Nonbarrier Contraceptive Use Research Articles

Contraceptive use and method mix dynamics in Sub-saharan Africa: time trends and the influence of the HIV pandemic

BackgroundContraceptive use dynamics continue to be of priority in sub-Saharan Africa because of persistently high levels of fertility. This paper focuses on the use of barrier versus non-barrier contraceptive use in sub-Saharan Africa hypothesizing that the HIV pandemic in the region would be responsible for increases in the use of barrier methods over time.MethodsThis paper uses Demographic and Heath Survey (DHS) data from 32 countries to conduct extensive analysis of trends in contraceptive use and method mix that refers to the distribution of contraceptive methods use among the sexually active population. The paper examines how contraceptive method mix dynamics have changed over time and whether the trends differ by marital status and gender using cross-tabulations. It furthers examines the determinants of method choice using logistic regressions.ResultsThe findings indicate that the use of barrier methods, most markedly for unmarried women and men, rose substantially between the late 1980s and late 2000s in the region in tandem with trends in HIV prevalence. The results further show marked differences in method mix by gender with men being more likely to report barrier method use than women.ConclusionsThe findings indicate shifting preferences in contraceptive choice. The time trend analyses highlight the importance of expanding the focus of contraceptive use studies beyond women in this context as the study finds differing trends for men.Graphical

101. The Relationship between Depression and Non-Barrier Contraceptive Use in Adolescent Females

101. The Relationship between Depression and Non-Barrier Contraceptive Use in Adolescent Females

Non-barrier contraceptive use patterns among Latina adolescents attending California reproductive health centers: A longitudinal study

ObjectivesTo describe use of non-barrier contraceptives over a 9-month period, consistency in method use, and identify factors associated with method nonuse, switching, and consistency among Latina adolescents attending California sexual and reproductive health (SRH) centers. Study designWe conducted a cohort study using data self-reported at baseline, and 3- and 9-months post-baseline. The analysis included 1162 sexually active adolescents aged 18 to 19 who self-identified as female and Latina, indicated that they were not currently pregnant or trying to become pregnant, and who attended California SRH centers between June 2016 and June 2020. We used binomial generalized multivariable linear models with a log link to assess the likelihood of nonbarrier method consistency, switching, and non-use. ResultsAt baseline, 453 of 1162 (39%) of respondents were using short-acting methods (pill, patch, ring, or injection), 113 of 1162 (9.7%) were using long-acting methods (implants or intrauterine devices [IUDs]), and 596 of 1162 (51.3%) reported using neither short- nor long-acting methods. Over a 9-month period, 22/33 (66.7%) of those using IUDs consistently used the method, which was a statistically greater frequency of consistency than individuals who selected other nonbarrier methods (270/530 [50.9%], aRR: 1.40; 95% CI: 1.11, 1.77). Implant users had rates of method consistency similar to users of other nonbarrier methods (aRR: 1.11; 95% CI: 0.89, 1.38). Factors independently associated with method consistency included being older, having never been pregnant, having greater perceived risk of pregnancy, and greater contraceptive knowledge. ConclusionSexually active Latina adolescents attending California SRH centers who were not trying to become pregnant maintained consistent contraceptive use more frequently when using an IUD. Using a patient-centered approach, contraceptive counseling for Latina adolescents can describe the combined efficacy and contraceptive stability offered by IUDs should patients desire it. ImplicationsThis study addressees gaps in knowledge about U.S. Latina adolescents’ contraceptive use patterns. We demonstrate that IUD users, and not implant users, appear more likely to consistently use their method than those using non-LARC methods. Patient-centered contraceptive counseling for Latina adolescents can describe the greater contraceptive stability that IUDs may offer.

