Genital Ulcer Disease, OC Use and HIV

Data from Plourde (1992) show that genital ulcer disease (GUD) and OC use are both independently associated with HIV (see Table 8). For women who have used OCs for more than 12 months and who have GUD, the relative risk of HIV is 25, a very highly significant relationship.

Table 8. Risk Assessment for HIV: Study of 600 Women Attending STD Clinic

Odds Ratio C.I. GUD 11.8 2.8-4.0 OC Use > 12 months 2.1 1.2-3.8 GUD and OC Use > 12 Months 25.7 5.5-90.7

Source: Plourde et al 1992.

Intrauterine Device

Early studies showed that the risk of PID was up to nine times greater among IUD users than among women using other methods (Senanayake and Kramer 1980). Problems with these studies include:

• The usual comparison groups were woman using pills or barriers, who have reduced risk of PID.
• Diagnosis of PID was usually syndromic and questionable, even with testing.
• The studies did not control for types of IUDs.

Recent studies (see Table 9) show a smaller risk of PID confined to the 2 to 3 weeks following insertion. Prophylactic antibiotics given at the time of insertion have not proven to be consistently useful in reducing risk. Given this, the use of the IUD must be preceded by an appropriate STD risk assessment and some form of STD screening.

Table 9. Studies of the Association Between the IUD and PID

Author and Year Published Comparison Group Relative Risk 95% C. I. Lee et al 1983     Women using no contraceptive, USA 1.9 1.5–2.4 Witoonpanich et al 1984     Parous women using no contraceptive, developing countries 2.3 1.4–3.9 Buchan et al 1990   Parous women using no contraceptive or relying on vasectomy, England Non-medicated Medicated 3.3 1.8  2.3–5.0 0.8–4.0

Source: Cates and Stone 1992b.

Mati et al’s 1995 study of 4404 women did not show any association between IUD use and HIV (see Figure 2).

Dual Methods

Regardless of the choice of contraceptive method, all clients at risk of STDs/HIV should be advised to use condoms.

The options are:

• abstinence,
• mutual monogamy,
• condom use with primary partner, or
• condom use with secondary partners.

The problem is that women may not be able to negotiate the use of condoms by their partner(s) and therefore it is necessary to give them alternatives. Possible alternatives:

• he uses condom and spermicide
• he uses condom, she uses vaginal spermicide
• he uses condoms without spermicide
• she uses diaphragm or female condom with vaginal spermicide
• she uses vaginal spermicide only

Conclusion

Given the increasing prevalence of STDs and HIV, it is important to find a method or combination of family planning methods that makes sex safe from unwanted pregnancy as well as STDs. Barrier methods of contraception have a major potential in reducing the spread of STDs/HIV. On the other hand, concerns about increased risk of STD/HIV infection with the use of hormonal methods is largely unfounded. In the absence of an ideal method that protects completely against STDs and pregnancy, the use of an effective method (pill, injectable or implant) with a barrier method (condom, diaphragm) offers the best protection.

References

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