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Query: UMLS:C0019693 (HIV)
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Among 30-40 year old women, 40% of pregnancies are unplanned, which is indicative of the unreliability of the birth control methods they are using. The 1992 Ortho Birth Control Study interviewed almost 7000 women, of whom 8% listed withdrawal and 4% listed the rhythm method. These two methods have failure rates of 24% and 19%, respectively. Birth control methods often disappoint the users and increasingly they turn to sterilization. 48% of married women aged 15-44 had themselves been sterilized or had a sterilized partner in the Ortho survey. Although reversal of tubal ligation succeeds in 43-88% of cases, conception cannot be guaranteed. For women over the age of 30 who are healthy and do not smoke, low-estrogen or no-estrogen oral contraceptive pills are considered safe. Taking the pill also helps prevent ovarian and endometrial cancer. The failure rate is 6%. Barrier methods also offer protection from sexually transmitted diseases including HIV. Condoms are favored by 33% of unmarried women and 19% of married women. Sexually active 40-44 year old unmarried women run a 14-19% risk of contracting a sexually transmitted disease (STD) in a 12-month period. Diaphragms offer some protection against STDs, but their failure rate is 18%. IUDs are regaining popularity, but only 1% of women use them (ParaGard T380A or Progestasert). Pelvic inflammatory disease is the reason: a 1992 study showed that 0.97% of women developed it within 20 days of use. Norplant is a long-term implant containing levonorgestrel with a failure rate of 0.5%. A 1993 study followed 1253 implant users over 12 months and found a very low rate of pregnancy, but 75% experienced some side effects during the first year. About half of the women using Norplant removed it after 2.5 years because of irregular bleeding. Depo-Provera is an injectable administered every 3 months, but after removal it can take up to a year for ovulation to return. Side effects may include hair loss and weight gain; and links to breast cancer have also been suggested.
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PMID:Birth control over 30. 1229 85

The recent finding that rhesus monkeys given progesterone were more likely to become infected after vaginal exposure to simian immunodeficiency virus than their nontreated counterparts has raised concerns about the effect of progestin-containing contraceptives on HIV risk. More research is needed to determine whether this finding extends to the progestins used in oral contraceptives, Norplant, injectables, and the levonorgestrel-containing IUD. Family Health International, in response to the animal study, reiterated its stance of support of dual contraceptive use: hormonal methods to prevent pregnancy and latex condoms to prevent sexually transmitted diseases.
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PMID:Does progesterone increase HIV risk? Contraceptive update. 1229 87

The 1995 US abortion rate of 20/1000 women of reproductive age was the lowest recorded since 1975. In the period 1994-95, the birth rate decreased 1.5%, and the abortion rate decreased 4.5%. Part of the explanation for this decline can be found in the demographic make-up of US women of reproductive age. The number of women in this group has grown since 1980, but the percentage in the most fertile younger age group has declined while that in the less fertile older age group grew. The decline in births and abortions is also due to increased contraceptive usage, especially among adolescents responding to the HIV/AIDS threat. The drop in the abortion rate may also be due to the use of Norplant by adolescents who had given birth and wanted to avoid another birth. Adolescents accounted for 26% of abortions in 1985 and only 20% in 1995. More abortions are being provided at high-volume clinics, and the number of small abortion providers is decreasing. High volume clinics are associated with low complication rates, but women may have to travel further to avail themselves of abortion services. Only 12% of family practice programs nationwide offer abortion training to their residents, and this may contribute to a shortage of abortion providers.
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PMID:Abortion rate lowest in United States since '75. 1229 75

