RESUMEN
OBJECTIVES: This study examined condom use in legal Nevada brothels. METHODS: Forty female prostitutes in two brothels were interviewed about client resistance to condoms and techniques for facilitating condom use. RESULTS: Of 3290 clients in the previous month, 2.7% (95% confidence interval [CI] = 2.2%,3.4%) were reluctant to use condoms. Of these individuals, 72% ultimately used condoms, while 12% chose nonpenetrative sex without condoms. The remaining 16% left the brothels without services. Condom use rates were markedly lower with nonpaying sex partners (lowers) than with clients. CONCLUSIONS: Brothel prostitutes may be at greater risk for acquiring HIV and other sexually transmitted diseases from lovers than from clients.
Asunto(s)
Condones , Conocimientos, Actitudes y Práctica en Salud , Comunicación Persuasiva , Trabajo Sexual/psicología , Parejas Sexuales/psicología , Adulto , Empleo/legislación & jurisprudencia , Empleo/estadística & datos numéricos , Femenino , Humanos , Masculino , Estado Civil , Persona de Mediana Edad , Nevada , Factores de Riesgo , Trabajo Sexual/legislación & jurisprudencia , Enfermedades de Transmisión Sexual/prevención & control , Encuestas y CuestionariosRESUMEN
PIP: This article answers some questions about use of emergency contraceptive pills (ECP) in the US. It is acceptable to prescribe ECPs over the telephone. ECPs should not be given to women with severe migraine headaches with neurologic impairment. ECPs are acceptable for women who are smokers and over 35 years old, diabetics with vascular disease, women with a history of severe migraine, and women with a benign or malignant liver tumor. Women who seek ECPs over 72 hours after unprotected sexual intercourse could have ECPs, insertion of a Copper T380 IUD, or Ru-486, when available in the US. Lo-Ovral4+4 is the preferred ECP. Ovral2+2 is less often available and tends to cost more. An ECP prescription might indicate Phenergan (25 mg), 4 tablets, taken between 6 and 7 PM, and repeated in 12 hours. Another ECP prescription might indicate Lo-Ovral (21-pill pack), 4 tablets taken one half hour after anti-nausea medication, and repeated in 12 hours. If nausea is severe from the first or second dose of Lo-Ovral, an extra tablet of Phenergan may be taken. For continued contraception, the patient should be prescribed a low-dose pill and not a 50 mcg pill. The most common transition from ECP combined pills to regular oral contraception is to prescribe 4 tablets followed by 4 tablets 12 hours later, and to start a new package of pills the Sunday after menstruation begins. Nonlapsed pill taking involves taking the 4 tablets, followed by 4 tablets in 12 hours, and 1 tablet taken daily for the next 13 days (with backup contraception the first 7 days), and a lapse for 7 days. Nothing needs to be done for vomiting. Women are not likely to abuse this option. It should be widely known and appreciated that mistakes do happen, emergency contraception does work, and women should be aware of ECPs. 98% of women bleed by 21 days after ECP use. There appears to be no increased risk of birth defects among pill users who become pregnant.^ieng
Asunto(s)
Anticonceptivos Orales , Anticonceptivos Poscoito , Prescripciones de Medicamentos , Directrices para la Planificación en Salud , Trastornos Migrañosos , Américas , Anticoncepción , Anticonceptivos , Anticonceptivos Femeninos , Atención a la Salud , Países Desarrollados , Enfermedad , Servicios de Planificación Familiar , Planificación en Salud , América del Norte , Organización y Administración , Estados Unidos , Enfermedades VascularesAsunto(s)
Condones , Anticoncepción , Falla de Equipo , Femenino , Humanos , Masculino , Enfermedades de Transmisión SexualRESUMEN
OBJECTIVES: The purpose of this study was to evaluate condom use and the incidence of breakage and slippage during vaginal intercourse among female prostitutes in legal Nevada brothels, where use of condoms is required by law. METHODS: Forty-one licensed prostitutes in three brothels were enrolled in a prospective trial in August 1993. Used condoms were collected to verify reported breaks visually. Retrospective breakage and slippage rates were obtained in a standardized interview. RESULTS: Condoms were used for every act of vaginal intercourse with a brothel client during the study period, as well as in the previous year. In the prospective study phase, condoms were used in 353 acts of vaginal intercourse with clients. No condoms broke, and none fell off the penis during intercourse. Only twice (0.6%) did condoms completely fall off during withdrawal. Twelve times (3.4%) during intercourse and 15 times (4.3%) during withdrawal, condoms slipped down the penis but did not fall off. CONCLUSIONS: These findings, among the lowest breakage and slippage rates published, suggest that regular condom use may lead to condom mastery and the development of techniques to reduce the likelihood of breakage and slippage.
