RESUMO
OBJECTIVES: This study measured the effect of information about family planning methods and STD risk factors and prevention, together with personal choice on the selection of intrauterine devices (IUDs) by clients with cervical infection. METHODS: We conducted a randomised, controlled trial in which family planning clients were assigned to one of two groups, the standard practice (control) group in which the provider selected the woman's contraceptive and the information and choice (intervention) group. The study enrolled 2107 clients in a family planning clinic in Mexico City. RESULTS: Only 2.1% of the clients had gonorrhoea or chlamydial infections. Significantly fewer women in the intervention group selected the IUD than the proportion for whom the IUD was recommended in the standard care group by clinicians (58.2% v 88.2%, p = 0.0000). The difference was even more pronounced among infected women: 47.8% v 93.2% (intervention v control group, p = 0.0006). CONCLUSIONS: The intervention increased the selection of condoms and reduced the selection of IUDs, especially among women with cervical infections, for whom IUD insertion is contraindicated.
Assuntos
Atitude Frente a Saúde , Comportamento de Escolha , Serviços de Planejamento Familiar/métodos , Educação Sexual/métodos , Adulto , Análise de Variância , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/prevenção & controle , Anticoncepção/métodos , Contraindicações , Feminino , Gonorreia/epidemiologia , Gonorreia/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Dispositivos Intrauterinos , México/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Análise de Regressão , Infecções Sexualmente Transmissíveis/prevenção & controleRESUMO
Vaginal microbicides are being developed in an attempt to expand women's and men's options for protecting themselves against HIV and other sexually transmitted infections. Taking account of men's attitudes during product development and introduction could increase the likelihood that products are acceptable and used. To capture the perspectives of urban and rural men from a range of cultural settings, we conducted focus group discussions with taxi drivers and farmers in Zimbabwe, Mexico and the USA. These explored HIV/STD risk perception and prevention strategies, desirable characteristics of vaginal products and of a microbicide, and attitudes towards use of a potential product. Men were generally supportive of the idea of a microbicide; urban somewhat more than rural men. Most thought microbicides would be preferable to condoms though many raised concerns about potential side effects. The men wanted these products to be as inexpensive and readily available as condoms, and differed as to whether a woman should have permission from her partner to use it. For them to be widely used, the men thought these products must not only be safe and effective, but should also have no negative effect on sexual pleasure. When a product becomes available, introductory messages must explain the limits on its effectiveness and encourage use with condoms. Further research is needed on definitions of pleasurable sex and the ramifications of this for microbicide formulation, and on partner communication around issues of sexuality and prevention of infection.