Context: Women who rely on long-term hormonal contraception may neglect to use condoms, and thus increase their risk of contracting sexually transmitted diseases, including AIDS.
Methods: Data from a prospective, multisite study were collected to examine the probability of condom use among 1,073 new users of either the contraceptive implant or injectable; users were interviewed when they accepted their method and again six months to one year later. Multivariate logistic regression analyses identified factors that significantly predicted the likelihood of dual method use.
Results: Condom use dropped markedly among women who adopted long-term hormonal contraception. The proportion who always used condoms in the previous three months fell from 21% at the time of adoption to 11% at follow-up. Among women with one sexual partner, this decrease was from 20% to 10%; however, among those with more than one partner, use increased from 25% to 31%. The factors significantly predicting dual method use included previous condom use (odds ratio of 2.5), receipt of AIDS-specific counseling (odds ratio of 1.6), the perception of being at some risk of AIDS at baseline (odds ratio of 1.4) and having had more than one sexual partner over the study period (odds ratio of 5.4). In addition, injectable users, teenagers and black women were more likely than other women to use condoms with their hormonal method.
Conclusions: Although condom use among all women declined markedly once they initiated long-term hormonal contraception, frequency of condom use varied by subgroup and was associated with several factors. Most importantly, women with more than one sexual partner and those who received a message during counseling on the need to continue using condoms were more likely than others to use condoms in conjunction with the implant or injectable.
Family Planning Perspectives, 1998, 30(5):240-243
Linda F. Cushman is associate clinical professor of public health, Diana Romero is a doctoral candidate and research assistant, Debra Kalmuss is associate professor of public health and Andrew R. Davidson is professor of public health, all at the Center for Population and Family Health, Columbia University School of Public Health, New York. Stephen Heartwell is associate professor of public health in the Department of Obstetrics and Gynecology and is director of the Division of Maternal Health and Family Planning at the University of Texas Southwestern Medical Center, Dallas. Marvin Rulin is professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at Magee Women's Hospital, Pittsburgh. The research on which this article is based was supported by grant R01-HD29638 from the National Institute of Child Health and Human Development and by grant 93-1071 from The Henry J. Kaiser Family Foundation.