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Why do university students use hormonal emergency contraception?

OBJECTIVES: To establish why university students in Finland, who have easy access to well-affordable health services, still use hormonal emergency contraception. METHOD: All students who sought emergency contraception in the Tampere Student Health Station during the period from 1 September 2000 to 31 December 2001 received a questionnaire on their use of it. Of the total, 114 (67%) were returned. RESULTS: Two-thirds of respondents experienced condom failure, and the remainder used no contraception. In open answers, respondents gave many explanations as to why they had used no contraception, e.g. having been over-passionate or drunk. CONCLUSION: Finnish students use emergency contraception, but to no great extent. Our results indicate that service providers should pay attention to sexual health in the full sense but not omit to give detailed advice on condom use during counselling.

Adult↗

Selling sex: female street prostitution and HIV risk behaviour in Glasgow.

Female prostitutes have often been seen as a major source of HIV infection. In this paper we report on a study of HIV-related risk behaviour among street prostitutes in Glasgow. This paper is based on street interviews using a standardized schedule with 68 women. We focus on the extent of HIV testing amongst the women, travel, the sexual services provided, the use of condoms with clients and private partners, and the extent of drug injecting and equipment sharing by the women. It is shown that female street prostitution within Glasgow is, at present, unlikely to be associated with significant heterosexual spread of HIV as most commercial sex is with a condom. However, some risk activities are continuing. Additionally, prostitutes report worrying rates of condom failure with clients. It is suggested that attention should switch away from an exclusive focus on women selling sexual services to target the men who purchase sex. These data indicate that much of the pressure for these women to provide unprotected sex comes from their clients.

AIDS Serodiagnosis↗

Interactive video behavioral intervention to reduce adolescent females' STD risk: a randomized controlled trial.

A longitudinal randomized design was used to evaluate the impact of a theoretically based, stand-alone interactive video intervention on 300 urban adolescent girls' (a) knowledge about sexually transmitted diseases (STDs), (b) self-reported sexual risk behavior, and (c) STD acquisition. It was compared to two controls, representing high-quality informational interventions. One used the same content in book form; the other used commercially available brochures. Following randomization, the interventions were administered at baseline, with booster sessions at 1, 3, and 6 months. Self-reports revealed that those assigned to the interactive video were significantly more likely to be abstinent in the first 3 months following initial exposure to the intervention, and experienced fewer condom failures in the following 3 months, compared to controls. Six months after enrollment, participants in the video condition were significantly less likely to report having been diagnosed with an STD. A non-significant trend in data from a clinical PCR assay of Chlamydia trachomatis was consistent with that finding.

Adolescent↗

[Emergency contraception: user's profile in primary care emergency services].

OBJECTIVES: To establish the emergency contraception (EC) users profile and whether she perceives this type of contraception as an emergency. Design. Cross sectorial study (over one year period: March 2002-March 2003). SETTING: Emergency Services in Primary Care. Usera and Carabanchel; 11th Area; Madrid. PARTICIPANTS: Women requesting EC in these centres. MAIN OUTCOME MEASURES: A questionary was filled out for all participants with their age, how many hours had spent since sexual intercourse took place (within 24 h), usual method of contraception used, previous use of EC, level of education, and reason for this request. RESULTS: 89 women. Drops out: 0. Average age: 23.7+/-48 years (range: 16-40 years). 79.8% of them came to medical emergency services in less than 24 h after sexual intercourse. Usual anticonceptive method was the condom (88.8%), 2.2% used hormones, 9% no contraceptive method at all and none of them had used the intrauterine device. 34.8% were previous users of EC. Education levels: 2.2% of women only could read and write, elementary school (37.1%), secondary school (34.8%) and high school (25.8%). Reasons for requesting EC: 91% condom failure, 7.9% not to have used any contraceptive method, and 1.1% wrong use of natural birth control methods. Among the women who had went to the emergency services within the 24 h of the sexual intercourse the 77.4% of all of them had requested EC previously and the 93% of those had requested EC for the first time (P=.032). Likewise all of them with high school level and who could write and read, the 93.9% with elementary school level, and the 71% with secondary studies went to the emergency services within the 24 h of the non protected sexual intercourse (P=.05). CONCLUSIONS: Most of the women were young, they perceived the unprotected sexual intercourses as an emergency, the condom was the most frequently used anticonceptive method, they requested EC due to condom breakage. In 1/3 of the cases the EC had been requested previously and this group and the young women with secondary studies one were who requested it later.

