Preventing unintended pregnancy and sexually transmitted infections (STIs), including
HIV, are public health priorities in the U.S.
1
Recognizing that both outcomes are related to sexual behavior, experts have called
for integration of these prevention efforts.
Healthy People 2020. Washington, DC: U.S. DHHS, Office of Disease Prevention and Health Promotion. www.healthypeople.gov/2020/topics-objectives. Accessed June 17, 2017.
2
,
3
Yet, integrating unintended pregnancy and STI/HIV prevention is challenging, partly
because the most effective contraceptive options for preventing pregnancy provide
no protection against STIs/HIV. Although condoms can be 98% effective at preventing
pregnancy when used correctly and consistently,
4
recent estimates indicate with typical use they are associated with a 13% pregnancy
rate during the first year.
5
Use of a condom for STI/HIV prevention along with a more effective method for pregnancy
prevention (e.g., intrauterine devices [IUDs], implants, oral contraceptives) is thus
typically recommended for heterosexual couples who are not in a mutually monogamous
relationship.
6
However, this behavior is uncommon.
7
Moreover, recent evidence suggests that users of long-acting reversible contraception
(LARC), namely implants and IUDs, are less likely to use condoms compared with users
of oral contraceptives.
7
,
8
Although the impact of LARC use on STI rates remains unclear, these findings have
renewed attention on STI prevention within the context of pregnancy prevention,
9
particularly because LARC use is increasing.
10
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References
Healthy People 2020. Washington, DC: U.S. DHHS, Office of Disease Prevention and Health Promotion. www.healthypeople.gov/2020/topics-objectives. Accessed June 17, 2017.
- Dual method use in adolescents: a review and framework for research on use of STD and pregnancy protection.J Adolesc Health. 2003; 32: 340-349https://doi.org/10.1016/S1054-139X(03)00018-1
- Sexually transmitted diseases and family planning. Strange or natural bedfellows, revisited.Sex Transm Dis. 1993; 20: 174-178https://doi.org/10.1097/00007435-199305000-00011
- Dual protection against unintended pregnancy and sexually transmitted infections: what is the best contraceptive approach?.Sex Transm Dis. 2002; 29: 168-174https://doi.org/10.1097/00007435-200203000-00007
- Contraceptive failure in the United States: estimates from the 2006–2010 National Survey of Family Growth.Perspect Sex Reprod Health. 2017; 49: 7-16https://doi.org/10.1363/psrh.12017
- Providing quality family planning services: recommendations of CDC and the U.S. Office of Population Affairs.MMWR Recomm Rep. 2014; 63: 1-54
- Correlates of dual-method contraceptive use: an analysis of the National Survey of Family Growth (2006–2008).Infect Dis Obstet Gynecol. 2012; 2012: 717163https://doi.org/10.1155/2012/717163
- Long-acting reversible contraception and condom use among female U.S. high school students: implications for sexually transmitted infection prevention.JAMA Pediatr. 2016; 170: 428-434https://doi.org/10.1001/jamapediatrics.2016.0007
- Long-acting reversible contraception and condom use: we need a better message.JAMA Pediatr. 2016; 170: 417-418https://doi.org/10.1001/jamapediatrics.2016.0141
- Trends in long-acting reversible contraception use among U.S. women aged 15–44.NCHS Data Brief. 2015; 188: 1-8
The National Campaign to Prevent Teen and Unplanned Pregnancy. Whoops proof birth control: how to reach women and increase their positive regard for the most effective methods of contraception. https://thenationalcampaign.org/sites/default/files/resource-primary-download/whoops_proof_insights.pdf. Accessed August 13, 2017.
- Condom use by adolescents.Pediatrics. 2013; 132: 973-981https://doi.org/10.1542/peds.2013-2821
Planned Parenthood. Advanced sex ed: dual use. http://plannedparenthood.tumblr.com/post/119202600875/welcome-to-advanced-sex-ed-put-on-your-smarty. Accessed June 17, 2017.
- Motivations for condom use: do pregnancy prevention goals undermine disease prevention among heterosexual young adults?.Health Psychol. 1999; 18: 464-474https://doi.org/10.1037/0278-6133.18.5.464
- Beyond HIV microbicides: multipurpose prevention technology products.BJOG. 2014; 121: 62-69https://doi.org/10.1111/1471-0528.12852
- Two good reasons: women’s and men’s perspectives on dual contraceptive use.Soc Sci Med. 1999; 49: 567-580https://doi.org/10.1016/S0277-9536(99)00060-X
- Strategies for managing the dual risk of sexually transmitted infections and unintended pregnancy among Puerto Rican and African American young adults.Am J Public Health. 2012; 102: 449-456https://doi.org/10.2105/AJPH.2011.300461
Kempner M. Why the CDC stopped calling sex without a condom “unprotected sex.” https://rewire.news/article/2014/02/24/cdc-stopped-calling-sex-without-condom-unprotected-sex/. Published 2014. Accessed June 17, 2017.
- Motivational Interviewing: Helping People Change. 3rd ed. Guilford Press, New York2013
- A national strategy to improve sexual health.JAMA. 2010; 304: 1005-1006https://doi.org/10.1001/jama.2010.1252
Article info
Publication history
Published online: December 26, 2017
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Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine
