Date of Award


Document Type


Degree Name

Master of Medicine (MMed)


Family Medicine (East Africa)


Title: Understanding the barriers to contraceptive use among HIV-positive women of child bearing age in Dar-es-Salaam, Tanzania- a multi-site study

Purpose: The purpose of this study was to explore the perceived barriers to contraceptive use and identify the factors that influence contraceptive choice, as well as the relationship of these among HIV-positive women living in an urban population in Dar-es-Salaam Tanzania.

Goals and Objectives: To determine the perceived barriers to contraceptive use among HIV-positive women of child-bearing age attending the Care Treatment Centres (CTCs) Tanzania and in the President’s Emergency Plan for AIDS Relief (PEPFAR) supported CTCs within Dar-es-salaam.

Methodology: In a phenomenological approach the study adopted a cross-sectional study design that utilized qualitative methodology to assess HIV-positive women’s perceptions towards modern methods of contraception (including barrier, hormonal, permanent, and dual protection methods). It was a multi-sited study involving a selection of Management and Development for Health (MDH) supported CTCs whose focus is HIV/AIDS in women and children. The study population included all sexually active women of child bearing age (15-49) confirmed HIV-positive and attending the MDH supported CTC facilities within Dar-es-salaam. The study assumed pragmatic purposive strategic sampling in selecting participants. All participants who meet the inclusion criteria on signage of informed consent were subjected to either In-depth Interviews or Focused Group Discussions. Data collected was transcribed based on emergent themes and analysed using Nvivo 9 qualitative analysis software. During data analysis, stigma was identified as an issue cutting across all other themes. As a result a further analysis of the data was undertaken using Erving Goffman’s Conceptualization of stigma as the analytical framework.

Ethical considerations: The study commenced once ethical approval and considerations were met by governing bodies of the Aga Khan University East Africa as well as the National Institute of Medical Research Tanzania.

Timeline: The study was carried out from January 2012-April 2014.

Results: The study identified eight barriers to contraceptive use: social and healthcare relationships, a woman’s current priorities in particular concerning motherhood, her beliefs about HIV/contraception/menstruation, her stage of acceptance of her HIV diagnosis, her own and other women’s previous experiences with various contraceptive methods, the knowledge she has on them and her access to these methods. Stigma was an underlying issue seen to cut across all these barriers and the subsequent theoretical analysis showed stigma to be a core issue reinforcing all barriers for the HIV-positive woman’s appropriate use of contraception.

Conclusion: The persistent stigmatization of HIV-positive women is an underlying issue enhancing the barriers to contraceptive use. This needs to be addressed. Two interventions are proposed, the merging of antenatal, MNCH, HIV/AIDS and STI clinics into one comprehensive sexual reproductive health clinic and advocacy for highly geared mass educational campaigns. The focus of these should be male partner involvement, support during disclosure and clear sexual and reproductive health education for all (healthcare workers, general public) so as to dispel myths and the stigma that surrounds these.