"Dual protection" refers to the use of methods which will prevent both unwanted pregnancy and HIV/STD infections during sexual intercourse. Such protection may be achieved through either the use of a barrier method such as a male or female condom together with another contraceptive method, or through the use of the male or female condom alone. In descending order of effectiveness, the following methods can protect against unwanted pregnancy: abstinence; sterilization; Norplant; injection; oral contraceptive pill; IUD; male condom with spermicide; male condom; female condom, diaphragm, or cervical cap; vaginal spermicide alone; and natural family planning. In descending order of effectiveness, the following methods can protect against the transmission of HIV and STDs: abstinence, nonpenetrative sex, long-term mutual monogamy with HIV testing, male condom with spermicide, male condom, female condom, diaphragm and cervical cap, and vaginal spermicide alone. When attempting to provide clients with the family planning and HIV/STD prevention method(s) which best suits their needs, clients' degrees of reproductive health, HIV/STD risk, and motivation must first be assessed. Counseling upon and selection of particular methods may then ensue, followed by skills building of method use and other prevention strategies, follow-up counseling, and HIV/STD testing and treatment either on-site or through referral.
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PMID:Dual protection against unwanted pregnancy and HIV / STDs. 1229 88

The fourth and final issue of The Alan Guttmacher Institute's 1992 State Reproductive Health Monitor: Legislation Proposals and Actions chronicles and summarized reproductive health-related legislation introduced and acted on in the 50 states in 1992, covering abortion, family planning services, sex education, teenage pregnancy, adoption, infertility, maternal and infant care, and sexually transmitted diseases/AIDS. Arkansas, Montana, Nevada, North Dakota, Oregon, and Texas did not convene. Abortion legislation involved parental consent/notice, informed consent and waiting periods, funding, abortion/reproductive rights, abortion bans, RU-486, clinic harassment, insurance coverage, reporting requirements, fetal research/remains, postviability abortion, sex selection, clinic licensing, spousal notification, conscience clauses, counseling and referrals, feticide, and proposals for promoting "alternatives to abortion." Family planning services, sex education, teenage pregnancy, Norplant welfare reform, infertility services, surrogacy contracts, perinatal drug and alcohol abuse and family and medical leave was also covered as was HIV testing, consent, and notification, education and prevention strategies, treatment, insurance coverage, and discrimination.
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PMID:Overview. 1231 63

A hearing was held November 24, 1992, by the US Subcommittee on Education and Health of the Joint Economic Committee to discuss the social and economic costs of teenage pregnancy and childbearing in the United States. The hearing was initiated by the subcommittee chair, New York State Democrat Representative James Scheur, to help ensure that this issue was central in future President Bill Clinton's new goals and programs. $120.4 billion of public funds went to teen childbearing related expenses during 1985-90, $48.2 billion of which could have been saved had childbearing been postponed until women were at least 20 years old. Scheuer posited that: adolescents need to be better informed about family planning options; family and institutional efforts to raise mature and responsible children should be supported; and life opportunities should be improved for young men and women. While some speakers stressed the need for education on sexuality and contraceptive methods, and others hope to see sex sanctioned only within mutually monogamous marriage, all called for greater prevention. Other industrialized nations openly accept and acknowledge that adolescent activity is common and provide education and contraceptive services. In so doing, these countries have more successfully prevented teen pregnancy and childbirth. Norplant was also discussed in the hearing. The national level of teen pregnancy remained constant over the 1980s despite higher rates of sexual activity. Teens are most likely responding to the threat of HIV infection by using condoms more frequently. The Centers for Disease Control also cite a decline in sexual activity among teenagers over the period 1989-91.
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PMID:House hearing on adolescent pregnancy focuses on social and economic costs. 1234 80

