Act Of Unprotected Intercourse Research Articles

Accurate information as a tool to decrease HIV test refusals in research studies.

It has been argued that researchers conducting surveys that include testing for human immunodeficiency virus (HIV) have a duty to tell potential subjects that they do not have the right to participate if they refuse to receive their HIV test results.1,2 Furthermore, promotion of the routine feedback of such test results has been based on the grounds that knowledge is power and information is liberation.3 However, other researchers argue that, although it is desirable to offer study participants post-test counselling, for practical and ethical reasons some study participants should be given the right to refuse such counselling.4 Although we support the right of participants to opt out of post-test counselling and thus not to receive their test results, we also propose that subjects who are – or may be – tested for HIV should be given information that may decrease their resistance to learning their test results. We draw on data, collected between 1998 and 2013, on rural Malawians’ experience with – and perceptions of – HIV testing. From the perspective of the organizations that promote HIV testing, it is axiomatic that people will benefit from knowing their HIV status. In Maher’s view, such benefit justifies sanctioning those who refuse to receive their test results.2 We disagree, for two reasons. First, the experience of many Malawians is that refusal to consent to testing may have serious consequences. For example, although the policy for antenatal HIV testing in Malawi includes an opt-out provision, accounts from pregnant women attending antenatal clinics show that HIV testing is compulsory if the women are to receive antenatal care.5 Moreover, in population-based HIV surveys, fieldworkers are always under pressure to minimize the numbers of test refusals and may exert undue pressure on individuals who do not want to receive their test results. While exclusion from antenatal services is, presumably, much more serious than exclusion from survey participation, in both of these examples people are sanctioned for not giving consent – which is a clear ethical violation. Second, our ethnographic data depict the anguish that many suffer as they anticipate the future receipt of their test results – an issue that has rarely been discussed in the public health and social science literature.6 Two common misperceptions among rural Malawian adults are that the result of an HIV test will almost always be positive and that a positive result will inevitably be followed by hastening psychological deterioration, suicidal thoughts and death. Yet survey data from people living in rural Malawi show that between 80% and 90% of respondents who believed that they were HIV-positive before they were tested learned that they were HIV-negative.7,8 That so many are convinced, wrongly, that an HIV test will inevitably produce a positive diagnosis is the consequence of rural Malawians’ incorrect understanding of the probabilities of HIV transmission. For example, most of our survey respondents believed that an uninfected individual was certainly or highly likely to be infected with HIV during a single act of unprotected intercourse with an infected person.8 Would it not be preferable to treat those living amidst the HIV epidemic as having an ethical right to accurate information on the probabilities of transmission? Efforts should be made to evaluate the potential benefits of disseminating accurate information on the probabilities of transmission, the approximate prevalence of HIV infection and the probability of a positive result in an HIV test – such that consent for HIV testing in surveys is fully, rather than incompletely, informed. We need to know whether such health education would be a liberation, lead to fewer test refusals in research studies and, importantly, increase the number of people who are willing to know their HIV status.

Contraceptive needs of women seeking care from a publicly funded sexually transmitted infection clinic

Objectives To determine the contraceptive needs [including emergency contraception (EC)] of women seeking care from a publicly funded sexually transmitted infection (STI) clinic and to better understand women's knowledge of and attitudes towards EC. Methods An anonymous survey was administered to 197 women seeking services at one Chicago Department of Public Health STI clinic. Results After excluding women unlikely to become pregnant within the next year because of age, sexual orientation, hysterectomy and those who desired pregnancy ( n=47), data from 150 women were available for analysis. Thirteen percent were using “very effective” contraception (intrauterine contraception, implant or sterilization) and 26% were using “effective” contraception (contraceptive pill, patch, ring or injectable). Approximately 23% (95% CI 16.5–30.0%) may have benefited from immediate use of EC as they reported at least one act of unprotected intercourse within the past 5 days. Conclusion Many women seeking care from public STI clinics are at high risk of unintended pregnancy. A substantial number of women have an immediate need of EC at the time of their clinical visit. Efforts are needed to improve provision of EC as well as effective ongoing contraception for this population.