Asunto(s)
Condones/estadística & datos numéricos , Trabajo Sexual , Adulto , Falla de Equipo , Femenino , Humanos , Masculino , Nevada , Estudios Prospectivos , Proyectos de Investigación , SexoRESUMEN
PIP: Norplant is a safe, effective contraceptive which is associated with long continuation rates. However, the problem of irregular bleeding causes many women to request removal of the implants. This situation can be ameliorated if women are properly counseled and advised to avoid the contraceptive implant if an altered pattern of bleeding will likely be unacceptable. Women must also be in charge of when the implant is removed. The client's decision to remove the implants should never be refused or postponed by the clinician; to do so turns a voluntary method of contraception into a compulsory one. If clinicians are inserting Norplant, they should be able to remove it. Several techniques have been developed, and the new Emory technique may prove to be helpful to clinicians experiencing difficulties. Only by urging women to return with problems and by removing the implant on demand will the future use of this excellent contraceptive be insured. A reproducible chart of precautions and early warning signs for Norplant users is attached to this article.^ieng
Asunto(s)
Conducta Anticonceptiva , Estudios de Evaluación como Asunto , Anticoncepción , Servicios de Planificación FamiliarRESUMEN
Reproductive experiences for women in today's affluent Western nations differ from those of women in hunting and gathering societies, who continue the ancestral human pattern. These differences parallel commonly accepted reproductive risk factors for cancers of the breast, endometrium and ovary. Nutritional practices, exercise requirements, and body composition are nonreproductive influences that have been proposed as additional factors affecting the incidence of women's cancers. In each case, these would further increase risk for women in industrialized countries relative to forager women. Lifestyles and reproductive patterns new from an evolutionary perspective may promote women's cancers. Calculations based on a theoretical model suggest that, to age 60, modern Western women have a breast cancer risk as much as 100 times that of preagricultural women.
Asunto(s)
Evolución Biológica , Neoplasias de la Mama/fisiopatología , Neoplasias de los Genitales Femeninos/fisiopatología , Conducta Social , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/genética , Femenino , Neoplasias de los Genitales Femeninos/epidemiología , Neoplasias de los Genitales Femeninos/genética , Humanos , Fenómenos Fisiológicos de la Nutrición , Factores de RiesgoRESUMEN
PIP: Norplant, Depo-Provera, and the progestin-only pill are good for 35-50 year old women, since they are safe and have low failure rates. A beneficial feature of progestin-only contraceptives is the lack of thrombotic complications. They are good for couples considering sexual sterilization. Neither antibiotics nor antiseizure medicines reduce Depo-Provera's effectiveness. The only drug which reduces its effectiveness is aminoglutethimide (Cytadren), used to suppress adrenal function in some people with Cushing syndrome. Research indicates that Depo-Provera even reduces the frequency of seizures. Antiseizure medicines (except valproic acid) and the antibiotic, rifampin, greatly reduce the effectiveness of Norplant to prevent pregnancy. Antiseizure drugs increase hepatic enzymes, resulting in the breakdown of levonorgestrel. In those cases where women who already have Norplant need an antiseizure drug or rifampin, family planning practitioners should advise them to use another contraceptive. Many women using Depo-Provera experience amenorrhea (30-50% at 1 year, 70% at 2 years, and 80% at 5 years), but most find it to be a benefit. The most undesirable side effect of Depo-Provera is weight gain (5.4-16.5 lbs. after 1-6 years use, respectively), likely due to increased appetite. Women who use Norplant for 5 years gain on average a little less than 5 lbs. Once a woman is injected with Depo-Provera, she cannot immediately discontinue it, and its effects cannot be stopped. It takes 6 to 8 months to clear the body. Only 2 women have experienced anaphylactic reactions to Depo-Provera. Despite this rare event, it is important for practitioners to have epinephrine, steroids, and diphenhydramine to treat severe allergic reactions. A study finds reduced bone density among longterm Depo-Provera users, but it did not match for parity or smoking and did not determine bone density prior to injections of Depo-Provera. Further research on bone density and progestin-only contraceptives is needed.^ieng
