contraceptives--postcoital and HIV-Infections

To review new evidence regarding ten controversial issues in the use of contraceptive methods among women with special conditions and to present World Health Organization recommendations derived in part from this evidence.. We searched MEDLINE and PREMEDLINE databases for English-language articles, published between January 1995 and December 2001, for evidence relevant to ten key contraceptive method and condition combinations: combined oral contraceptive (OC) use among women with hypertension or headaches, combined OC use for emergency contraception and adverse events, progestogen-only contraception use among young women and among breast-feeding women, tubal sterilization among young women, hormonal contraception and intrauterine device use among women who are human immunodeficiency virus (HIV) positive, have AIDS, or are at high risk of HIV infection. Search terms included: "contraception," "contraceptives, oral," "progestational hormones," "medroxyprogesterone-17 acetate," "norethindrone," "levonorgestrel," "Norplant," "contraceptives, postcoital," "sterilization, tubal," "intrauterine devices," "hypertension," "stroke," "myocardial infarction," "thrombosis," "headache," "migraine," "adverse effects," "bone mineral density," "breast-feeding," "lactation," "age factors," "regret," and "HIV.". From 205 articles, we identified 33 studies published in peer-reviewed journals that specifically examined risks of contraceptive use among women with pre-existing conditions.. Combined OC users with hypertension appear to be at increased risk of myocardial infarction and stroke relative to users without hypertension. Combined OC users with migraine appear to be at increased risk of stroke relative to nonusers with migraine. The evidence for the other eight method and condition combinations was either insufficient to draw conclusions or identified no excess risk.. Of ten contraceptive method and condition combinations assessed, the evidence supported an increased risk of cardiovascular complications with combined OC use by women with hypertension or migraine. As new evidence becomes available, assessment of risk and recommendations for use of contraceptive methods can be revised accordingly.

Topics: Cardiovascular Diseases; Contraceptives, Oral; Contraceptives, Oral, Combined; Contraceptives, Postcoital; Evidence-Based Medicine; Female; Headache; HIV Infections; Humans; Hypertension; Lactation; Myocardial Infarction; Progestins; Risk Factors; Stroke

To assess effects on condom use and other sexual behaviour of an HIV prevention programme at school that promotes the use of condoms with and without emergency contraception.. Cluster randomised controlled trial.. 40 public high schools in the state of Morelos, Mexico.. 10 954 first year high school students.. Schools were randomised to one of three arms: an HIV prevention course that promoted condom use, the same course with emergency contraception as back-up, or the existing sex education course. Self administered anonymous questionnaires were completed at baseline, four months, and 16 months. Students at intervention schools received a 30 hour course (over 15 weeks) on HIV prevention and life skills, designed in accordance with guidelines of the joint United Nations programme on HIV/AIDS. Two extra hours of education on emergency contraception were given to students in the condom promotion with contraception arm.. Primary outcome measure was reported condom use. Other outcomes were reported sexual activity; knowledge and attitudes about HIV and emergency contraception; and attitudes and confidence about condom use.. Intervention did not affect reported condom use. Knowledge of HIV improved in both intervention arms and knowledge of emergency contraception improved in the condom promotion with contraception arm. Reported sexual behaviour was similar in the intervention arms and the control group.. A rigorously designed, implemented, and evaluated HIV education course based in public high schools did not reduce risk behaviour, so such courses need to be redesigned and evaluated. Addition of emergency contraception did not decrease reported condom use or increase risky sexual behaviour but did increase reported use of emergency contraception.

Topics: Adolescent; Cluster Analysis; Condoms; Contraceptives, Postcoital; Female; Health Education; HIV Infections; Humans; Logistic Models; Male; Mexico; Prospective Studies; Safe Sex; School Health Services; Sexual Partners; Unsafe Sex

UK guidelines for HIV post-exposure prophylaxis (PEP) in adults have recently been updated. Indications for PEP have been modified and there has been a change in the recommended antiretroviral therapy for adults to a combination of raltegravir with tenofovir and emtricitabine (Truvada). Raltegravir and tenofovir are now available in paediatric formulations and offer improved safety and tolerability over previously recommended ritonavir-boosted lopinavir with zidovudine. This guideline provides recommendations for those caring for children potentially exposed to HIV and other bloodborne viruses in primary care, emergency departments, secondary care and specialist paediatric HIV centres.