Accuracy of information given by Los Angeles County pharmacies about emergency contraceptives to sham patient in need

Background As emergency contraception (EC) becomes increasingly available without prescription, it is important that women in need be provided accurate information about its use. Study Design A telephone survey of all retail pharmacies in Los Angeles County was conducted by women posing as a 23-year-old who wanted to prevent pregnancy after an unprotected act of intercourse. Results One thousand four hundred sixty unduplicated pharmacies listed in the Yellow Pages 2007 were called between October 2007 and April 2008. Sixty-nine percent had EC available on site; 19% referred the caller elsewhere. The remainder said nothing could be done or hung up. Multiple calls and multiple recitations of the situation were needed in over one third of calls. Isolated incidents of inappropriate comments occurred. Conclusion While most pharmacies provided information about EC that was consistent with labeling, barriers still exist to both accurate information and timely access to that product.

An Update on Emergency Contraception Use in Adolescents

Changing circumstances regarding access to emergency contraception (EC) warrant nurses' review of its current status. Nurses have the potential to improve adolescents' awareness of and access to EC so that adolescents may prevent pregnancy. Research suggests that adolescents lack awareness of EC methods that prevent pregnancy following an unprotected act of intercourse. Many pregnancies occurring in adolescence could be prevented with appropriate EC use. Studies show that adolescents are capable of using EC correctly and safely, and that access to EC is not associated with increased rates of unprotected intercourse or with higher rates of pregnancy or sexually transmitted infections.

Emergency contraception in Cuba with 10 mg of mifepristone

Background Mifepristone in a dose of 10 mg is an effective emergency contraceptive when administered up to 120 hours after unprotected coitus.Methods Between May 2003 and February 2005, we conducted in Cuba a single-arm trial to evaluate the effectiveness of 10 mg mifepristone for emergency contraception up to 6 days after unprotected coitus. A total of 635 women who requested emergency contraception after a single act of unprotected intercourse were included in the study.Results After treatment there were 7/635 (1.1%) pregnancies (95% CI 0.4–2.3%). Pregnancy that might have occurred was prevented in 88.0% of the cases (95% CI 77.1–95.1%). The most common side effects reported by participants were fatigue (10.7%), dizziness (6.1%) and nausea (4.9%); vomiting was only reported by 0.6%. In 38/635 (6.0%) women menstruation was delayed more than 7 days.Conclusions Mifepristone 10 mg administered is an effective emergency contraceptive with an acceptable profile of side effects up to five days, but greater studies are necessary to verify its efficacy up to 6 days after unprotected intercourse.

What‘s new in the other journals?

What‘s new in the other journals?

Current Issues in Emergency Contraception: An Overview for Providers

Emergency contraception has the potential to greatly reduce the number of unintended pregnancies occurring each year in the United States. Emergency contraception is a safe and effective intervention to which all women should have easy access in the event of an act of unprotected intercourse. Methods of emergency contraception include combined hormone oral contraceptive pills, progestin-only oral contraceptive pills, a dedicated progestin-only emergency contraceptive product, and insertion of a copper intrauterine device. Barriers exist to the increased use of emergency contraception, including the prescription-only status of all of the methods and lack of accurate knowledge on the part of health care providers and consumers. This article provides an overview of the clinical management of emergency contraception.

Sexual Compulsivity and HIV Serostatus Disclosure Among Men Who Have Sex with Men

To explore associations among sexual compulsivity, HIV serostatus disclosure, and sexual risk behaviors, data were collected from 180 gay and bisexual men living with HIV upon their self-enrollment into mental health care at an inner-city clinic. Results indicated associations among level of sexual compulsivity and a participant s likelihood of participation in high-risk sexual behavior, their perceived level of responsibility to disclose HIV serostatus to sexual partners, and whether they had disclosed their HIV status to a sexual partner in their most recent act of unprotected intercourse. These findings suggest the need to include, across the continuum of HIV care, activities related to the assessment of, and response to, sexual compulsivity and its association with behaviors likely to sustain the HIV epidemic.

