother passing the virus to the baby.

While this is the scenario, the choice to or not use contraceptives has been defined again by two other factors. The inability of HIV positive women and their partners to access condoms or other forms of family planning is one of them.

The KAIS study found nearly 50 per cent of all infected females have unmet need for family planning, while the unmet need among the KNH participants was 30 percent.

Only 24 per cent of infected women in the KAIS study were using modern contraceptives.

Yet, majority of them, 72 percent in the KAIS study and 86 percent in the KNH study, did not want to have children in the next two years. According to the KNH study, of 91.5 percent of the women who were not intending to have a child in the next two years, only 44 percent had access to contraceptives.

Getting the contraceptives in the public sectors, where they are provided for free or at heavily subsidized prices, is erratic, forcing women to seek them in the private sector where the supply is predicable and consistent.

The only problem is those women who cannot afford the contraceptives in the private sector have to content with consequences of unprotected sex. Likewise, KNH researchers warn that accessing contraceptives in the private sector has two drawbacks.

Women may get contraceptives from service providers who do not understand critical issues regarding contraception in HIV positive women or the women may not reveal their HIV status to these providers.

This is critical because World Health Organization recommends that HIV infected women use all methods of contraception, except intrauterine device (IUD), which is known to increase the risk of uterine infections among women who have progressed to AIDS and are not treatment. Otherwise, women responding well on ARVs can use the method, says WHO.

Besides the difficulties in accessing contraceptives, there those HIV positive women who are refusing to use family planning methods because they want to have babies regardless of their status.

Majority of these women are said to insist on having babies even against doctor’s advice. The 2008 KAIS study shows that 28 percent of the HIV positive women desire more children in the next two years.

Statistics coming from antenatal clinics confirm that this trend is real. Data released by KAIS show HIV prevalence among pregnant women attending antenatal clinics to have increased from 7.3 percent recorded in the 2003 Kenya Demographic and Health Survey (KDHS) to 9.6 percent by 2007.

When participants in the KAIS study were interviewed, less than 50 percent of the HIV infected sexually active men said they were using condoms during sexual intercourse.

Health experts believe that since a lot of the women know of the existence of drugs and other technologies which can significantly reduce their chances of passing the virus to the baby, the need to conceive is irresistible.

These women like Joyce Ademba believe they have a right to have children, and doctors should not advice them otherwise.

“With the presence of drugs and technologies to help one deliver an HIV negative baby, why can I not have a baby,” she poses.

The only challenge is the majority of the women like Ademba who need these services may not access them as they are mainly localized in urban centres and in some cases very expensive.

Without access to these services, then the plausible outcome is an increase in the number of HIV positive children, who will require extra funds to manage.

In view of this worrying state of affairs, researchers behind the KNH study want the government, NGOs, and donors to promote long-term family planning methods countrywide, particularly among HIV positive women who do not desire to have more children.

They further propose for dual protection – use of a condom to protect against sexually transmitted infections and a long-term contraception to prevent pregnancy- among HIV positive couples.

Meanwhile, UNAIDS report shows Kenya to be one of the over 20 African countries with less than 50 percent antiretroviral coverage for children with advanced HIV. This means Kenyan children who are HIV positive have very slim chances of survival if nothings is done to increase their access to these life-prolonging drugs.

Critics say one of the biggest undoing for the country is a lot of focus is placed on adults, with children remaining at the bottom of the treatment agenda.

The other issue is lack of enough health experts, particularly in the rural areas who have experience and confidence to administer antiretroviral drugs to children as well as monitor how they are doing.

The good news however is Kenya is rated among five African countries- Namibia, Rwanda, South Africa, and Swaziland – who have between 50 percent and 75 percent antiretroviral drugs for prevention of mother to child transmission (PMTC) of HIV, according to the UNAIDS 2008 Report on the Global AIDS Epidemic.  

As yet, Botswana is the only African country with PMTC coverage of over 75 percent, the best performer in Africa.