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Moving the Message Beyond the Methods: Toward Integration of Unintended Pregnancy and Sexually Transmitted Infection/HIV Prevention

Published:December 26, 2017DOI:https://doi.org/10.1016/j.amepre.2017.10.022
      Preventing unintended pregnancy and sexually transmitted infections (STIs), including HIV, are public health priorities in the U.S.

      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.

      Recognizing that both outcomes are related to sexual behavior, experts have called for integration of these prevention efforts.
      • Bearinger L.H.
      • Resnick M.D.
      Dual method use in adolescents: a review and framework for research on use of STD and pregnancy protection.
      • Cates Jr, W.
      Sexually transmitted diseases and family planning. Strange or natural bedfellows, revisited.
      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,
      • Cates Jr, W.
      • Steiner M.J.
      Dual protection against unintended pregnancy and sexually transmitted infections: what is the best contraceptive approach?.
      recent estimates indicate with typical use they are associated with a 13% pregnancy rate during the first year.
      • Sundaram A.
      • Vaughan B.
      • Kost K.
      • et al.
      Contraceptive failure in the United States: estimates from the 2006–2010 National Survey of Family Growth.
      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.
      • Gavin L.
      • Moskosky S.
      • Carter M.
      • et al.
      Providing quality family planning services: recommendations of CDC and the U.S. Office of Population Affairs.
      However, this behavior is uncommon.
      • Eisenberg D.L.
      • Allsworth J.E.
      • Zhao Q.
      • Peipert J.F.
      Correlates of dual-method contraceptive use: an analysis of the National Survey of Family Growth (2006–2008).
      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.
      • Eisenberg D.L.
      • Allsworth J.E.
      • Zhao Q.
      • Peipert J.F.
      Correlates of dual-method contraceptive use: an analysis of the National Survey of Family Growth (2006–2008).
      • Steiner R.J.
      • Liddon N.
      • Swartzendruber A.L.
      • Rasberry C.N.
      • Sales J.M.
      Long-acting reversible contraception and condom use among female U.S. high school students: implications for sexually transmitted infection prevention.
      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,
      • Potter J.
      • Soren K.
      Long-acting reversible contraception and condom use: we need a better message.
      particularly because LARC use is increasing.
      • Branum A.M.
      • Jones J.
      Trends in long-acting reversible contraception use among U.S. women aged 15–44.
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