A randomized comparative study on mifepristone alone and in combination with tamoxifen for emergency contraception

The purpose of the clinical study was to compare the efficacy and side effects of 10 mg of mifepristone alone (Group 1) and with 20 mg of tamoxifen (Group 2) for emergency contraception, especially as used within 72∼120 h after coitus. Four-hundred female volunteers with one act of unprotected intercourse or contraception failure (200 cases in each group) were recruited and completed the study. There were 198 women treated < 72 h after coitus (100 in Group 1 and 98 in Group 2), whereas the remaining 202 patients were treated between 72∼120 h (100 in Group 1 and 102 in Group 2). In total, four pregnancies occurred; one treated < 72 h in each group, two between 72∼120 h in Group 1. Efficacy for prevention of unwanted pregnancy by Trussell method is 84% for Group 1, and 95% for Group 2, and which is not significantly different between the two groups and even subgroups. The side effects (15.5% for Group 1 and 14.5% for Group 2) and changes in menstruation were infrequent and mild in both groups. Further studies should be conducted to determine whether tamoxifen combined with mifepristone for emergency contraception is more effective as compared with mifepristone alone.

STDs, AIDS and reproductive health.

In 1994, at the 10th International Conference on AIDS, the World Health Organization estimated that between 153 and 328 million cases of curable sexually transmittable disease (STD) occur in the world every year. Additionally between 52 and 122 million cases of gonorrhea occur; 57 to 102 million cases of trichomoniasis; 20 to 72 million cases of chlamydia; 10 to 24 million cases of syphilis and 5 to 7 million cases of chancroid. For 40 years, antibiotics have been available to treat common bacterial and protozoal STDs, so why does a problem still exist? The persistently high level of STD globally is not only a problem which can be referred to developing countries and the failing health policies. In the United States more than 12 million cases of STD occur per year. This figure includes 2.5 million teenagers. Some individuals are infected repeatedly and many have more than one infection simultaneously. Chlamydia infection is most commonly found, approximately 4 million episodes per year. The second most commonly found STD is trichomoniasis with approximately 3.0 million episodes per year. This is followed by gonorrhea, various non-specified urethritis and cervicitis. Finally, genital warts comprise a million cases. Genital herpes, hepatitis B and syphilis are less frequently found. Therefore, there is a wide variety of STDs caused by different organisms and they also have different clinical symptoms. Some people show no symptoms of illness. Though unaware they are carrying the disease, they may be able to transmit the disease to others. People who have more than one partner are at risk of acquiring an STD, as are those who have sex with someone who has multiple partners. The risk of transmission of STDs is extremely high. Each time a woman changes her sexual partner she faces the risk of contracting disease. If her partner has an STD, the probability of the woman becoming infected is high. By one single act of unprotected intercourse with a man infected by gonorrhea, the woman is running a 50% risk of contracting gonorrhea. Depending upon the infection of her partner the woman is running a 30-40% risk of contracting the disease by a single act of unprotected intercourse. In most cases, women are more susceptible to STDs than