The mediating role of partner communication on contraceptive use among adolescent girls and young women participating in a small-group intervention in Malawi: A longitudinal analysis

ABSTRACT Though effective reproductive health interventions have been developed for adolescent girls and young women (AGYW) in sub-Saharan Africa, few have explored whether specific components of the interventions are responsible for observed changes in behaviour. Data for this longitudinal mediation analysis come from a quasi-experimental, sexual and reproductive health study conducted among AGYW (age 15–24) in Malawi. We assessed the extent to which the relationship between attending communication-specific small-group sessions and contraceptive use at one-year was mediated by contraceptive communication with partners at six months, using a bootstrapping procedure to estimate indirect effects. Of 358 participants, 44% attended communication-specific small-group sessions, 37% communicated with partners about contraception at six months, and 21% used non-barrier contraception at one-year. Participants who attended communication-specific small-group sessions had increased contraceptive communication with partners at six months (aOR = 1.48, 95% CI: 1.07–2.38) and increased non-barrier contraceptive use at one-year (aOR = 3.53, 95% CI: 1.86–6.69). The relationship between attending communication-specific small-group sessions and non-barrier contraceptive use at one-year was partially mediated by contraceptive communication with partners at six months (indirect effect = 0.04, 95% CI: 0.01–0.07). Our results suggest that contraceptive communication with partners is modifiable through interventions and important for AGYW non-barrier contraceptive uptake.

Improving contraceptive use among Latina adolescents: A cluster-randomized controlled trial evaluating an mHealth application, Health-E You/Salud iTu

ObjectiveTo evaluate the effectiveness of Health-E You/Salud iTu, a mobile health application (app), on increasing knowledge, self-efficacy and contraception use among Latina adolescents, its impact on visit quality, and app satisfaction. Study DesignThis study used cluster-randomized controlled trial (CRCT) of 18 school-based health centers (SBHCs). Prior to the visit, intervention participants received the patient-centered contraceptive decision-making support app and controls answered sexual health questions on iPads. Participants completed a previsit questionnaire and 3 follow-up surveys (48 hours, 3-, and 6-months) after the recruitment visit (where intervention participants completed the app). Differences in adolescents’ contraceptive knowledge, self-efficacy, and use over the 6-month follow-up were assessed by generalized mixed effects regression models. ResultsA total of 1,360 Latina adolescents participated; 57.2% responded to the 48-hour survey, 50.1% to the 3-month, 49.7% to the 6-month, and 42.3% to both the 3- and 6-month surveys. Health-E You users’ demonstrated significant increases in pre-post knowledge (p < 0.001). Intervention participants who completed the follow-up survey reported greater increases in mean self-efficacy from baseline (23.2 intervention vs. 22.5 controls) to 6 months (26.1 vs. 23.4; b = 1.58, 95% CI 0.38–2.77, p = 0.01), and greater increases in non-barrier contraceptive use from baseline (29% intervention vs. 30% controls) to 3 months (63% vs. 45%; OR = 3.29, 95% CI 1.04–10.36, p = 0.04) and 6 months (63% vs. 44%; OR = 5.54, 95% CI 1.70–18.06, p = 0.005). Providers and adolescents reported high app satisfaction and stated it improved visit quality. ConclusionsWhile data suggest that Health-E You improved outcomes, findings must be interpreted cautiously. Intervention participants had higher baseline sexual activity rates, more recruitment visits for pregnancy testing, emergency contraception or birth control, and lower completion rates of follow-up surveys than controls. ImplicationsDespite declines in adolescent pregnancy in the United States, Latinas continue to have disproportionately high rates compared to white females. The Health-E You app may be an effective support tool for both adolescents and providers in SBHCs, and possibly other clinical settings, across the country to increase contraceptive use and thereby decrease unintended pregnancies. It could potentially reduce disparities in adolescent pregnancies and create more efficient visit time spent between clients and their providers.

Human Papilloma Virus infection and cervical cancer among women who sell sex in Eastern and Southern Africa: A scoping review.

Objectives:Women who sell sex have a high prevalence of human papilloma virus, which may cause cervical cancer. The objective of this review was to collate findings on prevalence, associated factors, screening, service provision and utilization of services in relation to human papilloma virus and cervical cancer among women who sell sex in Eastern and Southern Africa.Methods:A scoping review methodology was employed. Inclusion criteria were as follows: (1) empirical papers, (2) of studies conducted in Eastern and Southern Africa, (3) published in the last 10 years, and (4) addressing women who sell sex in relation to (5) human papilloma virus and cervical cancer. A thorough search of a range of databases surfaced 66 papers. Both authors applied inclusion and exclusion criteria, resulting in 14 papers being reviewed.Results:The reported prevalence of high-risk human papillomavirus virus varied between 23.6% and 70.5%. HIV sero-positivity, other sexually transmitted infections and Epstein-Barr virus were associated with human papilloma virus and high-grade cervical lesions. High-risk human papilloma virus was associated with women who reported younger age at first intercourse, non-barrier contraceptive use, and no history of condom use. For screening, there was overall agreement between physician- and self-collected samples. Contradictory results were found for visual inspection with acetic acid. Screening services utilization was associated with provider’s recommendation, history of sexually transmitted infections, frequency of facility visit and history of vaginal examination. A diagonal programme led to an increase in screening, attributed to the targeted services.Conclusions:Context is important in planning cervical cancer services. There is a need for enhanced sexually transmitted infections and viral management within cervical cancer prevention. Women who sell sex should be empowered in self-collection of stored-dry specimens, especially in resource-constrained regions. Cervical cancer screening services should be honed to the needs of women who sell sex.

Unmet Need for Family Planning and Experience of Unintended Pregnancy Among Female Sex Workers in Urban Cameroon: Results From a National Cross-Sectional Study

Female sex workers (FSWs) in Cameroon commonly have unmet need for contraception posing a high risk of unintended pregnancy. Unintended pregnancy leads to a range of outcomes, and due to legal restrictions, FSWs often seek unsafe abortions. Aside from the high burden of HIV, little is known about the broader sexual and reproductive health of FSWs in Cameroon. From December 2015 to October 2016, we recruited FSWs aged ≥18 years through respondent-driven sampling across 5 Cameroonian cities. Cross-sectional data were collected through a behavioral questionnaire. Modified-robust Poisson regression was used to approximate adjusted prevalence ratios (aPR) for TOP and current use of effective nonbarrier contraception. Among 2,255 FSWs (median age 28 years), 57.6% reported history of unintended pregnancy and 40.0% reported prior TOP. In multivariable analysis, TOP history was associated with current nonbarrier contraceptive use (aPR=1.23, 95% confidence interval [CI]=1.07, 1.42); ever using emergency contraception (aPR=1.34, 95% CI=1.17, 1.55); >60 clients in the past month (aPR=1.29, 95% CI= 1.07, 1.54) compared to ≤30; inconsistent condom use with clients (aPR=1.17, 95% CI=1.00, 1.37); ever experiencing physical violence (aPR=1.24, 95% CI=1.09, 1.42); and older age. Most (76.5%) women used male condoms for contraception, but only 33.2% reported consistent condom use with all partners. Overall, 26.4% of women reported currently using a nonbarrier contraceptive method, and 6.2% reported using a long-acting method. Previous TOP (aPR=1.41, 95%CI=1.16, 1.72) and ever using emergency contraception (aPR=2.70, 95% CI=2.23, 3.26) were associated with higher nonbarrier contraceptive use. Recent receipt of HIV information (aPR=0.72, 95% CI=0.59, 0.89) and membership in an FSW community-based organization (aPR=0.73, 95% CI=0.57, 0.92) were associated with lower use nonbarrier contraceptive use. Experience of unintended pregnancies and TOP is common among FSWs in Cameroon. Given the low use of nonbarrier contraceptive methods and inconsistent condom use, FSWs are at risk of repeat unintended pregnancies. Improved integration of client-centered, voluntary family planning within community-led HIV services may better support the sexual and reproductive health and human rights of FSWs consistent with the United Nations Declaration of Human Rights.

