1998_3_ dual protection

Sexual Health Exchange, 1998 - no. 3

Dual protection against unwanted pregnancy and HIV/STDs

The concept "dual protection" refers to the use of methods that will simultaneously prevent unwanted pregnancy and HIV/STD infections. It may be achieved in two ways: 1) use of a barrier method (male or female condom) together with another contraceptive method or 2) use of the male or female condom alone. Mantell and Weiss designed the chart below as a guide for counselling clients on dual protection. It shows which methods are most (top) and least (bottom) effective for achieving protection against unwanted pregnancy and HIV/STDs.

Family planning	HIV/STD protection
Abstinence Sterilization Norplant Injection Pill IUD Male condom with spermicide Male condom Female condom, diaphragm, cervical cap Vaginal spermicide alone Natural family planning	Abstinence Non-penetrative sex Long-term mutual monogamy with HIV testing Male condom with spermicide Male condom Female condom Diaphragm, cervical cap Vaginal spermicide alone

The chart forms part of a "female-initiated protection paradigm" for integrating family planning and HIV/STD prevention that has the following components:

reproductive health assessment
HIV/STD risk and motivation assessment
individualized interactive counselling on contraceptive methods and their selection
skills building on barrier method use and other prevention strategies
follow-up counselling that identifies barriers to using specific methods and develops problem-solving strategies
HIV/STD testing and treatment on site or through referral and partner referral.

Further information on the approach is available from: Joanne E. Mantell and Eugene Weiss, HIV Center for Clinical and Behavioral Studies, Columbia University/NYS Psychiatric Institute, 722 West 168th Street, New York, NY 10032, USA; Tel: 1-212-543-5969; Fax: 1-212-543-6003; e-mail: mantell@cnvlz.com or eweiss2@idt.net