Adolescent↗

Feasibility of human immunodeficiency virus vaccine trials in homosexual men in the United States: risk behavior, seroincidence, and willingness to participate.

Human immunodeficiency virus (HIV)-seronegative high-risk homosexual men were enrolled in a vaccine feasibility study in three US cities. HIV seroincidence was 2.3/100 person-years (95% confidence interval [CI], 1.7-2.9) over 18 months in 1975 men. After receiving an explanation of HIV vaccine trial design, 37% stated they were "definitely" willing to participate in future trials; seroincidence was 3.7/100 person-years (95% CI, 2.5-4.9) in this subgroup. An additional 57% "might be" or were "probably" willing. Independent predictors of HIV seroconversion in multivariable pooled logistic regression analysis were having a known HIV-seropositive sex partner (odds ratio [OR], 4.5; 95% CI, 2.6-7.8), injection drug use (OR, 3.6; 95% CI, 1.2-10.7), unprotected receptive anal sex (OR, 2.4; 95% CI, 1.4-4.2), condom failure (OR, 2.4; 95% CI, 1.4-4.1), gonococcal/nongonococcal urethritis (OR, 2.3; 95% CI, 1.1-4.7), and age < 25 years (OR, 2.2; 95% CI, 1.2-4.2). Interest in vaccine trials and seroincidence in high-risk homosexual men are sufficiently high to initiate efficacy trials once a suitable candidate vaccine is identified. Risk factors for seroconversion highlight important area for development of ancillary intervention strategies.

AIDS Vaccines↗

Availability of emergency contraception in Massachusetts emergency departments.

OBJECTIVES: To determine the availability of emergency contraception (EC) in Massachusetts emergency departments (EDs) and to identify patient, hospital, and system factors that could affect access to EC. METHODS: This was a prospective, cross-sectional study of all Massachusetts EDs using two structured scenarios: one, a patient asking for EC for condom failure (patient scenario); and the other, a social worker asking about EC for a client who was sexually assaulted the night before (social worker scenario). Calls were made during day and night shifts requesting information from a nurse or doctor. The data collected included EC availability, whether pills or prescription would be given, cost, services available to rape victims, and other institutions where EC could be obtained. Descriptive statistics and chi-square were used for comparisons. RESULTS: Responses were made by 248 of 288 nurses, ten of 288 physicians, and 30 of 288 clerks. Overall, EC was reported to be available in 80% of calls, not available in 15%, and up to the physician in 5%. In the patient scenario day shift, 53 of 72 (73%) responded that EC was available, 15 of 72 (20%) stated it was not available, and four of 72 (5%) said it was up to prescribing physician. In the social worker scenario day shift, 62 of 72 (86%) reported that EC was available, six of 72 (8%) reported it was not available, and four of 72 (5%) stated it was up to the prescribing physician. Availability did not vary comparing day vs. night shift for either scenario. Of the nine Catholic hospitals, for the patient scenario, one of nine (11%) reported that EC was available, seven of nine (78%) reported that EC was not available, and in one of nine (11%), it was up to the physician. In the social worker scenario, five of nine (56%) reported EC was available, three of nine (33%) reported it was not available, and in one of nine (11%), it was up to the physician. CONCLUSIONS: There was significant variability in access to EC in Massachusetts EDs and in services for sexual assault survivors. Hospital type and provider preference affected availability. This study suggests that access to EC is limited, and that there are not consistent services for women seeking EC, including for victims of sexual assault.

After-Hours Care↗

[Who are the users of emergency contraception?].