Rapid repeat pregnancy in women with schizophrenia

AimWomen with schizophrenia are vulnerable to adverse reproductive health outcomes. Short inter-pregnancy interval, or rapid repeat pregnancy, is associated with maternal and infant complications, and may be preventable. Whether women with schizophrenia are at disproportionate risk for rapid repeat pregnancy is unknown. MethodsThis population-based cohort study in Ontario, Canada (2002−2013) compared women with and without schizophrenia on their risk of rapid repeat pregnancy, defined as pregnancy within 12 months of an index live birth. Among women with public drug coverage, those with and without schizophrenia were compared on their use of non-barrier contraception (hormonal and surgical) post-delivery. ResultsWomen with schizophrenia (n = 1565) were at higher risk for rapid repeat pregnancy than women without schizophrenia (n = 924,657) (6.3% vs. 3.9%, adjusted relative risk, aRR 1.31, 95% confidence interval, CI, 1.07–1.59). They had more rapid repeat pregnancies resulting in live births (aRR 1.85, 95% CI 1.26–2.72), but not pregnancy losses (aRR 1.50, 95% CI 0.99–2.29) or induced abortions (aRR 1.07, 95% CI 0.81–1.42). Post-delivery non-barrier contraception use was similar between groups (43.7% vs. 43.6%, aRR 1.06, 95% CI 0.93–1.20), although women with schizophrenia were more likely to use injectable contraception (14.1% vs. 10.1%, aRR 1.67, 95% CI 1.35–2.07). DiscussionWomen with schizophrenia are at higher risk than their peers for rapid repeat pregnancy, but use non-barrier contraception at similar rates. The postnatal period is an opportune time to initiate targeted interventions designed to optimize planning for any future pregnancies, and contribute to improving maternal and child health in this vulnerable group.

Prevalence and predictors of unmet contraceptive need in HIV-positive female sex workers in Mombasa, Kenya.

ObjectivesFemale sex workers (FSWs) in sub-Saharan Africa are a key population for HIV prevention and treatment interventions, but less attention is given to their family planning needs. We evaluated the prevalence and predictors of unmet contraceptive need in HIV-positive FSWs.Study designThis cross-sectional analysis used data from an existing longitudinal study of FSWs in Mombasa, Kenya. This analysis included women who were HIV positive, age ≥18 years, pre-menopausal, not currently pregnant or desiring pregnancy, and reported exchanging sex for cash or in-kind payment at the time of enrollment. Unmet contraceptive need was defined as non-use of modern non-barrier contraceptives and not currently trying to become pregnant. Poisson regression was used to identify factors independently associated with unmet contraceptive need.ResultsAmong 346 HIV-positive FSWs, 125 (36.1%) reported modern non-barrier contraceptive use, leaving 221 (63.9%, 95%CI 58.8–68.9%) with unmet contraceptive need. Condom use was the only form of contraception for 129 (37.3%) participants. In unadjusted analyses, unmet contraceptive need was associated with physical abuse in the past year by someone other than a regular partner (PR 1.2, 95%CI 1.0–1.5), desire for (more) children (PR 1.3, 95%CI 1.1–1.5), and having 2–3 previous pregnancies compared to 0–1 prior pregnancies (PR 0.8, 95%CI 0.6–0.9). In adjusted analyses, lower number of previous pregnancies and having desire for future children remained significantly associated with a higher prevalence of unmet contraceptive need.ConclusionsUnmet need for modern non-barrier contraception was found in two-thirds of HIV-positive FSWs who reported that they were not currently trying to become pregnant, and was higher in women with the lowest number of prior pregnancies (0–1 prior pregnancies) and in those reporting desire for (more) children in the future. These findings highlight the need for concerted efforts to identify and eliminate barriers to contraceptive use in FSWs living with HIV.