Hormonal contraceptives include oral pills with lower steroid concentrations such as the triphasic gestodene. A dose of less than 20 mcg of ethinyl estradiol in the combined pill is effective. The use of RU-486 or mifepristone to inhibit ovulation or as a postcoital method is still being investigated. The vaginal rings that release 20 mcg of levonorgestrel (LNG) have a 97% rate of efficacy. There are newer types that release 30 mcg of LNG or desogestrel. A progesterone-releasing ring used during lactation is being studied. Among implants Norplant has been approved in many countries, including by the US Food and Drug Administration, with excellent results. In Brazil it continues to be banned. Studies have been initiated about implants, such as Norplant 11 and UNIPLANT. The studies conducted by the World Health Organization on injectables such as Cyclofem (which contains 5 mg of estradiol cypionate and 25 mg of medroxyprogesterone acetate) as well as Mesigyna (5 mg of estradiol valerate and 50 mg of norethindrone enanthate) are awaited. These two monthly injectables have minor side effects, produce regular cycles, and are highly effective. The use of GnRH analogues for ovulation inhibition are held back because of cost, dosage, and routes of administration The hormonal IUD releasing 20 mcg of LNG holds promise for high efficacy, probable protection against inflammations, and pronounced reduction of menstrual bleeding, particularly in long-term use. The frameless IUD, called Flexigard, consists of 6 fixed copper cylinders placed in the myometrium, which causes less endometrial irritation and less incidence of inflammation, pain, and bleeding. It has been in an experimental testing phase for some years. The female condom helps prevent STDs and is under the woman's control. Among male contraceptives, a hormonal method awaits development, while gossypol with the ability to inhibit HIV proliferation and the Chinese method of scalpel-free vasectomy are effective methods.
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PMID:[Information on advances in sciences and technology. Advances in contraceptive technology]. 1234 21

As more and more schools in the US have begun to establish programs to distribute condoms, opposition to this service has expanded beyond the arena of local hearings to the introduction of legislation to ban the practice in a number of states. During 1995, 11 measures were introduced, of which five would bar access to contraceptives, five would require parental consent, and one would prohibit the dispensing of longterm methods such as Norplant. None of these measures were enacted, and only two remain pending. Some of the proposed measures contained additional prohibitions, such as including inmates at state facilities, banning referrals for abortion without parental permission, and extending the scope of the restrictions beyond school-based services to include all minors. In all but six states, condom distribution in schools remains uncharted legal territory. 420 schools in 41 states currently provide condoms upon request. Only Massachusetts, however, has a Board of Education policy (which was upheld by the State Supreme Court) which encourages condom distribution in order to curtail HIV transmission. Opponents argue that condom distribution encourages sexual activity and usurps parental authority. Proponents point to the responsibility of the schools to perform public health functions.
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PMID:Without much success, state legislators take aim at school condom programs. 1234 46

HIV-positive women may be reluctant to attend gynaecology or family planning clinics for fear of divulging their condition. Therefore, a referral clinic was opened within the HIV clinic. Retrospective case-note reviews of 197 new patients revealed 109 with a variety of medical gynaecology conditions (menorrhagia being the commonest) and 88 sought contraception. The full range of contraceptives was used, including Mirena for the treatment of menorrhagia as well as contraception and the combined pill adjusted for interaction with liver enzyme-inducing antiretroviral drugs. The acceptance of contraceptive advice and gynaecological evaluation by the patients has resulted in improved reproductive health services for these HIV-positive women. In centres with large cohorts of HIV-positive women, this type of one-stop specialist clinic will be very effective in providing high-quality reproductive health care and hence, this type of clinic is recommended for such centres.
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PMID:Contraception and medical gynaecology for HIV-positive women in a one-stop clinic. 1910 2

This article reviews the two intrauterine devices (IUDs) available in the United States: the TCu380A, marketed as ParaGard (Duramed Pharmaceuticals, Inc. Pomona, NY), and the levonorgestrel-releasing intrauterine system (LNG-IUS), marketed as Mirena (Bayer HealthCare Pharmaceuticals, Inc., Wayne, NJ). The properties of the two devices are detailed, as well as noncontraceptive indications and appropriate candidates for use. Studies consistently demonstrate that the devices are safe, effective, and provide cost savings when compared with other reversible methods. The TCu380A may be used as postcoital contraception with close to 100% effectiveness. Menstrual blood loss is likely to increase with the TCu380A and decrease with the LNG-IUS. Reduction in menstrual blood loss and endometrial suppression make the LNG-IUS an increasingly popular treatment for menorrhagia, endometriosis, adenomyosis, and as an adjunct to estrogen therapy. IUDs may be inserted immediately after a first- or second-trimester abortion, immediately postpartum, and >or=4 weeks postpartum. Candidacy for IUDs has expanded, and includes nulliparous women, adolescents, and women with immunocompromised conditions including HIV.
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PMID:Intrauterine contraceptives: a review of uses, side effects, and candidates. 2035 61


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