Advancing Sexual and Reproductive Health and Rights
 
Perspectives on Sexual and Reproductive Health
Volume 35, Number 6, November/December 2003
FYI


CHOOSING DOES NOT MEAN USING

The majority of women who opted for a female-controlled over-the-counter barrier method after attending an educational session on sexual risk reduction at one of three clinics in the San Francisco Bay Area did not use the method during the next 12 months.1 After electing to use female condoms or a variety of spermicides, and receiving the quantity of supplies that they asked for, only 36-45% of women used the method. Twenty-three percent of women who chose the female condom and 40-79% of those who chose spermicides tried their method once and were highly satisfied with it; nonetheless, no more than half of these women used it again. On the other hand, two-thirds of those who opted for the female condom and up to one-third of those who selected spermicides reported a low level of satisfaction, and the majority of these women did not give their method a second try. Results for women who chose male condoms were quite different: Eighty-seven percent of this group used the method. Half of users were highly satisfied with it, and nine in 10 of these used it again; although three in 10 reported low satisfaction, two-thirds of this group used it again. According to the researchers, the findings underscore the need to "reframe" the way method acceptability is assessed so that "assessments are more closely aligned with future method use."

1. Minnis AM, Shiboski SC and Padian NS, Barrier contraceptive method acceptability and choice are not reliable indicators of use, Sexually Transmitted Diseases, 2003, 30(7):556-561.

SCREENING OPPORTUNITIES MISSED

Individuals who are infected with gonorrhea or chlamydia are at high risk for acquiring HIV or syphilis and thus would benefit from being tested for these diseases; for those on Medicaid, however, such testing is rare.1 In an examination of 1998 Medicaid data from four states, analysts found that only 19% of individuals with newly diagnosed gonorrhea or chlamydia infection were tested for either HIV or syphilis; only 7% were tested for both. Rates varied by state, but at best, fewer than half of patients were tested for either infection and one-fifth for both. Analyses controlling for patients' background characteristics, state and type of facility in which the first infection was detected revealed that males and 25-34-year-olds had reduced odds of being tested. The analysts comment that in addition to having "potentially adverse effects" for infected men and women, these low rates of testing represent "a huge gap in our national strategy for controlling the spread of HIV and for eliminating syphilis." They urge state Medicaid programs to work with public health officials to educate providers about the importance of HIV and syphilis testing among patients with other sexually transmitted diseases.

1. Rust G et al., Do clinicians screen Medicaid patients for syphilis or HIV when they diagnose other sexually transmitted diseases? Sexually Transmitted Diseases, 2003, 30(9):723-727.

DUAL USE GROWS AMONG TEENAGERS

Seven percent of sexually active U.S. teenagers surveyed in 2001 said they had used both a condom and a hormonal contraceptive at last sex, a significantly higher proportion than the 3% who reported using dual methods in 1991.1 Analyses of data from six Youth Risk Behavior Surveys, conducted among nationally representative samples of students in grades 9-12, show that similar increases occurred among males and females. Levels of dual use were significantly elevated among white students, youth aged 17 or older, and teenagers who had had fewer than four partners in the three months prior to the survey (8-9%). Despite limitations of the data and the measure of sexual activity used, the analysts conclude that sexually active teenagers are increasingly using dual methods to protect against pregnancy and sexually transmitted disease, and that this trend "could lead to further success by prevention programs in promoting this strategy."

1. Anderson JE, Santelli J and Gilbert BC, Adolescent dual use of condoms and hormonal contraception: trends and correlates 1991-2001, Sexually Transmitted Diseases, 2003, 30(9): 719-722.

WINE, WOMEN AND PREGNANCY

Wine drinkers who are trying to become pregnant may conceive in a shorter time than women who do not drink wine, according to a study of nearly 30,000 planned births in Denmark in 1997-2000.1 In an analysis controlling for a number of factors that may affect fecundity, the odds that women waited more than 12 months to conceive were reduced by about 30% among wine drinkers, and the reduction was about the same whether women reported drinking up to two glasses of wine weekly, between 2.5 and seven glasses, or more. By contrast, for women who consumed spirits while trying to become pregnant, the likelihood of waiting more than 12 months was reduced if consumption totaled no more than two drinks per week (odds ratio, 0.9) and were even lower (0.6) if it was in the 2.5-7-drink range, but were elevated (2.4) if weekly consumption was higher; beer drinking was not associated with waiting time until conception. Although other findings in the study were consistent with these, the researchers acknowledge that "the association between wine drinking and waiting time to pregnancy...was not very strong, and there was no clear dose-response pattern."

1. Juhl M et al., Intake of wine, beer and spirits and waiting time to pregnancy, Human Reproduction, 2003, 18(9):1967-1971.

