Dual protection and consistency of condom use
Kerry L. Wright
Results from a recent, cross-sectional observational study from Zimbabwe suggest that dual method users do not use condoms as consistently as those who use only condoms for dual protection against pregnancy and sexually transmitted infections. (1) But this does not necessarily mean that providers should recommend a condom-only, rather than a dual method, approach to dual protection, says Dr. Markus Steiner, an FHI senior epidemiologist and coauthor of the study.
“Almost certainly, those people using condoms alone are different from the people using them in conjunction with other methods,” he says. This suggests that consistency of condom use may depend at least as much on individual characteristics (such as background, lifestyle, and motivations for behavior) as on whether a condom-only or a dual method approach to dual protection is used.
Research from Ethiopia illustrates this point. Results of a cross-sectional survey of some 370 sex workers in Addis Ababa showed that sex workers who used condoms consistently (with at least 95 percent of their clients) had several unique characteristics: generally, they were at least 30 years old, had been counseled by peer educators, had very few clients each day, refused sex unless their clients used condoms, and had used condoms for contraception in the previous five years. Of note, 65 percent of 145 sex workers who had used condoms for contraception used them consistently in the study, compared with only 24 percent of 224 sex workers who had not previously used them for contraception. (Women in the former group also were less likely to be HIV-infected.) Furthermore, those sex workers motivated to use condoms for contraception were more likely to refuse sex with clients who would not use a condom (54 percent versus 10 percent). (2)
In the study conducted in Zimbabwe, researchers sought to determine the prevalence and consistency of condom use, alone or in conjunction with another contraceptive method, among nearly 900 family planning clients. Preliminary results of structured questionnaires showed that about one-third of the women were using two methods and 5 percent were using condoms alone. But those using only condoms used them more consistently than did those using condoms plus another method.
“The most striking finding was the low level of condom use in a place of such high HIV prevalence,” notes former FHI fellow Dr. Thulani Magwali, a lecturer at the University of Zimbabwe and lead author of the study. This may have been at least partly due to difficulties women have negotiating condom use within their relationships, he speculates.
(1.) Magwali TL, Steiner MJ, Brown JM, et al. Dual method and dual purpose use among family planning clients at three family planning clinics in Zimbabwe. Unpublished paper. Family Health International, 2002.
(2.) Aklilu M, Messele T, Tsegaye A, et al. Factors associated with HIV-1 infection among sex workers of Addis Ababa, Ethiopia. AIDS 2001;15(1):87-96.
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