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Resumption of Sexual Intercourse Among Postnatal Women Enrolled on Lifelong Antiretroviral Therapy in Uganda

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Abstract

The postnatal period is critical to the delivery of interventions aimed at improving maternal health outcomes. This study examined the timing to resumption of sexual intercourse and associated factors among postnatal women living with HIV (WLWH) in Uganda. A sample of 385 women was drawn from a larger prospective cohort study conducted between 2013 and 2015. We used survival analysis to estimate the postpartum time periods during which women had a higher risk of sexual intercourse resumption within 6 months after childbirth. Cox proportional hazards regression was used to examine associated factors with sexual intercourse resumption. The cumulative probability of sexual intercourse resumption was lowest (6.2%) in the sub-acute postpartum period (1–45 days since delivery) and highest (88.2%) in the delayed postpartum period (151–183 days since delivery). Having a live-term baby (adjusted HR 0.52, 95% CI 0.31–0.85, p = 0.01) and an advanced education (adjusted HR 0.63, 95% CI 0.40–0.98, p = 0.04) were associated with a lower risk of sexual intercourse resumption. Desire for another child (adjusted HR 1.36, 95% CI 1.08–1.73, p = 0.01), having a sexual partner (adjusted HR 5.97, 95% CI 3.10–11.47, p < 0.001) and contraceptive use (adjusted HR 2.21, 95% CI 1.65–2.95, p < 0.001) were associated with a greater risk of sexual intercourse resumption. However, only 1 in 4 women who resumed sexual intercourse by the 90th day after childbirth, reported currently using contraception. HIV programs should focus on supporting postnatal women to align the timing of sexual intercourse resumption with their return to contraceptive use. Interventions aimed at improving contraceptive uptake among postnatal WLWH should target the delayed postpartum period.

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Data Availability

The datasets analyzed for this study are available from the corresponding author if requested.

Abbreviations

GF:

Global Fund

MoH:

Ministry of Health

WHO:

World Health Organization

SDG:

Sustainable Development Goal

HIV:

Human Immunodeficiency Virus

ART:

Antiretroviral therapy

WLWH:

Women living with HIV

PMTCT:

Prevention of mother-to-child-transmission of HIV

MTCT:

Mother-to-child transmission

HR:

Hazard ratio

ANC:

Antenatal care

PNC:

Postnatal care

FP:

Family planning

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Acknowledgements

This research was supported by Global Fund Grant Number: UGD-708-G07-H. RKW received the award through the Ugandan Ministry of Health who supported and provided oversight for study implementation. We acknowledge the contribution of our study interviewers (Madinah Naiga, Susan Ssesanga, Fausta Nabateesa) and study participants. We also thank the management of the respective health facilities where the study was conducted.

Funding

This study was funded by Global Fund through the Ugandan Ministry of Health under Grant Number: UGD-708-G07-H. The content is solely the responsibility of the authors and does not necessarily represent the official views of Global Fund.

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda

    Rose Naigino

  2. Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda

    Fredrick Makumbi & Aggrey Mukose

  3. Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda

    Esther Buregyeya

  4. Ministry of Health, Kampala, Uganda

    Jim Arinaitwe & Joshua Musinguzi

  5. Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, CA, USA

    Susan M. Kiene

  6. Makerere University School of Public Health, Kampala, Uganda

    Rhoda K. Wanyenze

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  1. Rose Naigino
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  2. Fredrick Makumbi
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  3. Aggrey Mukose
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  4. Esther Buregyeya
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Contributions

All authors supervised data collection including recruitment and follow up of study participants. RN conceptualized the research question and wrote the first draft of the paper. FM led the analysis and interpretation of data. AM and EB revised the draft manuscript to strengthen its intellectual content. RKW conceived and led the design of the larger study protocol, reviewed and revised the paper for substantial intellectual content. SK contributed to revising the manuscript and helped to strengthen the global health component of the manuscript. JA and JM provided technical oversight and supervision of study implementation activities on behalf of the Ugandan Ministry of Health. All authors reviewed and approved the final version of the manuscript.

Corresponding author

Correspondence to Rose Naigino.

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Conflict of interest

The authors have no competing interests to declare.

Ethical Approval

Ethical approval was obtained from Makerere University School of Public Health Higher Degrees Research and Ethics Committee (Protocol number 064) and the Uganda National Council for Science and Technology (Registration number SS3153).

Informed Consent

Potentially eligible study participants were read an informed consent form and asked if they were willing to participate in the study. Consenting participants signed two copies of a written informed consent form and retained a copy for their future reference.

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Naigino, R., Makumbi, F., Mukose, A. et al. Resumption of Sexual Intercourse Among Postnatal Women Enrolled on Lifelong Antiretroviral Therapy in Uganda. AIDS Behav 26, 1684–1694 (2022). https://doi.org/10.1007/s10461-021-03520-5

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