Exploring Body Image, Contraceptive Use, and Sexual Health Outcomes Among an Ethnically Diverse Sample of Women

This cross-sectional study examined the links between body appreciation, contraceptive use, and sexual health outcomes. Body appreciation has been shown to influence contraceptive use in homogenous samples of women. However, a common problem in body image literature is a lack of racial and ethnic diversity with regard to sample; this study was able to take steps toward overcoming that limitation. A sample of 499 women aged 18-56 (M=26.24; SD=6.15) was recruited via Reddit.com-White (29.3%, n=120), Asian (19%, n=78), Black (17.3%, n=73), multiracial (13.9%, n=57), and Latina (13.9%, n=57). Covariates included race/ethnicity, body size as measured by body mass index, relationship status, age, sexual orientation, and education level. Results indicated that higher levels of body appreciation were related to a higher likelihood of using non-barrier contraception. Regarding the covariates, race, relationship status, age, and education were related to non-barrier contraceptive use and age was related to dual contraceptive use. Further exploration is needed to determine how body appreciation may affect contraceptive use and sexual health outcomes and how these differ by race/ethnicity.

Dual Method Use among Postpartum HIV-Infected and HIV-Uninfected Malawian Women: A Prospective Cohort Study.

Dual method use, use of condoms plus another effective contraceptive method, is important in settings with high rates of unintended pregnancy and HIV infection. We evaluated the association of HIV status with dual method use in a cohort of postpartum women. Women completed baseline surveys in the postpartum ward and telephone surveys about contraceptive use 3, 6, and 12 months later. Nonpregnant women who completed at least one follow-up survey were eligible for this secondary analysis. Prevalence ratios were calculated using generalized estimating equations. Of the 511 sexually active women who completed a follow-up survey, condom use increased from 17.6% to 27.7% and nonbarrier contraceptive use increased from 73.8% to 87.6% from 3 to 12 months after delivery. Dual method use increased from 1.0% to 18.9% at 3 to 12 months after delivery. Dual method use was negligible and comparable between HIV-infected and HIV-uninfected women at 3 months but significantly higher among HIV-infected women at 6 months (APR = 3.9, 95% CI 2.2, 7.1) and 12 months (APR = 2.7, 95% CI 1.7, 4.3). Dual method use was low but largely driven by condom use among HIV-infected women at 6 and 12 months after delivery.

Non-barrier contraceptive use and relation to condom use behaviour by partner type among female sex workers in Andhra Pradesh, India

ObjectiveThe study assessed non-barrier contraceptive use among female sex workers (FSW) in Andhra Pradesh, India and relation to inconsistent condom use among commercial and non-commercial male sexual partners.MethodsFSW at least...

Contraceptive use among female sex workers in three Russian cities.

To determine the prevalence of, and factors associated with, use of non-barrier contraception (intrauterine device, hormonal contraceptives, and female sterilization) among female sex workers (FSWs) in three Russian cities. A secondary analysis of data from a cross-sectional survey of FSWs aged 18 years and older from Kazan, Krasnoyarsk, and Tomsk was undertaken. Participants had completed a one-time computer-based survey in 2011. Among the 708 with a current contraceptive need, logistic regression was used to evaluate factors associated with use of non-barrier contraceptives. Use of non-barrier contraceptives was reported by 237 (33.5%) FSWs. Use of non-barrier contraceptives was associated with being in sex work longer (≥ 4 years vs < 1 year: adjusted odds ratio [AOR] 4.70; 95% confidence interval [CI] 1.51-14.66) and having a non-paying partner (AOR 2.02; 95% CI 1.32-3.11). Odds of non-barrier contraception were reduced among FSWs who had ever worked with a pimp/momka (AOR 0.46; 95% CI 0.24-0.87), who had experienced recent client-perpetrated violence (AOR 0.19; 95% CI 0.07-0.52), or reporting consistent condom use (AOR 0.30; 95% CI 0.16-0.54). Only 13 (5.5%) of the 237 FSWs using non-barrier contraception reported consistent condom use. Only one-third reported use of non-barrier contraception, suggesting substantial unmet contraceptive needs. FSWs are an important target population for family planning, reproductive health counseling, and care.

