Planned condom use by women with Norplant implants

Contraception choice for HIV positive women

UNAIDS/WHO estimates that 42 million people are living with HIV/AIDS worldwide and 50% of all adults with HIV infection are women predominantly infected via heterosexual transmission. Women with HIV infection, like other women, may wish to plan pregnancy, limit their family, or avoid pregnancy. Health professionals should enable these reproductive choices by counselling and appropriate contraception provision at the time of HIV diagnosis and during follow up. The aim of this article is to present a global overview of contraception choice for women living with HIV infection including effects on sexual transmission risk.

Planned condom use among women undergoing tubal sterilization

BACKGROUND AND OBJECTIVES

Women who are undergoing tubal sterilization are at risk for various sexually transmitted diseases (STDs) if they do not use a barrier method of contraception. There is a paucity of data concerning dual use of condoms among sterilized women.

GOAL

Planned use of condoms for protection against STDs was examined among 2,782 women undergoing surgical sterilization from 1991 to 1996.

STUDY DESIGN

Cross-sectional survey.

RESULTS

Planned condom use increased significantly over the 6-year study period. Of women who were using condoms before sterilization (n = 646), nearly half indicated no plans to do so after becoming sterilized. Thus, 11% of the total sample experienced an increased risk for exposure to human immunodeficiency virus or other STDs. Condom abandonment was significantly higher among Hispanic and married women. Multiple regression analysis was used to examine the association between condom use and various characteristics. Factors associated with future condom use were younger age, black ethnicity, being unmarried, previous STD, not having a steady partner, higher number of previous sexual partners, having used condoms for disease prevention in the past, and lack of partner involvement in the decision to undergo sterilization.

CONCLUSIONS

Use of condoms among sterilized women appears to be on the rise, women at higher risk for disease are more likely than others to be using condoms, and only a small group of women experience an increased risk for exposure to disease as a result of selecting this permanent method of contraception.

Use of hormonal methods of birth control among sexually active adolescent girls

OBJECTIVE

To identify factors associated with the use of various birth control methods among sexually active adolescent girls.

DESIGN

A survey distributed as part of a larger study measuring compliance with hepatitis B vaccination.

SETTING

A hospital-based and a school-based clinic.

MEASURES

Demographic and health behavior data including sexual activity, contraceptive method, substance use, condom use, and history of sexually transmitted diseases (STDs) were collected. Birth control method was confirmed by medical record review. Associations with the outcome variable of birth control method were analyzed using chi square, Kruskal-Wallis analyses of variance, and t-tests, followed by logistic regression analysis.

RESULTS

Among sexually experienced girls, 39% (n = 123) reported using oral contraceptive pills (OCPs), 5.4% (n = 17) used Depo-Provera (medroxyprogesterone acetate) or Norplant (levonorgestrel), and 55.6% (n = 175) used no hormonal method. Logistic regression analysis revealed that the factors most significantly associated with the use of hormonal methods were older age (odds ratio [OR] = 1.19; 95% confidence interval [CI], 1.07-1.33), not using a condom at last intercourse (OR = 0.55; CI, 0.34-0.90), and having had a well visit within 1 year (OR = 2.11; CI, 1.12-3.70). OCP users were less likely than Depo-Provera or Norplant users to have used alcohol (p = 0.041), cigarettes (p = 0.002), or marijuana (p = 0.018) in the past 30 days. OCP users were less likely than nonusers of hormonal methods to have smoked cigarettes (p = 0.034) or marijuana (p = 0.052). The school-based clinic had a greater proportion of subjects using long-acting progestins (p < 0.001).

CONCLUSIONS

The decreased rate of condom use among those who used hormonal birth control methods and the different rates of health risk behaviors among users of various methods require targeted counseling efforts to decrease pregnancy and STD rates among young women.

Long-acting hormonal contraception

For 30 years, the combined oral contraceptive pill has been an almost automatic choice for effective contraception in sexually active adolescent women. Nevertheless, consideration of the criteria of a hypothetical "ideal" contraceptive suggests that long-acting progestogen-only methods may have considerable advantages for some adolescents. These would include greater efficacy, easier compliance, avoidance of estrogenic side effects, and potentially greater privacy. The disadvantages of menstrual irregularity, progestogenic side effects including weight gain, and the initial greater medicalization of the method, particularly implants, must be weighed against the wishes and preferences of the adolescent. A number of studies of the uptake and utilization of these methods in adolescence have arisen, particularly from the United States. These are reviewed together with experience from programs in the United Kingdom.

Condom use with main partners by sterilized and non-sterilized women

This study examined condom use with main partners by surgically sterilized and non-sterilized women at risk for HIV infection. Data were obtained from 379 African American women residing in low-income urban communities. Sterilized women were one-fifth as likely as non-sterilized women to use condoms. Multivariate logistic regression indicated that for both groups of women, higher perceived benefits of condom use for disease prevention were associated with condom use. In addition, younger age, self-efficacy for condom use, peer support for condom use, and whether condoms were ever used for pregnancy prevention were associated with condom use among non-sterilized women. Results of this study indicate the role of fertility status in condom use and the value of developing targeted prevention programs that reach women at high risk for HIV infection. Risk reduction programs need to emphasize the role of condoms in disease prevention and address attitudes towards condom use.

Women, contraception and STDs including HIV

It is estimated that eight million women are infected with the human immunodeficiency virus (HIV) worldwide. Heterosexual transmission is the predominant mode of HIV transmission on a global basis and is becoming increasingly important in the Western world. Women have long used contraceptives as a means of protection against an unwanted pregnancy, some of which may also protect against sexually transmitted disease (STD) including HIV. We review the relationship between contraceptive methods and STD acquisition and transmission; HIV acquisition and transmission; and the implications of contraceptive use, particularly regarding disease progression, in those women who are already infected with the virus. It is important for all women that protection against both unwanted pregnancy and HIV acquisition and transmission are considered together and not in isolation as nowhere is the argument for a broad based multi-disciplinary approach more cogent.