Table 2.

Barriers and facilitators for contraception use among adolescent females living with HIV

Characteristics	Barriers	Facilitators
Individual/personal	Lack of knowledge of contraceptive methods and services Refusal of services because not ready to initiate contraception	Knowledge of contraceptive methods and services
Interpersonal	Fear of being judged for seeking services without male partner Community stigma for being sexually active and seeking services Fear of parental attitudes in seeking services Provider biases in not providing hormonal contraception methods Fear of stigma by health providers preventing contraception discussion	Peer encouragement to seek services Positive staff attitudes Provider confidentiality in providing services
Institutional	Health facility barriers, such as physical environment, scheduling and language differences among providers and adolescents	Youth-friendly service provision Integration of HIV and contraception services for ease of accessing care Appropriate counselling and health education regarding contraception Contraceptive commodity availability
Societal/public policy	Parental consent needed in accessing services Illegality of abortion servicesa	Legal access to services for emancipated minorsb

^aAccording to the current Kenyan constitution, abortion is illegal in all circumstances outside of emergency situations to protect the health of the mother. Even with these laws, an estimated 465,000 Kenyan women experienced abortions in 2012, and of those, 120,000 women experienced complications from the unsafe services [31].

^bCurrently, the Kenyan government requires parental consent for adolescents to receive reproductive health services. Many clinics provide more reproductive health services than is indicated by the current law, and in 2014 the Reproductive Health Care Bill was introduced to the Kenyan Senate that would make family planning and contraceptive services available to all adolescents, starting at 10 years of age [32,33].