History and Efficacy of Emergency Contraception: Beyond Coca-Cola

Over 30 years of clinical use of emergency contraception has confirmed that such methods substantially reduce the chances of pregnancy, do not entail onerous service provision requirements, and are acceptable to women. The major obstacle to the more widespread use of postcoital methods is a lack of awareness on the part of both potential acceptors and service providers of this important option. Most extensively researched have been the Yuzpe method (200 mcg of ethinyl estradiol and 1.0 mg of levonorgestrel, taken within 72 hours of unprotected intercourse and then 12 hours later), levonorgestrel (two doses of 0.75 mg 12 hours apart starting within 48 hours of unprotected intercourse), and postcoital insertion of a copper IUD. Two new agents--RU-486 and the synthetic progestin and antigonadotropin danazol--offer promise, but require further evaluation. The Yuzpe method is estimated to reduce the likelihood of pregnancy by at least 75%. Lacking in the available literature are studies with rigorous research designs and methodologies capable of generating reliable data on efficacy and side effects, especially among women in developing countries. There is a need, for example, to limit samples to women who have had only one act of unprotected intercourse during a menstrual cycle and to those of proven fertility. Also important are studies that evaluate a range of distributional systems (e.g., vending machines) and user educational approaches. Finally, studies are needed to determine whether the Yuzpe method can be broadened to encompass all the progestins (e.g., desogestrel) used in combined oral contraceptives.

The Effectiveness of the Yuzpe Regimen of Emergency Contraception

A review of the 10 clinical trials of the Yuzpe method of emergency contraception that reported the data required to calculate effectiveness rates suggests that this may be a more accurate measure of efficacy than the failure rate. The Yuzpe regimen, which involves the administration of 200 mcg of ethinyl estradiol and 2.0 mg of norgestrel, was associated with failure rates ranging from 0.2% to 2.8%; the pooled rate was 1.5% (95% exact confidence interval, 1.2-1.9%). The equality of failure rates across studies was compromised by two assumptions: women lost to follow-up (as high as 22%) became pregnant at the same rate as women observed, and all women in the trials had an equal probability of failure. The effectiveness rate--the proportionate reduction in the probability of conception caused by emergency contraception use--avoids these sources of error by including data on both the observed and expected number of pregnancies and computing the risk of conception for each day of the menstrual cycle. These estimates range from 55.3% to 94.2%, with a pooled effectiveness rate of 74.0% (95% exact confidence interval, 68.2-79.3%). On the other hand, four methodological issues are inherent in use of the effectiveness rate: the assumption of homogeneity implicit in pooling observations, bias introduced by the unknown pregnancy rate among women lost to follow-up, the probability some women violated study protocol and had more than one unprotected act of intercourse during their cycle, and possible underestimation of the expected number of pregnancies.

A Model of Age-specific Fecundability

A new model of the behavioural and physiological causes of age-specific variation in marital fecundability is presented. Total fecundability is decomposed into a series of susceptibility factors (the length of ovarian cycles, the length of the fertile period within each cycle, the probability that a cycle is ovulatory, and the likelihood that an act of unprotected intercourse within the fertile period results in conception) and an exposure factor reflecting the effect of duration of marriage on coital frequency. The impact of intra-uterine mortality on effective fecundability is also modelled. Data on western women, from which standard age curves of fecundability are estimated, suggest that any decline in fecundity between ages 30 and 40 is attributable to changes, not in the ability to conceive, but in the capacity to carry a pregnancy to term. Sensitivity tests suggest that the most important potential sources of inter-population variation in fecundability are intra-uterine death and the incidence of an...

Postcoital contraception.

The evolution of postcoital contraception has led to the development of emergency measures to be used following a single unprotected act of intercourse and to ongoing methods, such as the administration of a contraceptive steroid agent following every coital exposure. In emergency situations, the most commonly employed hormonal steroids are the synthetic, conjugated and natural estrogens, administered in large doses for five days. Recently, a combination of an estrogen and a progestin has been employed for the same purpose. A copper-bearing intrauterine device (IUD), inserted within seven days of coitus, has also been utilized with success. Progestins alone have been utilized as an ongoing method of postcoital contraception. Failure rates have been found to vary with the dosage, the specific progestin employed and the frequency of intercourse. The major role of postcoital contraception in the developed world appears to be as an emergency measure. Ease of availability, a high degree of efficacy and a low incidence of side effects are essential for patient and physician acceptance.