Asunto(s)
Factores de Edad , Amenorrea , Apetito , Peso Corporal , Interacciones Farmacológicas , Hipersensibilidad , Entrevistas como Asunto , Acetato de Medroxiprogesterona , Congéneres de la Progesterona , Américas , Biología , Anticoncepción , Anticonceptivos , Anticonceptivos Femeninos , Recolección de Datos , Demografía , Países Desarrollados , Enfermedad , Servicios de Planificación Familiar , Trastornos de la Menstruación , América del Norte , Preparaciones Farmacéuticas , Fisiología , Población , Características de la Población , Investigación , Signos y Síntomas , Terapéutica , Estados UnidosRESUMEN
PIP: A new form of postcoital contraceptive therapy is described as more effective because of reduced incidence of nausea, vomiting, and breast tenderness. Other forms of emergency contraceptive pills (ECPs) are the "Yuzpe" method or high-dose contraceptives. The new method calls for administration of 3 200-mg tablets of danocrine (Danazol) within 72 hours of unprotected intercourse and a second dose 12 hours later. There are mixed reviews of the efficacy of danocrine and ECPs. In one comparative study of ECP and danocrine use, efficacy of danocrine was greater but not significantly so. Another study found danocrine so ineffective that the study was halted. ECP use would not end unintended pregnancies caused by method failure unless it was condom failure. Estimates of ECP use involve 75% of the 1.7 million women with user or method failure, all 1.9 million women with unintended pregnancies from nonuse of contraceptives, and some of the 1.6 million abortion users. An obstacle to ECP use is lack of knowledge due to lack of Food and Drug Administration approval of Ovral and Danazol and physician concern for legal liability. Another obstacle consists in the logistics of obtaining ECPs and the fear of side effects. Provision of ECP kits with 3-5 regimens in clinic or physician offices is proposed for women without contraindications. Anticipated objections are reported to be encouragement of contraceptive risk taking, the health risks of repeated use, restrictions in Title X programs, and the drug effect on fertilization. Another proposal is to sell ECPs as over the counter drugs or in vending machines and changing US contraceptive prescription laws. Objections to elimination of the physician prescription requirement might be an increase in use among women with contraindications and a decrease in regular checkups and Pap tests. The objections could be overcome with proper package labeling. Paternalism is not a sufficient justification for requiring prescription of contraceptives and medical visits. ECPs, in fact, are already available as low dose contraceptives such as Lo/Ovral, Nordette, Levlen, Triphasil, and Tri-Levlen when 4 pills are used. Instructions for ECP use are given.^ieng
Asunto(s)
Anticonceptivos Poscoito , Embarazo , Femenino , Humanos , Resultado del TratamientoRESUMEN
Barriers and spermicides are being developed for the prevention of unwanted pregnancy and sexually transmitted infection. The inconvenience of current methods limits their acceptability and leads to higher user failure rates. New methods, such as female condoms, nonlatex male condoms, and new cervical caps are being developed: the Reality (Wisconsin Pharmacal, Jackson, WI) polyurethane vaginal pouch has already received conditional Food and Drug Administration approval for use in the United States. The material used in a Food and Drug Administration-approved nonallergenic glove is being tested for its effectiveness as a condom. In addition, the Fem Cap, a cervical cap that had a life table probability of failure within 1 year of 4.8%, is expected to be available within the next 2 years. It is important for clinicians to be informed of new options becoming available for those patients who may be good candidates for these barrier methods.
