Contraceptive choice, sexually transmitted diseases, HIV infection, and future fecundity

Because contraception affects not only the risk of unplanned pregnancy but also that of sexually transmitted infections, the choice of particular methods is important to future fertility. However, certain trade-offs are necessary. Contraceptives with the best record of preventing pregnancy provide little protection against sexually transmitted diseases (STDs). Conversely, those barrier methods with higher failure rates for pregnancy can reduce the risk of acquiring or transmitting an STD. For example, condoms used correctly and consistently provide the best protection against infection. Although spermicides reduce lower genital tract bacterial STDs, their effectiveness against HIV is still unknown. In contrast to barrier methods, the IUD is associated with an increased risk for developing upper genital tract infection, primarily in the first month after insertion. Current literature raises paradoxical questions regarding the role of hormonal contraception in STDs and pelvic inflammatory disease. Moreover, epidemiological studies are equivocal regarding the public health value of recommending dual methods of contraception, one to prevent unplanned pregnancy and the other to prevent STDs. Investigations to date have focused on the use of the male condom added to other methods of contraception. In general, where participants were using primary methods other than the condom, the more effective the primary contraceptive method was in preventing pregnancy, the lower the level of consistent use of the male condom. Continued biologic and behavioral research will be necessary to disentangle these complex relationships.

DECS tries out instructional materials on AIDS prevention education

A national try-out of the newly developed print and non-print instructional materials on AIDS Education is being conducted by the Department of Education, Culture and Sports (DECS) this school year 1993-to 1994. To determine the effectiveness of these materials, various public and private schools in Region IV (Southern Tagalog), VII (Central Visayas) XI (Southern Mindanao) and National Capital Region (Metro, Manila) were chosen as try-out institutions. The AIDS education materials will be tried out in different subjects in some grade and year levels such as civics and culture (grade one); science and health (grades three and six); home economics and livelihood education (grade five); physical education, health and music (second year) and Pilipino Language (third year). The materials for the elementary level consist of posters, cut-out pictures, voice tapes, jingles, talking books and slides, while the secondary school level utilizes modules. For the tertiary level, a Resource Book on AIDS Prevention Education is used by the Teacher Training Institutions and the Non-Formal Education employs the Facilitator's Guide for Levels I-III. These materials will be tried out in both urban and rural schools, with control school and experimental school at each level.

Providing support to caregivers and self-care

The evolution of HIV/AIDS care has resulted in a wide range of caregivers who work out of public and private hospital facilities, nongovernmental organizations (NGOs) and community-based facilities. Others are volunteers and community health and social workers based at facilities or community sites. Many caregivers are family members or part of a client's close social network. Additionally, people living with HIV/AIDS (PHA) themselves engage in self-care and provide support to other PHA through support groups. In the best-case scenario the services of these caregivers are sometimes provided free of charge at one site by a specialized NGO. In many cases, however, a person wishing to gain access to care and social services may need an understanding how the systems and procedures of various institutions operate. Many PHA are unprepared for the administrative, financial, and legal barriers that they may encounter. To cope with this need, a new type of support service called the "buddy" system has emerged. Buddies are individuals who are less directly involved with, but who know about HIV/AIDS, the services available and the rights of PHA. A buddy is close enough for the PHA to approach, has sufficient time to devote to him/her and can be asked almost everything. The article on the Rio de Janeiro Buddy Project provides an example of a project for gay men in Brazil. In other parts of the world where the buddy system is non-existent, the PHA must often rely on support provided by family and friends.