Induced abortion, contraceptive use, and dual protection among female sex workers in Moscow, Russia

ObjectiveTo describe abortion history and current contraceptive use among female sex workers (FSWs) in Moscow, Russia. MethodsA clinic-based survey was conducted among 147 FSWs in Moscow during an 8-month period in 2005. ResultsIn total, 83 of 143 (58.0%) FSWs reported a history of abortion, with 45 of 143 (31.5%) indicating multiple abortions. Condoms were the primary form of contraception (145/146 [99.3%]); just 17 of 142 (12.0%) FSWs reported using non-barrier modern contraception. All women who reported using a non-barrier modern method also indicated condom use (i.e. dual protection). Non-barrier contraceptive use was associated with inconsistent condom use (odds ratio [OR] 3.10; 95% confidence interval [CI], 1.07–9.02) and multiple abortions (OR 4.71; 95% CI, 1.19–18.62). ConclusionThe results illustrate substantial risk for unintended pregnancy among FSWs. Further research is needed regarding the dynamics of non-barrier contraception and condom use. Efforts to improve the health and wellbeing of FSWs should include access to safe and effective contraception, in addition to HIV prevention.

Successful increase in contraceptive uptake among Kenyan HIV-1-serodiscordant couples enrolled in an HIV-1 prevention trial

Objective: To evaluate a multipronged approach to promote dual contraceptive use by women within heterosexual HIV-1-serodiscordant partnerships. Methods: For 213 HIV-1-serodiscordant couples in Thika, Kenya, participating in an HIV-1 prevention clinical trial, contraceptive promotion was initiated through a multipronged intervention that included staff training, couples family planning sessions, and free provision of hormonal contraception on-site. Contraceptive use and pregnancy incidence were compared between two time periods (before versus after June 2007, when the intervention was initiated) and between Thika and other Kenyan trial sites (Eldoret, Kisumu, and Nairobi). Generalized estimating equations and Andersen–Gill proportional hazards modeling were used. Results: Nonbarrier contraceptive use increased after implementation of the intervention: from 31.5 to 64.7% of visits among HIV-1-seropositive women [odds ratio 4.0, 95% confidence interval (CI) 3.0–5.3] and from 28.6 to 46.7% of visits among HIV-1-seronegative women (odds ratio 2.2, 95% CI 1.4–3.5). In comparison, at the other Kenyan sites, where the intervention was not implemented, contraceptive use changed minimally, from 15.6 to 22.3% of visits for HIV-1-seropositive women and from 13.6 to 12.7% among HIV-1-seronegative women. Self-reported condom use remained high during follow-up. Pregnancy incidence at the Thika was significantly lower after compared with before June 2007 (hazard ratio 0.2, 95% CI 0.1–0.6) and was approximately half that at other Kenyan sites during the intervention period (hazard ratio 0.5, 95% CI 0.3–0.8). Conclusion: A multipronged family planning intervention can lead to high nonbarrier contraceptive uptake and reduced pregnancy incidence among women in HIV-1-serodiscordant partnerships.