PIP: Reproductive health providers have long overlooked barrier and spermicide contraceptives, but they are rather effective when used consistently and correctly, have relatively few side effects, and protect against sexually transmitted diseases (STDs) and HIV. The mean percentage of women who have an unplanned pregnancy during the first year, if they have correctly and consistently used condoms is 2%, 3% for spermicides, 6% for cervical cap and diaphragm, 6% for nulliparous users of the sponge, and 9% for parous users of the sponge. If they do not use these methods and/or spermicides properly, however, failure rates increase 3-7 times. New barrier methods and spermicides should help people overcome obstacles, e.g., sensitivity or allergy to latex. One condom manufacturer is developing nonlatex male condoms for those who are sensitive or allergic to latex or the chemicals added to latex during the manufacturing process. Another manufacturer has altered the male condom by adding a silicone-lubricated pouch of latex to fit loosely around the glans penis, thereby reducing sensation loss. A new barrier method is the cervical cap which fits and covers the cervix snugly. Female condoms empower women to protect themselves against pregnancy, STDs, and HIV. They should be available to the US market soon. Some research indicates that spermicide use with barrier methods poses a risk of urinary tract infections, but the benefits exceed the risk. Barrier and spermicide methods appear to protect against cervical cancer and pregnancy complications. In conclusion, reproductive health providers need to realize their role in controlling patient use of barriers and spermicides, as well as the important role barrier methods play in protecting against pregnancy and STDs. Therefore, they should encourage patients to use the new methods and teach them to use them effectively.
Asunto(s)
Dispositivos Anticonceptivos/estadística & datos numéricos , Espermicidas/uso terapéutico , Dispositivos Anticonceptivos/efectos adversos , Anticonceptivos Poscoito/uso terapéutico , Estudios de Evaluación como Asunto , Femenino , Humanos , Masculino , Aceptación de la Atención de Salud , Embarazo , Complicaciones del Embarazo/epidemiología , Complicaciones del Embarazo/mortalidad , Embarazo no Deseado/estadística & datos numéricos , Espermicidas/efectos adversos , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiología , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/mortalidadRESUMEN
A prospective study using two brands of condoms found that of 405 condoms used for intercourse, 7.9% either broke during intercourse or withdrawal or slipped off during intercourse; none of these events were related to condom brand, past condom use or use of additional lubricant. Of the remaining condoms, 7.2% slipped off during withdrawal; slippage was not related to condom brand or past use of condoms, but it was significantly higher when additional lubricant was used.
