Moving the Message Beyond the Methods: Toward Integration of Unintended Pregnancy and Sexually Transmitted Infection/HIV Prevention

• Type of Material: Article
• Authors: Riley Steiner, Emory University; Nicole Liddon, Centers for Disease Control and Prevention; Andrea Swartzendruber, Emory University; Karen Pazol, Centers for Disease Control and Prevention; Jessica Sales, Emory University
• Language: English
• Date: 2018-03-01
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.amepre.2017.10.022
• Title of Journal or Parent Work: AMERICAN JOURNAL OF PREVENTIVE MEDICINE
• Volume: 54
• Issue: 3
• Start Page: 440
• End Page: 443
• Keywords: Medicine, General & Internal; Science & Technology; Public, Environmental & Occupational Health; General & Internal Medicine; Life Sciences & Biomedicine; PROTECTION; ADOLESCENTS; ACTING REVERSIBLE CONTRACEPTION; CONDOM USE; YOUNG-ADULTS

Abstract

Preventing unintended pregnancy and sexually transmitted infections (STIs), including HIV, are public health priorities in the U.S.1 Recognizing that both outcomes are related to sexual behavior, experts have called for integration of these prevention efforts.2,3 Yet, integrating unintended pregnancy and STI/HIV prevention is challenging, partly because the most effective contraceptive options for preventing pregnancy provide no protection against STIs/HIV. Although condoms can be 98% effective at preventing pregnancy when used correctly and consistently,4 recent estimates indicate with typical use they are associated with a 13% pregnancy rate during the first year.5 Use of a condom for STI/HIV prevention along with a more effective method for pregnancy prevention (e.g., intrauterine devices [IUDs], implants, oral contraceptives) is thus typically recommended for heterosexual couples who are not in a mutually monogamous relationship.6 However, this behavior is uncommon.7 Moreover, recent evidence suggests that users of long-acting reversible contraception (LARC), namely implants and IUDs, are less likely to use condoms compared with users of oral contraceptives.7,8 Although the impact of LARC use on STI rates remains unclear, these findings have renewed attention on STI prevention within the context of pregnancy prevention,9 particularly because LARC use is increasing.10