Dual Protection: More Needed than Practised or Understood

Although non-barrier contraceptive use has become a global norm, unprotected sex in relation to sexually transmitted infections remains the norm almost everywhere. Dual protection is protection from unwanted pregnancy, HIV and other sexually transmitted infections, and is a form of safer sex for heterosexual couples that is more needed than practised or understood. This paper draws on a review of the literature in family planning, obstetrics and gynaecology, and AIDS-related journals from 1998 to early 2005. Definitions of dual protection, found mainly in family planning literature, are very narrow. Condoms remain the mainstay of dual protection, but the aim of this paper is to provide an expanded list of dual protection methods to show that there is a range of options. These include non-penetrative sex and the increasing use of condoms with the back-up of emergency contraception on the part of young people. The fact that people may fail to use dual protection consistently and correctly is not a valid reason not to promote it. It is never too late for those providing family planning and STI/HIV prevention services to start promoting condoms and dual protection. In the long-term, the development of highly efficacious and highly acceptable methods of dual protection is an urgent research priority, starting with a wider range of condoms that will appeal to more people.RésuméBien que l’emploi de contraceptifs non mécaniques se soit généralisé dans le monde, les relations sexuelles non protégées par rapport aux IST demeurent la norme presque partout. Une double protection permet d’éviter une grossesse, et la transmission du VIH et d’autres IST ; c’est une forme de sexualité sans risque pour les couples hétérosexuels trop peu pratiquée ou comprise. Cet article analyse des articles publiés dans les revues sur la planification familiale, l’obstétrique, la gynécologie et le SIDA, de 1998 au début de 2005. Les définitions de la double protection, trouvées essentiellement dans les revues sur la planification familiale, sont très étroites. La principale méthode de double protection demeure le préservatif, mais l’article souhaite donner une liste élargie afin de montrer qu’il existe une gamme d’options, notamment les relations sans pénétration et l’utilisation accrue de préservatifs complétée par une contraception d’urgence pour les jeunes. Que la double protection ne soit pas toujours utilisée de manière suivie et correcte n’est pas une raison valable pour ne pas l’encourager. Il n’est jamais trop tard pour que les responsables des services de planification familiale et de prévention des IST/du VIH commencent à promouvoir les préservatifs et la protection double. À long terme, le développement de méthodes très efficaces et acceptables de double protection est une priorité de la recherche, à commencer par un éventail plus large de préservatifs qui plairont à davantage de gens.ResumenAunque el uso de anticonceptivos que no son de barrera se ha vuelto la norma mundial, el sexo sin protección en relación con las infecciones de transmisión sexual (ITS) continúa siendo la norma en casi todas partes. La doble protección –protección del embarazo no deseado, el VIH y otras ITS – es una forma de que las parejas heterosexuales tengan sexo más seguro, que es más necesitada que practicada o entendida. Este artículo se basa en una revisión de artículos sobre la planificación familiar, obstetricia y ginecología, en revistas relacionadas con el SIDA desde 1998 hasta principios de 2005. Las definiciones de la doble protección, encontradas principalmente en el material sobre la planificación familiar, son muy estrechas. El condón continúa siendo el pilar, pero el objetivo de este artículo es proporcionar una lista más amplia de los métodos de doble protección para mostrar que existe una variedad de opciones. Entre éstas figuran el sexo no penetrador y el uso en alza del condón con el respaldo de la anticoncepción de emergencia por parte de los jóvenes. El hecho de que las personas quizás no usen la doble protección de manera sistemática y correcta no es una razón válida para no promoverla. Nunca es muy tarde para que aquéllos que proporcionan servicios de planificación familiar y de prevención de ITS/VIH empiecen a promover el condón y la doble protección. A la larga, el desarrollo de métodos de doble protección de alta eficacia y aceptación es una urgente prioridad de investigación, comenzando por una mayor variedad de condones que atraerá a más personas.

Cervical human papillomavirus infections in commercial sex workers-risk factors and behaviours.

We have investigated the prevalence of, and risk factors for, cervical human papillomavirus (HPV) infection in commercial sex workers (CSWs) and controls attending the same sexual health clinics in Sydney. A self-administered 'risk factor' questionnaire was completed and a Pap smear and a specimen for HPV detection and typing were taken. Results from the 288 CSWs and 266 controls were assessed by univariate and multivariate analyses. No significant difference in the rates of cervical HPV infection in CSWs (31.6%) and controls (24.4%) was found but HPV related cytological abnormalities were more common on the CSWs (P <0.05). In both groups, factors independently associated with HPV infection were the use of non-barrier contraception, cytological abnormalities, age under 36 and the number of non-paying sexual partners. A risk factor for CSWs only was sex-work in Japan. A detailed 'work' history from CSWs may be useful to identify unsafe practices or work in countries where safer sex may be less acceptable.