PIP: The use of the Pleasure Plus condom was compared with Trojan-Enz to determine the breakage and slippage during use by US couples. Factors associated with slippage and breakage are discussed. The comparison indicated that thicker than currently available condoms (standards) were considered more comfortable. The prospective study involved complete data from 68 couples recruited from the Emory University Family Planning Program of which 79% were black, 18% non-hispanic white, and 3% native American or White Hispanic. The woman's mean age was 34.4 years. 25% were 30.3 years and 25% were 39.0 years. Male partner's mean age was 37.7 years, with similar proportions 30 and 42 years. 65% were circumcised males. 26% had not used a condom in the year preceding the study. 21% had never used a condom in their relationship. Among users, average use in the preceding month was 5.8 condoms and in the preceding year, 21.1 condoms. Among condom users, the average breakage rate was 3.1%/couple in the preceding month and 4.7% in the preceding year. These breakage rates were higher than reported rates in the US. Couples were asked to use 3 experimental and 3 standard condoms within a 4-week period. The results of the use of 203 experimental condoms showed that 3 broke during intercourse or withdrawal and 4 broke after the use of 202 standard condoms. Of the 405 condoms used, breakage reported was 1.7% with no significant differences between the 2 types. Those inexperienced had the highest breakage rate of 2 out of 84 condoms (2.4%). Previous users had 1.6% breakage rates. Of the experienced users, those who had reported condom breaks prior to the study experienced higher rates of breakage (2.8%) vs. those who did not (.9%), but the difference was not statistically significant. Slippage was 6.4% for the experimental and 5.9% for the standard condoms. Of those experimental condoms not breaking or falling off during intercourse, 6.4% slipped during withdrawal. Sensitivity ratings for women were 6.7% for the experimental condoms and 5.7% for the standards compared with the male sensitivity ratings of 6.1% and 5.1%, respectively. Ratings were lower among circumcised men. Women rated the experimental condoms at 6.9 and 5.6 for the standards on the average, while men rated them at 6.4 and 5.1, respectively. Some preferred the blue color. It is pointed out that the 14.6% slippage and breakage rate for both condoms is high and creates risk. These method failure and user failure rates are higher than in reported studies. An explanation for the high rates may be lack of user seriousness in the study, or poor wording of questions, and imperfect use with oil-based lubricants. Condom efficacy studies are a high priority given the AIDs and sexually transmitted disease prevention efforts.
Asunto(s)
Dispositivos Anticonceptivos Masculinos , Adolescente , Adulto , Femenino , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Humanos , Masculino , Persona de Mediana EdadRESUMEN
PIP: Since Norplant was approved late 1990 for use in the US, Grady Memorial Hospital in Atlanta has trained 121 physicians and six nurses to insert the device, and Norplant has been inserted in 138 women at the facility. 1-3 months after receiving Norplant, 75% and 13% of women report being very pleased and pleased with the method, respectively. Indeed, as soon as the gauze bandage is removed, women tend to begin showing the implanted Norplant system rods to their family and friends. Two women have chosen to have their implants removed; one because of an increased number of menstrual bleeding days and one because she had a problem with acne while using the method. Acne is a side effect reported by about 1% of Norplant users. It is not known whether the woman's acne improved since Norplant removal. Among the 136 women who are continuing to use Norplant, there have been no pregnancies, insertion-site infections, or episodes of syncope during insertion. Clinician satisfaction has been as positive as that of the Norplant acceptors. Clinicians inserting Norplant are encouraged to carefully counsel women considering the method and to stress the following points: Norplant will probably change women's periods, bruises after insertion may be fairly large and will change color as they fade, removal of Norplant is more difficult than insertion, and a missed period in a woman who otherwise has regular periods could indicate pregnancy. Such a woman with a missed period needs to be evaluated by a physician or nurse practitioner.^ieng
Asunto(s)
Consejo , Levonorgestrel , Aceptación de la Atención de Salud , Satisfacción Personal , Instituciones de Atención Ambulatoria , Conducta , Anticoncepción , Conducta Anticonceptiva , Anticonceptivos , Anticonceptivos Femeninos , Servicios de Planificación Familiar , Planificación en Salud , Organización y Administración , PsicologíaRESUMEN
For those who choose to be sexually active, condoms are the best available means of protection against sexually transmitted diseases including the human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome (AIDS). Condoms are also an effective method for preventing pregnancy. Unfortunately, condoms are not 100% effective at preventing pregnancy or the spread of infection, in part because condoms do break. In order to gain insight into condom breakage, a questionnaire was administered to women attending a municipal hospital family planning clinic. Thirty-six percent of the 106 subjects had experienced at least one condom breakage. Condom breakage occurred in approximately 1 out of 100 acts of intercourse using condoms, with a lifetime breakage rate of 10 per 1000 condom uses and a past year breakage rate of 8 per 1000 condom uses. Breakage rates did not differ substantially by age. Five percent of the women's unplanned pregnancies were attributed to broken condoms. The results of this study corroborate previously reported rates. Factors associated with these women's most recent breakage experiences included: vaginal intercourse, minimal foreplay, and breakage prior to ejaculation. Controlled studies will be needed to determine how the condom can be used to reduce the likelihood of breakage.