YOU THINK YOU KNOW A PERSON

When people with sexually transmitted diseases (STDs) are asked their partner's age, race or ethnicity, or the duration of their relationship, they usually give the same answer as their partner; not so for other key indicators of sexual health risk.1 In a study comparing interview data from 151 clinic patients with gonorrhea or chlamydia and 189 of their partners, agreement between patients' and their partners' responses regarding several characteristics of the partner (injection-drug use, history of incarceration and, for male partners, circumcision status and bisexuality) and the relationship (condom use and frequency of communication) was moderate (kappas, 0.4-0.6). Agreement was low (0.2-0.3) on questions regarding the partner's sexual history, the couple's relationship before they began having sex and the quality of their communication. The researchers encourage "interventions to promote sexual health communication within partnerships" as a way to "generate greater awareness of partner risk behaviours and promote adherence to protective health strategies to reduce risk of STD transmission."

1. Stoner BP et al., Avoiding risky sex partners: perception of partners' risks v partners' self reported risks, Sexually Transmitted Infections, 2003, 79(3): 197-201.

YOUNG WOMEN GAIN ON CANCER

Between 1973 and 1999, the annual incidence of invasive cervical cancer among U.S. women younger than 30 declined from nearly two to 1.3 per 100,000 women; analysts studying surveillance data from the National Cancer Institute estimate that the annual reduction was nearly 1%.1 Trends for the two most common types of cervical cancer differed: The incidence of squamous cell carcinoma followed the overall pattern, declining by about 1% per year, from 1.3 to less than one per 100,000. By contrast, the incidence of adenocarcinoma increased by almost 3% annually, from less than 0.1 per 100,000 to 0.2 per 100,000; it leveled off, however, after 1990. The analysts contend that if the findings are valid, they may reflect that aggressive screening among young women is compensating for increases in the prevalence of several risk factors for cervical cancer. Striking a balance between effective screening and increasing risk factors, they add, "might result in a stable trend over time."

1. Chan PG, Sung H-Y and Sawaya GF, Changes in cervical cancer incidence after three decades of screening US women less than 30 years old, Obstetrics & Gynecology, 2003, 102(4): 765-773.

INCHING TOWARD A MALE METHOD

A male contraceptive method involving testosterone implants and progestin injections produced very promising results in a preliminary study, and the findings pave the way for more extensive trials of this approach.1 The 55 study participants—healthy Australian men in stable relationships in which neither partner had a history of infertility—received the implants every four or six months and injections every three months. They continued to use barrier contraceptives until sperm production was suppressed (which took no more than three months for 94% of the men), then discontinued other method use for one year. None of the men's partners became pregnant during the study period; participants experienced no adverse effects of the drugs, and their normal sperm production resumed soon after they stopped using the method. Noting that this was the first study to examine the contraceptive efficacy of a long-term male combined hormonal method, the investigators conclude that the results demonstrate the medical and scientific feasibility of commercial development of such methods.

1. Turner L et al., Contraceptive efficacy of a depot progestin and androgen combination in men, Journal of Clinical Endocrinology & Metabolism, 2003, 88(10):4659-4667.

HISTORY REPEATS ITSELF

Adolescent women who are physically assaulted by a romantic partner are at increased risk of having a similar experience during their first year of college; furthermore, throughout the college years, the risk of experiencing dating violence is elevated among those who have been victimized in the past.1 In a longitudinal study of 1,569 university women, nine in 10 reported that a partner had physically or sexually assaulted them at least once between adolescence and their fourth year of college: Eleven percent had experienced only physical abuse, 14% only sexual abuse and 64% both. The risk of physical abuse by a partner during the first year of college was three times as high among women who had been abused previously as among others (relative risk, 3.0); during each subsequent year of college, women who had experienced physical abuse in the past were 3-4 times as likely as others to experience abuse. Women also were at risk of physical assault during a given year if they had been sexually assaulted that same year (prevalence ratios, 1.5-3.1). The investigators conclude that preventing dating violence among teenagers may help to "prevent dating violence during college and possibly domestic violence in adulthood."

1. Smith PH, White JW and Holland LJ, A longitudinal perspective on dating violence among adolescent and college-age women, American Journal of Public Health, 2003, 93(7):1104-1109.

IN BRIEF

America's Children: Key National Indicators of Well-Being, 2003 presents a detailed picture of the context in which children live, including population and family characteristics and indicators of children's economic security, health, behavior and social environment, and educational attainment. The report, the seventh annual product of the Federal Interagency Forum on Child and Family Statistics, may be obtained online at http://childstats.gov.

•Regardless of whether they are sexually experienced, the overwhelming majority of U.S. 15-17-year-olds think that it is "a good thing" to postpone sexual involvement until after high school, according to results of a nationally representative survey conducted by the Kaiser Family Foundation and seventeen magazine. Teenagers also see a variety of benefits to waiting, including issues related to respect, religious values, and pregnancy and health concerns. The survey report, Virginity and the First Time, is available from Kaiser at www.kff.org.