Influences on initial acceptance and intention to use a modern family planning method in HIV -discordant couples in Lusaka, Zambia

An important means of decreasing vertical transmission and numbers of AIDS orphans would be reducing the number of unwanted pregnancies in couples in which one or both members are HIV-positive. The use of family planning methods will be essential for this reduction. A previous study (Mark et al. submitted for publication) with HIV-discordant couples in Zambia attempted to influence acceptance of family planning methods in a three-armed intervention trial. The current study includes the same subjects as that intervention trial. Data on background characteristics, knowledge, attitudes and practices relevant to family planning were collected at the time of enrollment to assess factors beyond the intervention that influenced family planning practices in couples. Another questionnaire focusing on components of the theory of reasoned action and inheritance laws was administered 9--21 months after enrollment. Focus group discussions and in-depth interviews were conducted to gain further insights into fertility decision-making processes and beliefs and attitudes that might influence decision-making. Of particular interest were beliefs about inheritance laws and fear of property grabbing (i.e., confiscation of the husband's property by his family after his death).;The findings of this study suggest that factors associated with acceptance of family planning in other populations (i.e., wife's age, education level, number of children, the experience of the death of a child) were not significant influences on family planning acceptance in this HIV-discordant couple population. The results of the analysis using data from the theory of reasoned action questionnaire support the theory's usefulness in understanding intention to use a modern family planning method in HIV-discordant couples. Participation in the Zambian inheritance laws discussion (the third intervention arm) was not associated with increased Initial acceptance of modern family planning methods. The latter result might be attributable to the high level of knowledge of Zambian inheritance laws in this population, and to the fact that knowledge of inheritance laws was not associated with wife's fear of property grabbing or husbands writing a will.;Further research is needed on factors Influencing contraceptive acceptance, continuation, and decision-making processes pertaining to family planning in HIV-discordant couples before clear policy and programmatic recommendations can be formulated.