Context: Few U.S. women protect themselves against both pregnancy and sexually transmitted diseases (STDs) by using an efficient contraceptive method and a condom. Understanding the factors that influence dual-method use could help improve interventions aimed at encouraging protective behaviors.
Methods: Interviews were conducted with 552 low-income women at risk of HIV who attended public health or economic assistance facilities in Miami in 1994 and 1995. Multinomial logit analyses were used to determine the influence of women's background characteristics, perceived vulnerability to pregnancy and AIDS, and relationship characteristics on the odds of dual-method use.
Results: Overall, 20% of the women used dual methods. Women who were not married, who worried about both pregnancy and AIDS, who had ever had an STD, who were confident they could refuse a sexual encounter in the absence of a condom and who made family planning decisions jointly with their partner were the most likely to use dual methods rather than a single method (odds ratios, 2.0–3.5); those who considered the condom only somewhat effective in preventing AIDS or who shared economic decision-making with their partner were the least likely to use dual methods rather than a single method (0.5–0.6). The results were generally similar in analyses examining the odds of dual-method use involving an efficient contraceptive, except that black and Hispanic women were significantly more likely than whites to use condoms in conjunction with efficient contraceptives (3.3–7.1).
Conclusions: Both women's individual characteristics and the context of their sexual relationships influence whether they simultaneously protect themselves from pregnancy and HIV. The involvement of male partners in family planning decision-making and women's control over economic decision-making ensure greater protection against HIV infection.
Family Planning Perspectives, 1998, 30(5):212–217
Kara S. Riehman is research fellow, UCLA Drug Abuse Research Training Center, UCLA School of Medicine, Los Angeles. Hosanna Soler is graduate assistant and Isaac W. Eberstein is professor, Center for the Study of Population and Department of Sociology; David F. Sly is professor, Center for the Study of Population and Department of Geography; David Quadagno is professor, Department of Biological Sciences; and Dianne F. Harrison is dean of the School of Social Work—all at Florida State University, Tallahassee. The research on which this article is based was supported by grant RO1-HD31025-01-04 from the National Institute of Child Health and Human Development.