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The effect of sexual behavior and a pregnancy on contraceptive method switching among black female teens.

Little is known about determinants of contraceptive method switching and few reports use data that can link events that occur close in time. Using retrospective information from the sexual calendars of black female teens who attended a reproductive health clinic, determinants of method switching in four areas were investigated. Method switchers, those who switched from an unprepared to a prepared method (n = 62) and those who switched from a prepared to an unprepared method (n = 18), were matched with nonswitchers who used the same initial method. Associations between switching and changes in the frequency of intercourse, sexual abstinence, and pregnancy were found. It is suggested that abstinence may have a different role in switching from each type of method. Counselors need to emphasize the importance of method continuation, even when sex has not occurred for a short period of time.

Adolescent↗

Epidemiologic characteristics of two different populations of women with Chlamydia trachomatis infection and their male partners.

Two groups of women under the age of 26 with chlamydial infection (A-asymptomatic women from a screening program, B-traditional STD clinic patients) and their partners were compared with respect to history of STD, sexual behavior, contraception, and indices for income and social welfare expense. The mean number of partners was 1.3 in group A and 1.8 in group B. Women in group B, in spite of more frequent condom use, demonstrated greater risk behavior both with respect to STD and to unwanted pregnancy and also had higher indices for social welfare expense. More group A partners than group B partners were asymptomatic and chlamydia negative. Group B partners also more often had low income as well as high social welfare expense indices. In both groups, complicated chains of transmission were found, and the need for expert contact tracing in both types of patient groups is stressed.

Adolescent↗

Adolescent contraception. Review and recommendations.

In the light of the increase in teenage sexual activity over the past decade, the authors review current social, psychological, and educational attitudes. Together with a summary of the legal ramifications, they provide recommendations for treatment of this patient group.

Adolescent↗

[AIDS epidemiology and prevention in i.v. drug addicts].

The incidence of AIDS cases in intravenous drug abusers is growing faster than in other risk groups, in Switzerland as well as in Europe in general. By end of May 1988, 27% of all AIDS cases registered nationally were injecting drugs. The prevalence of HIV antibodies is known from selected samples only, on the basis of voluntary testing. In 1986, among all intravenous drug users in residential treatment nation-wide, 90% were tested and thereof 55% seropositive. In a sample of drug abusers in out-patient treatment in Zurich in 1987, seropositivity was documented for 42% of male and 63% of female patients. According to registered AIDS cases, there is no differential risk for both sexes. Duration of intravenous drug abuse is the only relevant risk factor so far. Preventive change in risk taking behaviour is a minimalization of utilizing contaminated syringes/needles and a minimalization of unprotected sex (safer sex by regular use of condoms). An analysis of published data demonstrates that dissemination of information and availability of syringes/condoms are a pre-requisite for behaviour change, but by no means sufficient in order to elicit behaviour change. Drug abusers engaged in out-patient/residential treatment are available in high proportions for voluntary testing and for the intended behavioural changes. It is therefore of primary preventive interest to engage as many intravenous drug abusers as possible in treatment. Apart from drug-free residential treatment, out-patient treatment using Methadone provides positive results, whereas compulsory measures are considered to be of doubtful value.

Acquired Immunodeficiency Syndrome↗

The impact of women's employment and education on contraceptive use and abortion in Kinshasa, Zaire.

This report examines contraceptive behavior and abortion among women residing in Kinshasa, Zaire's capital city, with particular emphasis on women's employment and education. A data set collected in 1990 covering 2,399 women of reproductive age was used. While the practice of contraception is a common event in Kinshasa, dominated by the rhythm method, the use of modern contraceptives remains limited, but is on the rise. Induced abortion is reported by 15 percent of the ever-pregnant women in the survey. Women's employment and education are strongly linked to contraceptive use and abortion, and differences in the incidence of abortion by schooling and employment status appear to play an important role in contributing to corresponding observed differences in fertility. Modern contraceptives and induced abortion appear to be used as complementary fertility-control strategies in Kinshasa, and analyses of the findings suggest that better-educated women employed in the modern sector are most likely to be in the forefront of the contraceptive revolution.

Abortion, Induced↗

A family planning intervention to reduce vertical transmission of HIV in Rwanda.

OBJECTIVES: Since contraception is an effective way of preventing the vertical transmission of HIV, we evaluated the impact of a family planning intervention on hormonal contraceptive use and incident pregnancy in a group of HIV-positive and HIV-negative urban Rwandan women. SUBJECTS AND METHODS: In a longitudinal cohort study, 502 women who were not pregnant or infertile and who had been previously HIV tested and counseled viewed an informational video about hormonal contraception followed by a facilitated discussion. They were given access to oral or injectable hormonal contraception and Norplant at the research clinic; those who used these methods were seen every 3 months. RESULTS: Of the 330 HIV-positive and 172 HIV-negative women who underwent the intervention, 120 either became new hormonal method users (n = 40), continued their previous use of a hormonal method (n = 64), or switched to another hormonal method (n = 16) following the intervention. There was a shift to use of longer lasting hormonal methods, and the annualized attrition rate was < 15%, compared to > 50% prior to the intervention. Rates of oral and injectable contraceptive use were similar among HIV-positive and HIV-negative women. Nine per cent of HIV-positive women became pregnant in the year after the intervention compared to 22% in a prior 12 month period when contraceptives were not provided at the study site. The corresponding proportions for HIV-negative women were 20% after the intervention versus 30% before the intervention. CONCLUSIONS: Access to and information about hormonal contraceptives resulted in increased use and reduced attrition among both HIV-positive and HIV-negative women in this study. The reduction in incident pregnancy was greatest among HIV-positive women, suggesting that factors other than access to hormonal contraceptives may have influenced fertility outcomes. Knowledge of HIV serostatus may have an important influence on family planning decisions.

Adolescent↗