Recommendations for Contraceptive Use
RH TOC		Dual Method Use

Q.2. When should women/couples be advised to use dual methods for protection against pregnancy and sexually transmitted diseases (STDs)?

Decisions about contraceptives should reflect both the need to prevent unplanned pregnancies and the need to prevent STDs. To date, the methods most effective at preventing STDs - especially condoms, but also other barrier methods - may not necessarily be the most effective contraceptives. Combining a barrier method with a more effective contraceptive can maximize the dual protective effect. Yet, dual method use is relatively new, and is not appropriate for all clients. Choosing when to promote dual method use can be difficult, especially since it requires more counseling, more supplies, and places greater demands on each client. Providers have a responsibility to help clients decide which method or methods to use in light of this dilemma between pregnancy prevention and disease prevention. Providers will have to evaluate the dual needs of each client to assist him or her in making a safe, appropriate, and practical decision.

• A risk assessment and local sexually transmitted disease/human immunodeficiency virus (STD/HIV) prevalence rates can help providers understand how much STD risk their clients generally face. A risk assessment can identify individuals at higher risk and STD surveillance studies can measure STD/HIV prevalence rates for a geographical area.
• Clients who consider themselves or their partners at high risk of HIV and other STDs are good candidates for dual method use. These clients may choose to use one method for the primary purpose of pregnancy protection and condoms (or other barrier methods) for STD protection.
• Some clients may be able to achieve protection against both STDs and pregnancy using a barrier method alone. Motivated clients might use male condoms alone, since condoms are effective for both disease and pregnancy prevention when used correctly and consistently.
• For women who cannot persuade their male partners to use a male condom and who are at risk of contracting STDs, spermicides, a female condom, or a diaphragm with spermicide can be used for both STD protection and contraception. However, although spermicides, and probably diaphragms, appear to be modestly protective against bacterial STDs (gonorrhea and chlamydia), their effectiveness at protecting against viral STDs, including HIV, has not been determined.
• A woman should be informed if the contraceptive method she is using does NOT protect her against STDs. She should also be made aware that some methods may protect against some STDs but not others and that only male latex condoms have been proven to be highly effective for HIV prevention. If she is ever in a situation where she suspects she may be at risk (e.g., she thinks her husband or partner may have other sex partners), she should immediately start using additional protection.

Any part of Recommendations for Updating Selected Practices in Contraceptive Use may be reproduced or adapted to meet local needs without prior permission from the TG/CWG Secretariat, provided the TG/CWG is acknowledged and the material is made available free of charge or at cost.