Dual protection to address the global syndemic of HIV and unintended pregnancy in Brazil

Kiyomi Tsuyuki; Jessica D Gipson; Lianne A Urada; Regina Maria Barbosa; Donald E Morisky

doi:10.1136/jfprhc-2015-101175

Dual protection to address the global syndemic of HIV and unintended pregnancy in Brazil

J Fam Plann Reprod Health Care. 2016 Oct;42(4):271-279. doi: 10.1136/jfprhc-2015-101175. Epub 2016 Feb 15.

Authors

Kiyomi Tsuyuki¹, Jessica D Gipson², Lianne A Urada³, Regina Maria Barbosa⁴, Donald E Morisky⁵

Affiliations

¹ NIDA Post-doctoral Fellow, Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
² Assistant Professor, Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles (UCLA), USA.
³ Assistant Professor, Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
⁴ Professor, Population Studies Center (NEPO), University of Campinas (UNICAMP), Campinas, Brazil.
⁵ Professor, Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles (UCLA), USA.

Abstract

Background: Syndemic HIV and unintended pregnancy is prevalent in Brazil, where 79% of female HIV cases occur in women of reproductive age and 55% of all pregnancies are unintended. Although increasing condom use to prevent HIV may decrease non-barrier contraception and increase unintended pregnancy, few studies focus on dual protection or dual methods (condoms with another modern contraceptive).

Aim: To describe the correlates of dual method use and consistent condom use in women of reproductive age in Brazil.

Method: Data are from the 2006 Pesquisa Nacional de Demografia e Saúde da Mulher e da Criança, a decennial nationally representative household survey of women of reproductive age in Brazil. Multivariate logistic regression models identify the socio-demographic, sexual debut, fertility and relationship factors associated with dual method use and consistent condom use.

Results: Two-thirds of contracepting women in Brazil used dual protection (40% exclusive condoms, 27% dual methods). Consistent condom use in the past year occurred among 61% of exclusive condom users and 27% of dual method users. Dual methods (vs exclusive condoms) was associated with some high school education [relative risk ratio (RRR)=1.69, p<0.05], living in the Southern region (RRR=1.59, p<0.01), and number of children (RRR=1.22, p<0.01), net of other factors. Consistent condom use was associated with condom use at sexual debut [adjusted odds ratio (AOR)=1.84, p<0.001], wants no (more) children (AOR=1.86, p<0.001), single/separated relationship status (AOR=2.77/2.45, p<0.001) and using exclusive condoms (vs dual methods: AOR=0.19, p<0.001).

Conclusions: Findings highlight that targeting and delivering integrated HIV and family planning services should focus on completed/large families. single/separated individuals, and promoting dual protection at sexual debut.

Keywords: Brazil; condom; dual method use; family planning service provision; hormonal contraception; human immunodeficiency virus.

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Abstract

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