PIP: For those who choose to be sexually active, condoms are the best available means of protection against sexually transmitted diseases, including human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome (AIDS). Condoms are also an effective method for preventing pregnancy. Unfortunately, they are not 100% reliable at preventing pregnancy or the spread of infection, in part because condoms break. In order to understand condom breakage, a questionnaire was administered to women attending a municipal hospital family planning clinic. 36% of the 106 subjects had experienced at least 1 condom breakage; condom breakage occurs in approximately 1 of 100 acts of intercourse where the condom is used, with a lifetime breakage rate of 10/1000 condom uses. The past year breakage rate was 8/1000 condom uses. The past year breakage rate was 8/1000 condom uses. Breakage rates did not differ substantially by age. 5% of the women's unplanned pregnancies were attributed to broken condoms. Results of this study corroborate previously reported rates. Factors associated with most recent breakage experiences included: vaginal intercourse, minimal foreplay, and breakage prior to ejaculation. Controlled studies will need to determine how the condom can be made to better withstand the likelihood of breakage.
Asunto(s)
Dispositivos Anticonceptivos Masculinos/normas , Servicios de Planificación Familiar/métodos , Falla de Equipo , Femenino , Georgia , Hospitales Municipales , Humanos , Masculino , Encuestas y CuestionariosRESUMEN
Results of trials of various birth control methods and contraceptive products may provide misleading data and engender unrealistic expectations regarding efficacy. An analysis of published efficacy-trials reveals numerous fallacies in their design, performance, and reporting. Consequently, family planning clinicians find it virtually impossible to make valid comparisons among the methods or products. This article reviews the definitions and measures that have been used to assess contraceptive efficacy, describes and illustrates some of the flaws that confound interpretation and comparison of studies, and presents a set of recommendations for future studies. A summary table providing comparative failure rates for all methods of contraception is included.
Asunto(s)
Anticonceptivos , Dispositivos Anticonceptivos , Factores de Confusión Epidemiológicos , Femenino , Humanos , Embarazo , Embarazo no Deseado , Proyectos de InvestigaciónRESUMEN
This report provides an update of the authors' previous estimates of first-year probabilities of contraceptive failure for all methods of contraception. Estimates are provided of failure during typical use (which includes both incorrect and inconsistent use) and during perfect use (correct use at every act of intercourse). The difference between these two probabilities provides a measure of how forgiving of imperfect use each method is. These revisions are prompted by recent studies that provide the first estimates of failure during perfect use for periodic abstinence and the cervical cap, by more complete evaluations of implants, and by the appearance of the Copper T 380A and disappearance of other IUDs from the US market. Also provided is a more complete explanation of how the previous estimate of the probability of becoming pregnant while relying solely on chance should be interpreted, and this estimate is revised slightly downward.