Topics: Adolescent; Aftercare; Ambulatory Care; Anti-HIV Agents; Antiemetics; Child; Coinfection; Community-Acquired Infections; Contraceptives, Postcoital; Drug Therapy, Combination; Hepatitis B, Chronic; Hepatitis C, Chronic; HIV Infections; Humans; Needlestick Injuries; Post-Exposure Prophylaxis; Risk Assessment

Sexual exposure to STDs including HIV and hepatitis is common. Sexual assault is also prevalent and should be screened for in a patient presenting for medical care after potential sexual exposure to STDs. Primary care providers should be familiar with current recommendations for STD prophylaxis and treatment after sexual exposure to STDs, and be aware that HIV postexposure prophylaxis is effective and available if indicated after sexual exposure to HIV. Providers should also be aware of the need for prompt referal for evaluation and medical care of the adult patient after a sexual assault.

Topics: Contraceptives, Postcoital; Female; Hepatitis B; Hepatitis C; HIV Infections; Humans; Rape; Risk Assessment; Sexually Transmitted Diseases; Young Adult

To estimate comprehension of the over-the-counter emergency contraception label among female adolescents aged 12 through 17 years, and to compare the results with a similar study that focused on adults.. Surveys were administered to female adolescents in New York City in public venues such as malls, movie theaters, and parks. Participants were asked to read the emergency contraception (levonorgestrel) label before answering survey questions. Comparisons were made in SPSS version 13.0 using chi tests of independence and Fisher exact tests for sparse data.. One thousand eighty-five girls between the ages of 12 and 17 participated in the study. Overall, adolescents demonstrated high comprehension of the key points of emergency contraception: (1) that it is a method of preventing pregnancy 92% (confidence interval [CI] 91-94%); (2) that it has to be taken within the first 72 hours after unprotected intercourse 83% (CI 83-87%); (3) that if you are already pregnant emergency contraception will not be effective 87% (CI 85-89%); (4) that emergency contraception will not protect against human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) 95% (CI 94-96%); and (5) that emergency contraception should not be used as a method of long-term birth control 85% (CI 83-87%).. After reading the emergency contraception (levonorgestrel) label, female adolescents aged 12 to 17 understood the information necessary to use emergency contraception safely and effectively as well as their adult counterparts.. III.

Topics: Adolescent; Child; Contraception Behavior; Contraception, Postcoital; Contraceptive Agents, Female; Contraceptives, Postcoital; Female; Health Knowledge, Attitudes, Practice; HIV Infections; Humans; Levonorgestrel; New York City; Psychology, Adolescent; Surveys and Questionnaires

Women attending a dedicated medical gynaecology and family planning referral clinic for women with HIV were surveyed using a standard questionnaire about their knowledge and attitudes to post-exposure prophylaxis after sexual exposure (PEPSE) and emergency hormonal contraception (EHC). Eighty percent of them had not heard of PEPSE, but once informed about it, 86% said they would inform a partner about it. Less than 10% had any idea of the duration of effectiveness. Seventy-three percent of the women knew about EC and 45% of them had used it previously. Ninety-eight percent of them would use it in the future if necessary. Eighty percent of them knew its period of effectiveness. There is a clear need for information about PEPSE, which needs to be delivered around the time of HIV diagnosis and reinforced later. Some women will need help in discussing it with HIV-negative partners.

Topics: Adult; Anti-HIV Agents; Chemoprevention; Contraception, Postcoital; Contraceptives, Postcoital; Female; Health Knowledge, Attitudes, Practice; HIV Infections; Humans; Middle Aged; Surveys and Questionnaires

Topics: Contraceptives, Postcoital; Female; Government; Government Programs; Health Policy; Health Priorities; HIV Infections; Humans; Peru; Politics; Public Health Administration; Reproductive Medicine

The study describes a cross-section of women using the emergency contraceptive pill (ECP), with regard to demographics, ECP use, sexual health, sexually transmitted infection (STI)/HIV risk perception and attitudes to condom use. All women attending a London hospital for the ECP over a four-month period were invited to complete a 30-item questionnaire anonymously. Of the 150 women attending, 88 (59%) took part. Over 60% needed the ECP because of unprotected sexual intercourse (UPSI). A third had had UPSI in the previous three months, 70% had used ECP previously. The vast majority (>95%) did not think they were at high risk of STIs or HIV infection, and though the most likely explanations for UPSI were that it is more enjoyable and that people get 'carried away'. There are concerns that women are using the ECP as a form of contraception and are putting themselves at risk of STIs and HIV infection. Information regarding risk behaviour needs to be routinely given with the ECP in order to avoid further large increases in infection.

