Prevalence and factors associated with modern and dual contraceptive use among women living with HIV in Cross River State, Nigeria: a cross-sectional study

Modern contraceptive use for unwanted pregnancy among women living with HIV (WLH) is crucial to family planning agenda and the global HIV prevention strategy. However, such studies are scarce in Nigeria. As such, we investigated the prevalence of, and factors associated with modern and dual contraceptive use among WLH in Cross River State – a state with a high HIV burden and highest unmet need for family planning in Nigeria. From June to August 2024, we conducted a cross-sectional study involving 931 WLH receiving ART in Cross River State, Nigeria. We purposively recruited WLH from four clinics with high patient volumes. We applied binary logistic regression to determine factors associated with modern and dual contraceptive usage at 95% confidence interval. The median age of WLH was 34 years (interquartile range [IQR]: 25–40), had disclosed their HIV status (94.7%) mostly to their mothers (50.1%), and had been on antiretroviral therapy for an average of 6 years (IQR: 3–10). Many initiated sexual intercourse before age 18 years (61.2%), and 38.1% used a condom at last sex. Modern and dual contraceptive use was 59.0% and 37.7%, respectively. WLH were more likely to use modern contraceptives if they had a current partner (AOR: 8.33, 95%CI: 2.08–33.33), had transactional sex in the past year (AOR: 4.41, 95%CI: 1.46–13.37), and did not have fertility desire (AOR: 3.37, 95%CI: 1.40–8.15). WLH were also more likely to utilize dual methods if they were currently in school (AOR: 13.12, 95%CI: 1.97–87.24), unemployed (AOR: 105.01, 95%CI: 11.45-963.17), earned at least ₦100,000 Naira [$67] (AOR: 9.45, 95%CI: 1.59–55.86), highly religious (AOR: 1.17, 95%CI: 1.01–1.36), had disclosed HIV status (AOR: 22.45, 95%CI: 1.92-263.23), and started menstruation at an earlier age (AOR: 0.66, 95%CI: 0.44–0.98). Many WLH were not using modern contraceptives, and even fewer were on dual contraceptives. This has implications for unwanted or unplanned pregnancies, heightened risk of unsafe abortion, mother-to-child HIV transmission, and risk of pregnancy complications. Healthcare providers must consistently emphasize the importance of contraceptive use for WLH, especially dual contraception, to prevent unplanned pregnancies and onward transmission of HIV to children and sexual partners.