PIP: Previous estimates of 1st-year probabilities of contraceptive failure for all contraceptive methods are updated. Estimates are given for typical use (both incorrect and inconsistent use) and perfect use (correct use at every intercourse). The difference between these 2 probabilities gives a measure of how "forgiving of imperfect use" each contraceptive method is. The revisions were done because new studies "provide the 1st estimates of failure during perfect use" for the cervical cap and periodic abstinence, more complete implant evaluations are available , and the Copper T 380A (TCu 380A) is now on the US market. Other IUDs have disappeared from the same market. The previous estimate of the probability of getting pregnant while depending only on chance should be revised downward a little. The lowest expected typical, and lowest reported failure rates during the 1st year of use of many contraceptive methods and 1st-year continuation rates are given for the IUD. The estimate for "parous sponge users" has been upwardly revised. The final estimate of spermicide rates is 3%. The efficacy of the ovulation method (OM) of periodic abstinence is quite high, but the method is very unforgiving of less than perfect use. The estimates of the probability of failure of the newer methods, of sexual abstinence, symptothermal and postovulation, have been lowered. Clinical trials of implants have shown higher efficacy. Only 2 IUDs are available in the US--the TCu 380A and Progestasert. These have greater efficacy that the IUDs that were available. 1st-year failure probabilities should be revised downward. The estimate of the proportion of women who would get pregnant during 1 year of unprotected intercourse is questioned. In the National Survey of Family Growth only 43.1% of the married women who said they didn't want to get pregnant but reported no contraceptive use, did get pregnant within the 1st year. The probability estimate could be lowered from 89% to 85%.
Asunto(s)
Anticonceptivos , Dispositivos Anticonceptivos , Embarazo no Deseado/estadística & datos numéricos , Ensayos Clínicos como Asunto , Coito , Femenino , Fertilidad , Humanos , Modelos Estadísticos , Métodos Naturales de Planificación Familiar , Embarazo , Estados UnidosRESUMEN
PIP: At present, condoms represent the best means for couples who are at risk of acquired immunodeficiency syndrome (AIDS) and sexually transmitted diseases (STDs) to prevent infection. In addition to protecting against infection and pregnancy, condoms have the advantages of accessibility, low cost, and male involvement. Consistent condom use has been shown to reduce human immunodeficiency virus (HIV) transmission from 82% to 17%. However, this study of heterosexual transmission of HIV found that 79% of the couples using condoms experienced breakage at least once in the 18-month study period and another 8% experienced at least 1 episode of leakage. The heterosexual partners of HIV-positive individuals were least likely to seroconvert if abstinence was practiced (none of 12). Of the 18 couples who used condoms consistently, 3 (17%) seroconverted during the 18 months. In the 17 couples who either used condoms erratically or did not use them at all, 14 (84%) became seropositive during the study period. Latex condoms, particularly in conjunction with spermicide, appear to be the best choice if prevention of infection is a priority. Condoms should be used by such individuals even if they are already using sterilization, oral contraceptives, or any other means of birth control to prevent pregnancy. In the US, condom use has increased from 12% in 1982 to 16% in 1986; in xonrear, 1% or less of married women of reproductive age in 36 of 66 developing countries surveyed in 1987 reported condom use. It is recommended that family planning programs and health agencies encourage more widespread condom use by making condoms available to clients free or at the lowest possible cost, offering clients sufficient quantities of condoms, instructing clients in their proper use, assisting clients in enlisting partner cooperation in condom use, and providing community education to overcome barriers to use of this method.^ieng
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Condones , Recolección de Datos , Estudios de Evaluación como Asunto , Infecciones por VIH , Planificación en Salud , Enfermedades de Transmisión Sexual , Anticoncepción , Enfermedad , Servicios de Planificación Familiar , Infecciones , Investigación , Muestreo , VirosisRESUMEN
PIP: For those women who want maximum protection from both pregnancy and infection, the only approach is to use both the pill and condoms. It is important to counsel such women that the pill is not enough if they have several different partners, or even if their partner does so. Some ways to emphasize this point are to write the condom prescription, perhaps after having discussed different brands with her and decided on a brand, on the prescription sheet. Both physicians and family planning clinics could consider prescribing or dispensing 6 months' worth of condoms, not just 3 or 6, each time a client visits. Another aid is to employ movies, videotapes, posters and pamphlets to get the message across. Finally, it is vital to think through one's own values on the topic of double protection and to believe in it. Reproductive health professionals should at least be prepared to offer their clients protection from infection.^ieng