FHI - February 25, 1997

When Condoms Fail -- February 25, 1997

RESEARCH TRIANGLE PARK, NC -- Couples who use latex condoms correctly and consistently are protected from both pregnancy and sexually transmitted diseases, including the AIDS virus, HIV. But because condoms must be applied at the time of use, correct and consistent use is not always achieved.

To address this problem, family planning experts are recommending that emergency contraception (EC) in the form of oral contraceptives be available as a backup contraceptive, to be used in the event of incorrect use of condoms and similar methods, or unprotected intercourse.

A user of the condom, diaphragm, sponge or spermicide could be given the correct number of pills for emergency contraception along with instructions for their use as a precaution, say experts in the winter issue of Network, Family Health International's (FHI) quarterly health bulletin.

Combined oral contraceptives must be taken in higher doses (multiple pills) within 72 hours after unprotected intercourse, and repeated 12 hours later. (For "progestin-only" pills, which do not contain estrogen, the initial dose should be taken within 48 hours of exposure and repeated in 12 hours.) Emergency contraception should only be used when necessary, and not as a routine method. When used for emergency contraception, the pill prevents only about 75 percent of the pregnancies that would be expected if emergnecy contraception had not been used. This compares with 97 percent pregnancy prevention for the pill during regular, daily use. Also, unpleasant side effects may occur when EC is used, including nausea. However, using oral contraceptives in this way is safe for any woman, including women with health conditions that might prevent them from using the pill on a regular basis.

"Many people are beginning to recommend that all barrier method users should be provided with emergency contraceptive pills in advance, to use in case they fail to use the method or the method fails -- for example, a condom breaks," says Dr. Elizabeth Raymond of FHI's clinical trials division.

In 1996, a U.S. Food and Drug Administration panel concluded that oral contraceptives are safe for EC use. The panel said the following dosages of six brands were known to work: two tablets per dose of Wyeth's Ovral or four tablets of Wyeth's Nordette, Lo/Ovral or Triphasil (yellow pills only) brands, or four tablets of Berlex Laboratories' Levlen or Tri-Levlen (yellow pills only) brands.

The current issue of Network focuses on ways family planning and AIDS prevention services can be used to complement one another, thus promoting better reproductive health in more efficient ways. Among other topics discussed are the following:

In an opinion article, two FHI senior scientists outline the crucial role that AIDS prevention will continue to play, even as new treatment breakthroughs are being developed. "Even when an effective vaccine against HIV becomes available, it will not be perfect, and we will still need all the other prevention approaches working together in combination," write Dr. Willard Cates Jr., FHI senior vice president for biomedical affairs, and Dr. Peter Lamptey, FHI senior vice president for AIDS programs.

FHI's AIDS Control and Prevention (AIDSCAP) Project and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have pioneered a three-pronged HIV prevention strategy of condom promotion, behavior change and better services for other sexually transmitted diseases, since other STDs can enhance HIV transmission. Uganda and Thailand are countries where these strategies are demonstrating a reduction in the transmission of HIV and other STDs, they write.

Sexually active young adults are especially vulnerable to both STDs and unplanned pregnancy, but are often reluctant to go to clinics or have difficulty obtaining services. Yet the highest incidence of chlamydia and gonorrhea of any age group in the United States is among young women ages 15 to 19. Convenient ways for young adults to obtain latex condoms include vending machines and other services in places young adults gather, the bulletin reports. Project ACTION in Portland, OR has installed 240 condom vending machines in restaurants, college buildings, recreation centers, stores and other places where young adults typically congregate. Planning services with the help of parents, community and business leaders, and youth themselves is an important step in developing successful services, experts say.

Other articles examine social and cultural factors that influence women's access to contraception, new HIV treatment strategies, current research involving HIV transmission to infants from their HIV-infected mothers through pregnancy or breastfeeding, and the use of risk assessments to help identify STD infections. Based in North Carolina, FHI is a nonprofit research and technical assistance organization dedicated to improving reproductive health worldwide.

See Also:

When Condoms Fail -- February 25, 1997