Contraceptive utilization among hiv-positive women aged 15-49 years accessing art services at Kotor PHCC in Juba City Council, South Sudan

Abstract

Women of reproductive age living with HIV face a dual challenge of unintended pregnancies and the risk of mother-to-child transmission (MTCT). Family planning (FP) is critical for addressing these risks, yet contraceptive use in South Sudan remains among the lowest globally. Understanding utilization and the barriers HIV-positive women face is vital for designing effective interventions. This study assessed contraceptive utilization among HIV-positive women aged 15–49 years accessing ART services at Kotor Primary Health Care Centre (PHCC) in Juba City Council. Specifically, it determined the prevalence of modern contraceptive use, identified associated factors, and explored women’s perceptions and experiences regarding FP. A sequential explanatory mixed-methods design was used. Quantitative data were collected from 439 HIV-positive women through structured questionnaires, whereas qualitative data were obtained from key informant interviews to explore socio-cultural and systemic factors influencing contraceptive decisions. Data were analyzed using multivariable logistic regression and thematic analysis, guided by the Health Belief Model. Of the 439 participants,75.2% (95% CI: 70.9% -78.9%) reported using modern contraceptive methods, with condom being the most commonly used method. The results indicated that the following groups of women were more likely to utilize modern contraceptive methods; women with multiple sexual partners (adj. PR= 1.45, 95%CI: 1.00-2.10, p=0.048), and history of abortion (adj. PR=1.16, 95%CI: 1.01-1.33, p=0.035). Whereas women aged 45 years and above (adj. PR=0.27, 95%CI:0.07-1.00, p=0.050), those who rarely engage in sexual activity (adj. PR= 0.68, 95%CI: 0.51-0.90, p=0.006), with increasing age at menstruation (adj. PR= 0.93, 95%CI: 0.88-0.99, p=0.016) were less likely to utilize modern contraceptive methods. Qualitative findings revealed barriers such as stigma, cultural and religious opposition, stockouts, limited provider training, and myths around infertility and Antiretro Viral Therapy contraceptive interactions. Despite these barriers, provider counseling and partner support emerged as important facilitators of uptake. Contraceptive use among HIV-positive women in Juba is high and is shaped by a complex interplay of individual, socio-economic, cultural, and health system factors. While knowledge and empowerment predict use, stigma, misconceptions, and weak service delivery continue to hinder uptake. Integrating family planning within HIV care, addressing myths and stigma through community engagement, and strengthening provider capacity are essential strategies to improve under utilized contraceptive methods, reduce mother to child transmission, and enhance reproductive health outcomes in South Sudan.