Recommendations for Contraceptive Use
RH TOC		Dual Method Use

Considerations Concerning Dual Method Use

A difficult issue for reproductive health (RH) providers serving clients at risk of STDs/HIV is when and whether to encourage use of dual methods - one to prevent pregnancy and the other to prevent STDs/HIV. Clinicians promoting dual use must weigh factors such as cost and user compliance, as well as their relation to effective STD protection among particular client populations. Moreover, clients may attach differing priorities to preventing either pregnancies or infections, and these priorities may change over time and among various relationships.

Studies on dual method use are limited and have focused on the use of the male condom in combination with other methods of contraception. In general, based on preliminary evidence where participants were using primary methods of contraception in addition to condoms, the more effective the primary contraceptive method was at preventing pregnancy, the lower the level of consistent use of the male condom.

Several reasons can explain why concurrent condom use may decrease as perceived contraceptive effectiveness increases. First, many persons - even those with sexual behaviors putting them at risk of STD - see pregnancy as a greater immediate threat than STDs. Thus, having taken precautions against unintended pregnancy, they seem to be less motivated to undergo the extra effort and expense to use condoms. Second, this may represent differences in convenience of use between longer-term, coitally-independent methods and the coitally-dependent barrier methods. Without regular reminders of the need to protect against both pregnancy and STDs, individuals may be less likely to have condoms available when sexual intercourse occurs.

Clearly, more research is needed. Studies that examine the use of the female condom, diaphragm, and/or spermicides in conjunction with long-term methods will help clarify this issue. More research is also needed on the patterns of dual method use with different sex partners. For example, if an individual uses one method with a primary partner and adds condoms with other partners, this might reduce risk, even if dual method use is not consistent with the primary partner. Another important question is whether providers of temporary or less effective methods should routinely provide and counsel use of a second method, such as EC, as a back-up method.

Citations:

1. Anderson JE, Brackbill R, Mosher WD. Condom use for disease prevention among unmarried U.S. women. Family Planning Perspectives 1996;28(1):25-8.
2. Feldblum PJ, Morrison CS, Roddy RE, Cates W Jr. The effectiveness of barrier methods of contraception in preventing the spread of HIV. AIDS 1995;9(Suppl. A):S85-S93.
3. Fox LJ, Williamson NE, Cates W Jr, Dallabetta G. Improving reproductive health: integrating STD and contraceptive services. Journal of the American Women's Medical Association 1995;50(3-4):129-36.
4. Institute of Medicine. The best intentions: unintended pregnancy and the well-being of children and families. Washington, DC: National Academy Press, 1995:118-21.
5. Cates W Jr. The Dual Goals of Reproductive Health. Network 1996;16(3):4-5.

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.