Are Dual-Method Messages Undermining STI/HIV Prevention?

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Are Dual-Method Messages Undermining STI/HIV Prevention?

  1. 1. Are Dual-Method Messages Undermining STI/HIV Prevention? Ann O’Leary Senior Behavioral Scientist National HIV Prevention Conference August 17, 2011 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Place Division name here
  2. 2. Why recommend use of dual methods?□ Many teens and young women are at risk for both of two events: ■ Unintended pregnancy ■ Among low-income women, 62% of pregnancies were unintended ■ 410,000 births among teens in 2009 ■ Sexually transmitted infections (STIs), including HIV ■ 38% of teen girls; 44% of black girls, had an STI in 2009 Condoms are extremely effective against STIs and HIV Condoms are less effective against pregnancy than HC* All references available upon request of O’Leary, 2011 paper
  3. 3. Why recommend use of dual methods (cont.)? In theory, the use of hormonal contraceptives and condoms together should prevent both of these adverse effects of sex Thus, guidelines from “Healthy People” and the World Health Association recommend counseling young women to use HC and condoms. But how many do?* All references available upon request of O’Leary, 2011 paper
  4. 4. Do women use dual methods?□ Review of literature reveals few teens and young women use hormonal contraceptive (HC) and condoms: ■ In 2009, YRBS showed the following rates of dual-method use: ■ 10.7% of whites ■ 3.6% of blacks ■ 3.9% hispanics ■ Even among dual method users, consistent use is not common ■ In general, younger women use condoms alone and, when a committed relationship is established, they use HC alone* All references available on request of O’Leary, 2011 paper
  5. 5. Problems with multiple messages□ The second of two may not be processed cognitively□ If primary concern is addressed (most frequently pregnancy) other risk reduction method may be foregone (risk compensation) Condom negotiation with partner may be more difficult if partner knows HC is being used.* All references available on request of O’Leary, 2011 paper
  6. 6. How effective are interventions to increase dual method use?□ Literature review suggests promoting dual use is difficult. Interventions that have been tested have yielded: □ Inconsistent results □ Null results □ Non-sustained results* All references available on request of O’Leary, 2011 paper
  7. 7. Who are successful dual method users?□ Relationship characteristics: □ Single, young, in uncommitted relationship □ At lower risk-fewer partners□ Motivations for use: □ More concerned about HIV/STI □ Among teens, STRONG desire to avoid pregnancy* All references available on request of O’Leary, 2011 paper
  8. 8. A proposed RCT□ Two arms: □ Use HC and condoms □ Use condom s only Provide all participants with condoms and emergency contraception (EC)* All references available on request of O’Leary, 2011 paper
  9. 9. Messages for proposed RCT arms□ Two arms: □ “I recommend that you use a hormonal contraceptive to prevent pregnancy, and condoms to prevent sexually transmitted disease, including HIV.” □ “I recommend that you use condoms to prevent pregnancy and sexually transmitted disease, including HIV.”* All references available on request of O’Leary, 2011 paper
  10. 10. A proposed RCT (cont.)□ Hypotheses: □ Fewer sexually transmitted diseases in condom-only arm □ More use of EC, possibly pregnancy, in condom-only arm We could also identify the characteristics of successful dual- method users and successful condom-only under conditions of controlled messaging so that messages can be tailored to women with different profiles* All references available on request of O’Leary, 2011 paper
  11. 11. Is this RCT ethical?□ Some think no: □ Randomization removes women’s free reproductive choice □ It is wrong to randomize some women to an inferior form of birth control* All references available on request of O’Leary, 2011 paper
  12. 12. Is this RCT ethical? (cont.)□ Responses to these arguments: □ Randomization will occur only after informed consent; participants are free to discontinue study or make own reproductive choices irrrespective of participation. □ It may also be morally problematic to prescribe hormonal contraception to women who are at risk for STI/HIV.* All references available on request of O’Leary, 2011 paper
  13. 13. Summary□ Dual protection is routinely recommended to teens and young women.□ Most of these women do not use dual methods.□ Use of hormonal contraceptives is associated with non- use of condoms.□ The possibility that dual-method recommendations are adding substantially to the societal burden of STI/HIV compared with condom-only recommendations is an empirical question that can be answered via a randomized controlled trial.* All references available on request of O’Leary, 2011 paper
  14. 14. Email address:aoleary@cdc.gov
  15. 15. The views presented here are thoseof the author and do not reflectnecessarily represent the officialposition of the CDC.

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