Topics: Adult; Attitude; Condoms; Contraception Behavior; Contraceptives, Postcoital; Female; HIV Infections; Humans; Risk-Taking; Sexual Behavior; Sexually Transmitted Diseases; Surveys and Questionnaires

To determine emergency department (ED) practitioner willingness to offer emergency contraception (EC) following sexual assault and consensual sex, and to compare responses of practitioners from states whose laws permit the refusal, discussion, counseling, and referral of patients for abortions (often called "opt-out" or "abortion-related conscience clauses") with those of practitioners from states without these laws.. Using a structured questionnaire, a convenience sample of ED practitioners attending a national emergency medicine meeting was surveyed.. The 600 respondents were: 71% male, 29% female; 34% academic, 26% community, and 33% resident physicians; and 7% nurse practitioners and physician assistants. Many respondents (88%) were inclined to offer EC to those sexually assaulted by unknown assailants. More practitioners said they were willing to offer EC if the assailant was known to be HIV-infected rather than if the assailant had low HIV risk factors (90% vs. 79%, p < 0.01). More respondents would prescribe EC after sexual assault than consensual sex (88% vs. 73%, p < 0.01). The rates of willingness to offer EC were the same for practitioners in states with "abortion-related conscience clauses" and those from other states.. Most ED practitioners said they were willing to offer EC. Although the risk of pregnancy exists after consensual sex, practitioners were less willing to prescribe EC after those exposures than for sexual assault. "Abortion-related conscience clauses" did not seem to influence willingness to offer EC.

Topics: Adolescent; Adult; Attitude of Health Personnel; Chi-Square Distribution; Contraceptives, Postcoital; Data Collection; Emergencies; Emergency Medicine; Emergency Service, Hospital; Female; Health Surveys; HIV Infections; Humans; Male; Practice Patterns, Physicians'; Pregnancy; Sex Offenses; Surveys and Questionnaires; United States

Topics: Anti-HIV Agents; Contraceptives, Postcoital; Female; HIV Infections; Humans; Infectious Disease Transmission, Vertical; Pregnancy

Topics: Contraception; Contraceptive Devices, Male; Contraceptives, Postcoital; Female; HIV Infections; Humans; Male; Pregnancy

If used correctly, only 2 out of every 100 women using a diaphragm would conceive over a year; however, because of forgetfulness the figure increases to 19 out of every 100. With good care they can last up to 12 years. The contraceptive sponge works because of the sperm-killing ingredients in the spermicide and because it blocks the cervix. The condom may also provide some protection against a variety of sexually transmitted diseases (STDs), such as herpes and gonorrhea. Missing one day of a low-dose oral contraceptive formulation (35 mcg) will have no consequences since the pill works by keeping hormone levels in the body elevated over time. With IUDs the only potential pitfall is forgetting to check for the tail every week of the first month and once a month thereafter to be sure the IUD is still in place. Some physicians suggest using a second form of contraception for the first three months after an IUD is inserted, since the odds are slightly higher it will be dislodged during this time. The manufacturers of Cu-7's and Cu-T's, as well as most physicians, recommend replacement of this device every three years. Experts are in agreement, however, that copper-containing IUDs carry a slightly lower risk of infection than Progestasert and the Lippes Loop. For postcoital contraception douching or using a spermicide within 10 minutes may help a bit. Although an IUD insertion can prevent pregnancy 90-95% of the time if it is done within five days of unprotected intercourse, because of the infection risk, this is not recommended unless a woman is planning on leaving the device in place as a contraceptive. The morning-after pill also works by preventing implantation of the fertilized egg. Taking two within 24 hours and two more 12 hours later prevents pregnancy 90-95% of the time, possibly with mild nausea or headache.

Topics: Condoms; Contraception; Contraceptive Agents; Contraceptive Devices, Female; Contraceptives, Oral; Contraceptives, Postcoital; Disease; Family Planning Services; HIV Infections; Infections; Intrauterine Devices; Sexually Transmitted Diseases; Spermatocidal Agents; Virus Diseases