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      Contraceptive need and use among individuals with HIV/AIDS living in the slums of Nairobi, Kenya

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          Abstract

          Objective

          To understand contraceptive need and use among individuals with HIV/AIDS living in slums.

          Methods

          A sequential mixed-methods study was conducted in two slums in Nairobi, Kenya, from November 6th, 2009 to April 18th, 2010. Data were obtained by quantitative survey (n = 513), qualitative in-depth interviews (n = 41), and key informant interviews (n = 14).

          Results

          In all, 250 (55.5%) participants used contraceptives. Condoms were the most frequently reported modern method (n = 142; 60.4%), followed by injectables (n = 55; 23.4%) and dual methods (n = 38; 15.3%). Unmet need was reported by 151 (33.6%) individuals. Factors associated with contraceptive use were education, marital status, number of living children, discussion of contraception with a provider, and social support. Personal, conceptual, and structural barriers to contraceptive use were identified.

          Conclusions

          Individuals with HIV/AIDS wished to limit their fertility but experienced high unmet need for contraception. Multi-level interventions, including educational campaigns and integration of HIV and family planning services, are required to overcome barriers.

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          Estimating wealth effects without expenditure data--or tears: an application to educational enrollments in states of India.

          Deon Filmer, Lant H. Pritchett (2001)
          Using data from India, we estimate the relationship between household wealth and children's school enrollment. We proxy wealth by constructing a linear index from asset ownership indicators, using principal-components analysis to derive weights. In Indian data this index is robust to the assets included, and produces internally coherent results. State-level results correspond well to independent data on per capita output and poverty. To validate the method and to show that the asset index predicts enrollments as accurately as expenditures, or more so, we use data sets from Indonesia, Pakistan, and Nepal that contain information on both expenditures and assets. The results show large, variable wealth gaps in children's enrollment across Indian states. On average a "rich" child is 31 percentage points more likely to be enrolled than a "poor" child, but this gap varies from only 4.6 percentage points in Kerala to 38.2 in Uttar Pradesh and 42.6 in Bihar.
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            Linking family planning with HIV/AIDS interventions: a systematic review of the evidence.

            Alicen Spaulding, Deborah Bain Brickley, Caitlin Kennedy … (2009)
            To conduct a systematic review of the literature and examine the effectiveness, optimal circumstances, and best practices for strengthening linkages between family planning and HIV interventions. Systematic review of peer-reviewed articles and unpublished program reports ('promising practices') evaluating interventions linking family planning and HIV services. Articles were included if they reported post-intervention evaluation results from an intervention linking family planning and HIV services between 1990 and 2007. Systematic methods were used for searching, screening, and data extraction. Quality assessment was conducted using a 9-point rigor scale. Sixteen studies were included in the analysis (10 peer-reviewed studies and six promising practices). Interventions were categorized into six types: family planning services provided to HIV voluntary counseling and testing (VCT) clients, family planning and VCT services provided to maternal and child health clients, family planning services provided to people living with HIV, community health workers provided family planning and HIV services, VCT provided to family planning clinic clients, and VCT and family planning services provided to women receiving postabortion care. Average study design rigor was low (3.25 out of 9). Most studies reported generally positive or mixed results for key outcomes; no negative results were reported. Interventions linking family planning and HIV services were generally considered feasible and effective, though overall evaluation rigor was low.
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              Overview of migration, poverty and health dynamics in Nairobi City's slum settlements

              Eliya M Zulu, Donatien Beguy, Alex C Ezeh … (2011)
              The Urbanization, Poverty, and Health Dynamics research program was designed to generate and provide the evidence base that would help governments, development partners, and other stakeholders understand how the urban slum context affects health outcomes in order to stimulate policy and action for uplifting the wellbeing of slum residents. The program was nested into the Nairobi Urban Health and Demographic Surveillance System, a uniquely rich longitudinal research platform, set up in Korogocho and Viwandani slum settlements in Nairobi city, Kenya. Findings provide rich insights on the context in which slum dwellers live and how poverty and migration status interacts with health issues over the life course. Contrary to popular opinions and beliefs that see slums as homogenous residential entities, the findings paint a picture of a highly dynamic and heterogeneous setting. While slum populations are highly mobile, about half of the population comprises relatively well doing long-term dwellers who have lived in slum settlements for over 10 years. The poor health outcomes that slum residents exhibit at all stages of the life course are rooted in three key characteristics of slum settlements: poor environmental conditions and infrastructure; limited access to services due to lack of income to pay for treatment and preventive services; and reliance on poor quality and mostly informal and unregulated health services that are not well suited to meeting the unique realities and health needs of slum dwellers. Consequently, policies and programs aimed at improving the wellbeing of slum dwellers should address comprehensively the underlying structural, economic, behavioral, and service-oriented barriers to good health and productive lives among slum residents.
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                Author and article information

                Journal
                Journal ID (nlm-journal-id): 0210174
                Journal ID (pubmed-jr-id): 3342
                Journal ID (nlm-ta): Int J Gynaecol Obstet
                Journal ID (iso-abbrev): Int J Gynaecol Obstet
                Title: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics
                ISSN (Print): 0020-7292
                ISSN (Electronic): 1879-3479
                Publication date Nihms-submitted: 24 August 2018
                Publication date (Electronic): 07 May 2015
                Publication date (Print): August 2015
                Publication date PMC-release: 26 April 2019
                Volume: 130
                Issue: Suppl 3
                Pages: E31-E36
                Affiliations
                [a ]Reproductive Health Program, Population Council, Nairobi, Kenya
                [b ]Department of Social Policy, London School of Economics, London, UK
                Author notes
                [* ]Corresponding author at: Reproductive Health Program, Population Council, General Accident House, Ralph Bunche Road, P.O. Box 17643–00500, Nairobi, Kenya. Tel.: +254 202713480 3; fax: +254 202713479. eliudwekesa@ 123456yahoo.co.uk (E. Wekesa).
                Article
                Manuscript ID: EMS79096
                DOI: 10.1016/j.ijgo.2015.05.001
                PMC ID: 6485368
                PubMed ID: 26165907
                SO-VID: 3cf986f4-9d0e-465a-81e5-250764abfac3
                License:

                This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/).

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                Categories
                Subject: Article

                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: contraception,family planning,hiv/aids,kenya slums,unmet need
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: contraception, family planning, hiv/aids, kenya slums, unmet need

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