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Family Planning Can Offer "Dual Protection" -- January 22, 2001

Many of today’s couples carefully plan the number of children they will raise, often with the help of modern contraceptive choices available from their physicians or family planning clinics.

But against sexually transmitted infections, including the virus that causes AIDS, most modern contraceptives offer no protection. As a result, many family planning clinics are helping their clients understand their risk of these diseases, and how to protect themselves. These clients are learning about "dual protection," ways to prevent both pregnancy and sexually transmitted infections.

The most reliable form of dual protection is when neither the man nor the woman are infected and remain faithful to each other (never becoming sexually involved with another person), and they also use effective contraception.

For other couples, dual protection can be achieved in one of two ways, according to the current issue of Network, a health bulletin published by Family Health International (FHI):

• Two contraceptive methods can be used, one that is a highly effective method for pregnancy prevention and the male or female condom for prevention of infections, including HIV, the virus that causes AIDS.
• Condoms can be used for both purposes.

Which of the two approaches should a couple use? The chosen approach should fit the individual couple’s needs and motivations, says Dr. Willard Cates, Jr., FHI president and an expert on HIV and other sexually transmitted infections.

"Whether the major goal is to prevent pregnancy, infection or both undoubtedly will influence selection of an approach," he says. Contraceptives offering the best pregnancy prevention include male or female sterilization, oral contraceptives (the pill), injectables, implants and intrauterine contraceptive devices. None of them, however, protects against HIV or other sexually transmitted infections.

Condoms used alone can prevent both infections and pregnancy, and do this very well if condoms are used correctly and consistently. But because some people use condoms incorrectly or do not use them every time, the risk of pregnancy is greater than for other methods.

"A key factor is the client’s likelihood of being exposed to infection, which may be assessed by the prevalence of sexually transmitted infections in the community and by the client’s specific risk behaviors," says Dr. Cates. "If exposure is likely, particularly to the more serious infections such as HIV, condom use should be recommended.

On the other hand, Dr. Cates says, in cases where unintended pregnancy is the greater concern, emphasizing the two-method approach may be better.

"Women using a highly effective contraceptive method could be counseled on when or with whom concurrent condom use is most important: with new partners, with partners who have other partners, and with partners who have not been tested for sexually transmitted infections," he says.

Much remains to be learned about the characteristics of couples who choose either approach to dual protection. "Identifying such characteristics brings an awareness of potential barriers to dual protection, which is important during client counseling," says Dr. Thulani Magwali, an obstetrician/gynecologist at the University of Zimbabwe.

Under an FHI fellowship, Dr. Magwali is conducting a study of the prevalence and consistency of use among 900 family planning clients in Zimbabwe of two contraceptive methods versus use of just male or female condoms for protection against pregnancy and disease. His study compares the two approaches with a variety of client characteristics.