INTRODUCTION: A user profile is necessary in order to direct future campaigns for emergency contraception (EC). MATERIAL AND METHODS: Over a three-month period, 423 women with prescriptions for EC were consecutively entered in the study, which was carried out in four inner-city pharmacies in Copenhagen, Denmark. RESULTS: The median age was 24 years (range 13-50 years). Most women (73%) were first-time users of EC. The reason for the current need for EC was most often condom failure (54%) or non-use of any contraceptive method (41%). Only six women (1.4%) reported non-use of contraception because of their knowledge of EC and only four women (0.9%) reported EC as the usual method of contraception. Knowledge about EC more often came from family or friends (51%) and advertising (47%), than from general practitioners (26%) or through sex education in schools (3%). Altogether 282 women (69%) received EC from a doctor in the medical emergency service or a casualty ward. DISCUSSION: Overall, EC is used as recommended. Its availability does not seem to reduce the use of safer contraceptive methods. The mandatory sex education in school should include information on EC.

Adolescent↗

[Emergency contraception with levonorgestrel for teenagers--efficacy, tolerability, and level of information awareness].

OBJECTIVE: Assessment of efficacy and side effects of emergency contraception for teenagers with levonorgestrel (LNG) and the level of users' informedness about possibilities and practical application. METHODS: The subjects are healthy girls (n = 49) with regular menstrual cycles at the age between 15 and 19, having had one unprotected or faultily protected sexual intercourse. All of them have administered 0.75 mg LNG within the 72nd hour, repeated after 12 hours. The data have been processed by variational analysis. RESULTS: One pregnancy was registered of a girl with firstintake at the 67th hour - pregnancy rate - 2,0%. The most frequent side effect was nausea - 26,5%, folowed by breast tenderness - 22,4% and fatigue - 20,4%. An up to 7th day delay in menstrual cycle is non significantly more frequent - 14,3%, followed by a delay of more than 7 days breakthrough bleeding - 8,2%. No significant changes were established in the lenght of the menstrual cycle. Emergency contraception is sought for after unprotected sexual intercourse in 69,4%, and condom failure problems in 30,6%. Only 18,4% have sufficient information about the possibilities and practical use of emergency contraception. CONCLUSION: LNG provides effective, highly tolerable contraception with a small number of side effects. Need is felt for serious popularization of the application of emergency contraception with teenagers.

Adolescent↗

Abortion patients in 1994-1995: characteristics and contraceptive use.

Results of a 1994-1995 national survey of 9,985 abortion patients reveal that women who live with a partner outside marriage or have no religious identification are 3.5-4.0 times as likely as women in the general population to have an abortion. Nonwhites, women aged 18-24, Hispanics, separated and never-married women, and those who have an annual income of less than +15,000 or who are enrolled in Medicaid are 1.6-2.2 times as likely to do so; residents of metropolitan counties have a slightly elevated likelihood of abortion. When age is controlled, women who have had a live birth are more likely to have an abortion than are those who have never had children. Catholics are as likely as women in the general population to have an abortion, while Protestants are only 69% as likely and Evangelical or born-again Christians are only 39% as likely. Since 1987, the proportion of abortions obtained by Hispanic women and the abortion rate among Hispanics relative to that for other ethnic groups have increased. The proportion of abortion patients who had been using a contraceptive during the month they became pregnant rose from 51% in 1987 to 58%. Nonuse is most common among women with low education and income, blacks, Hispanics, unemployed women and those who want more children. The proportion of abortion patients whose pregnancy is attributable to condom failure has increased from 15% to 32%, while the proportions reporting the failure of other barrier methods and spermicides have decreased.

Abortion, Legal↗

Failure rate of condoms during anogenital intercourse in homosexual men.

Two hundred and seventy seven homosexual men participating in an AIDS study in Amsterdam, The Netherlands, were interviewed in July to December 1986 regarding their experiences with the use of condoms during anogenital intercourse. It appeared that in many cases the condoms used could not be described as reliable, or were not used safely. In 8% (117/1468) of cases the condom tore or slipped off. When different condoms were compared, it was seen that "qualified" anal condoms functioned best. Other anal condoms functioned worse, and in many cases even worse than classic vaginal condoms. Whether these differences exclusively depended on differences in quality cannot be assessed. Men who buy a qualified anal condom are possibly more motivated and thus also less likely to have failures. Regarding the apparent unreliability of the condoms used, homosexual men are advised to refrain from anogenital intercourse. When this is not feasible, a qualified anal condom should be used.