Does large loop excision of the transformation zone of the cervix predispose to the development of antisperm antibodies in women?

To determine whether large loop excision of the transformation zone of the uterine cervix for cervical intraepithelial neoplasia predisposes to the development of female isoimmunity to human spermatozoa. A prospective, controlled study. Colposcopy and Andrology units at the John Radclife and Churchill Hospitals, Oxford, United Kingdom. Serum samples were collected from 33 women before large loop excision of the transformation zone of the cervix and repeated at a minimum time interval of 4 months after the procedure. Women were questioned regarding the procedure and subsequent reproductive function. A control population of 30 women not undergoing cervical surgery also underwent serial serum screening for antisperm antibodies. The detection of serum antisperm antibodies by flow cytometry. None of the serum samples before large loop excision of the cervical transformation zone had clinically significant levels of antisperm antibodies. There was, however, a significant rise in antisperm antibody levels in women following large loop excision of the transformation zone. Apparent risk factors for the development of antisperm antibodies included a short duration of sexual abstinence and the use of nonbarrier contraception after surgery. There was no rise in antisperm antibody levels in the control population. Large loop excision of the transformation zone of the cervix is a risk factor for the development of antisperm antibodies in women. Women should be advised to use barrier contraception or avoid sexual intercourse until complete healing of the cervix has occurred.

Immunosuppressive mechanisms in semen: implications for contraception.

The immunosuppressive effects of human seminal plasma are mediated by several factors. The prostaglandins (PG) of the E series (PGE and 19-hydroxy PGE) predominate and raise intracellular cAMP in leukocytes. By this mechanism they suppress lymphocyte proliferation, natural killer (NK) cell activity and are likely to modify cytokine release from antigen presenting cells (APC). In this way, acquired and innate responses (including immune surveillance) in the reproductive tract will be curtailed, at least temporarily, after intercourse. Semen contains several inhibitors of complement and a unique reservoirs of CD59, a major complement inhibitor, is found on the prostasomes which are sub-micron organelles with lipid membranes. The prostasomes also inhibit lymphocyte proliferation and the activity of phagocytic cells. Other suppressive agents are also present in semen and may exert specific effects, for example, transforming growth factor-beta which may inhibit primed responses to antigen, and receptors for Fc fraction of gamma-globulin which might bind inflammatory agents. A thesis is proposed that the balance between maximum chances of survival for spermatozoa and minimum chances for micro-organisms has been disturbed by an increased use of non-barrier contraception, an increase in population mobility and sexual contact and the arrival of new diseases such as AIDS. A further major concern is that following infection of cells of the cervix with virus, repeated exposure to human seminal plasma may accelerate the progression of disease.

4377030 Metallization of selectively implanted AIII-BV compound semiconductors

To describe abortion history and current contraceptive use among female sex workers (FSWs) in Moscow, Russia.A clinic-based survey was conducted among 147 FSWs in Moscow during an 8-month period in 2005.In total, 83 of 143 (58.0%) FSWs reported a history of abortion, with 45 of 143 (31.5%) indicating multiple abortions. Condoms were the primary form of contraception (145/146 [99.3%]); just 17 of 142 (12.0%) FSWs reported using non-barrier modern contraception. All women who reported using a non-barrier modern method also indicated condom use (i.e. dual protection). Non-barrier contraceptive use was associated with inconsistent condom use (odds ratio [OR] 3.10; 95% confidence interval [CI], 1.07–9.02) and multiple abortions (OR 4.71; 95% CI, 1.19–18.62).The results illustrate substantial risk for unintended pregnancy among FSWs. Further research is needed regarding the dynamics of non-barrier contraception and condom use. Efforts to improve the health and wellbeing of FSWs should include access to safe and effective contraception, in addition to HIV prevention.