Sexual health · 2025
Socioeconomic disparities in access to antiretroviral therapy, current use and unmet need of modern contraception among women living with HIV in Ibadan, Nigeria.
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Abodunrin Olunike Rebecca, Akinsolu Folahanmi Tomiwa, Okova Denis, Lukwa Akim Tafadzwa, Bodzo Paidamoyo, Ola Oluwabukola Mary, Adelaja Gift Modupe, Raji Dolapo Omotayo, Ezechi Lilian Ogochukwu, Chiwire Plaxcedes, Ezechi Oliver Chukwujekwu
Аннотация
BACKGROUND: Despite expanded antiretroviral therapy (ART) coverage in Nigeria, socioeconomic disparities continue to limit equitable access to HIV and reproductive health services, especially for women living with HIV (WLHIV). This study examines socioeconomic inequalities in ART access, modern contraceptive use, and unmet need for modern contraception. It further decomposes contributing factors and assesses marginal effects of key predictors.
METHODS: A cross-sectional survey was conducted among WLHIV (aged 18-49 years) at three HIV treatment centers in Ibadan, Nigeria. We used Erreygers-normalized concentration indices (ENCIs), Lorenz curves, dominance testing, Erreygers decomposition, and marginal effects regression to assess inequalities.
RESULTS: Modern contraceptive use was significantly pro-poor (ENCI = -0.09, P = 0.03), whereas unmet need was pro-rich (ENCI = 0.08, P = 0.11), and access to HIV care was pro-poor (ENCI = -0.05, P = 0.40), although both were not statistically significant. Dominance tests confirmed systematic inequality across all outcomes. Decomposition revealed education as the dominant driver; primary education explained 24.49% of the pro-poor pattern in contraceptive use, 23.30% of the pro-rich inequality in unmet need, and 10.96% of the pro-poor inequality in HIV care access. Marginal effects indicated that employed women were 15% more likely to access HIV care, contraceptive use declined by 0.5% with each additional year of age, and unmet need was 17% higher among women with comorbidities.
CONCLUSION: Contrary to most population-level evidence in Nigeria and sub-Saharan Africa, contraceptive use was more concentrated among poorer WLHIV, possibly reflecting the success of targeted family planning interventions. Policy should consolidate pro-poor gains in contraceptive use while safeguarding method choice, tailor services across the life course, and integrate family planning with HIV and chronic care to reduce unmet need and strengthen equity.
METHODS: A cross-sectional survey was conducted among WLHIV (aged 18-49 years) at three HIV treatment centers in Ibadan, Nigeria. We used Erreygers-normalized concentration indices (ENCIs), Lorenz curves, dominance testing, Erreygers decomposition, and marginal effects regression to assess inequalities.
RESULTS: Modern contraceptive use was significantly pro-poor (ENCI = -0.09, P = 0.03), whereas unmet need was pro-rich (ENCI = 0.08, P = 0.11), and access to HIV care was pro-poor (ENCI = -0.05, P = 0.40), although both were not statistically significant. Dominance tests confirmed systematic inequality across all outcomes. Decomposition revealed education as the dominant driver; primary education explained 24.49% of the pro-poor pattern in contraceptive use, 23.30% of the pro-rich inequality in unmet need, and 10.96% of the pro-poor inequality in HIV care access. Marginal effects indicated that employed women were 15% more likely to access HIV care, contraceptive use declined by 0.5% with each additional year of age, and unmet need was 17% higher among women with comorbidities.
CONCLUSION: Contrary to most population-level evidence in Nigeria and sub-Saharan Africa, contraceptive use was more concentrated among poorer WLHIV, possibly reflecting the success of targeted family planning interventions. Policy should consolidate pro-poor gains in contraceptive use while safeguarding method choice, tailor services across the life course, and integrate family planning with HIV and chronic care to reduce unmet need and strengthen equity.