Acquired Immunodeficiency Syndrome↗

[Factors associated with the failure to use condoms among a population of parenteral drug addicts].

Use of condom in sexual intercourse by intravenous drug users has been assessed among a clinical population (n = 139). The multiple logistic regression results show that being a female (OR = 5.1, 95% CI = 2.0-13.2), on drug dependence for a 5-year period or more (OR = 3.0; 95% CI = 1.3-6.9) correlates with non-condom use. Less than 25% of females use condom in their sexual contacts. On the contrary a higher educational level seems to protect subjects against non-condom use (R = 0.3; 95% CI = 0.1-0.8). The most parsimonious model fitting to data at hand includes such variables as sex, educational level, partnership and frequency of sexual intercourse, as well as years on addiction. Other set of variables such as living and working status, age, and previous sexually-transmitted diseases experience are not required for the final model. Emphasis is placed on the need for developing programs aimed at modifying the high risk behavior intravenous drug users resort to in their sexual intercourse, stressing that the main dissemination cause of the human immunodeficiency virus among such a population is due to their sharing drug injections equipment.

Adult↗

HIV risk difference between condom users and nonusers among U.S. heterosexual women.

Using data from the National Survey of Family Growth, we estimate that among 3,498,060 U.S. reproductive-age women least likely to be protected from HIV, 12% rely on condoms for birth control. We have modeled the risk difference between condom users and nonusers and projected the number of preventable and nonpreventable HIV infections likely to occur among the 419,201 condom users as a function of 50 HIV-incidence/relative risk assumptions. Results of the attributable-risk model suggest that at the current low HIV-incidence level in U.S. women, condom-user failure rates will be less than 1% per year, substantially lower than the 10% condom-user failure rate for pregnancy. As few as 1% but up to 11% of all new HIV cases may be prevented by the current low level of condom use, depending on the exact degree of condom effectiveness in this population at risk. However, the model further projects that up to 45% of all new HIV cases may be prevented if condoms are maximally effective and far more widely used. Women with seropositive partners may enjoy the same protective benefits of condoms, but the costs in terms of condom-user failures will be much higher than in the remainder of the population at risk. Among serious and reliable users, condom-user failure rates for HIV may approach those for pregnancy, but only in women who have known seropositive partners.

Adolescent↗

Estimating and comparing correct-use failure probabilities in clinical studies of condom functionality.

In a clinical study comparing the failure probabilities of two condom types, the sample of all reported acts of intercourse in which a study condom was used by a randomized participant is typically defined to be the primary analysis sample. However, it may also be desirable to make comparisons among only those acts in which the participants correctly followed all condom use instructions before, during, and after the act of intercourse (i.e., the "correct-use" subset). The timing associated with the definition of correct use creates a dilemma in that an act cannot be classified as a "correct-use act" until after the completion of both intercourse and withdrawal; if a condom fails (e.g., breaks or slips completely off of the penis) during intercourse then the couple has no chance at correct use during withdrawal. As a result of the implicitly conditional nature of this problem, it is not a simple matter to specify a correct-use subset of the primary analysis sample. With this in mind, we develop estimators for the correct-use failure probabilities, the corresponding standard errors, and test statistics for comparing the correct-use failure probabilities between condom groups. We demonstrate the utility of the proposed methods by applying them to data from a clinical study of condom contraceptive effectiveness, and we use simulated data to investigate the finite sample properties of the proposed methods. The simulation results indicate that one of our proposed estimators is at least approximately unbiased, even in small samples. Furthermore, one-sided noninferiority tests performed using this estimator tend to have sizes that are only marginally larger than the nominal test size in moderate to large samples.

Computer Simulation↗