Women plan condom use after sterilization

Women are not only hearing the HIV/AIDS prevention message, they are putting it into practice by planning condom use after sterilization. Of nearly 3,000 women who chose tubal sterilization at the Baylor College of Medicine in Houston from 1991 to 1996, 42% reported plans for future condom use.1

A cross-sectional study reveals steady and significant growth of planned condom use among women choosing the permanent form of birth control.

Communicating the need for continued protection against HIV/AIDS and other sexually transmitted diseases (STDs) is doubly important when women are counseled prior to choosing sterilization, says Amy Pollack, MD, MPH, president of AVSC International in New York City.

It has been documented that women who receive tubal sterilizations visit their family planning providers less often because they no longer require birth control supplies,2 Pollack notes. Therefore, the opportunity for stressing the need for HIV/AIDS and STD protection comes before the procedure is done, she stresses.

Getting the disease prevention message across is crucial when one considers a large majority of women report sterilization as their chosen method of contraception, says Haleh Sangi-Haghpeykar, PhD, assistant professor in the contraceptive research and development division and lead author of the Baylor study. "It is estimated that in the U.S. alone, more than 1 million tubal sterilizations are performed each year.3 Although sterilization is very effective at prevention of pregnancy, it does not prevent exposure to STDs," she says.

Women who are older and in long-term monogamous relationships may think they are at low risk for HIV/AIDS and STDs. That belief may keep them from planning condom use once they undergo tubal sterilization, and they need to understand that their partners may continue to place them at risk, she says. "[The women] might be faithful, but their partners may not. In this day and age, I think prevention is an issue that everyone should be concerned about, not just a certain population of non-married, single young women."

Little data available

There is a shortage of research on women’s use of HIV/AIDS and STD prevention strategies following sterilization, Sangi-Haghpeykar notes. The Baylor researchers decided to question patients in the Houston family planning clinic over six years to learn more about their plans for condom use following tubal sterilization.

Women at the clinic receive a standard counseling and educational session, where information is presented on the importance of condom use. After the physical exam, patients are asked to complete a questionnaire, which includes the following question: "Do you plan to use condoms during intercourse in the future to protect yourself and/or others from HIV infection and other sexually transmitted diseases?"

The 2,782 women who received tubal sterilizations at the clinic ranged in age from 18 to 51. One-fifth of the women had a known risk factor for HIV. Nearly one-fourth of the women reported regular condom use for contraception or disease protection during the three months before sterilization.

Over the six-year period, planned condom use increased steadily, from 32% in 1991 to 51% in 1996, with this increase occurring regardless of age, marital status, or ethnic background. Of the 646 women who used condoms before sterilization, nearly half indicated no plans to do so after the procedure. As a result, 11% of the total sample experienced an increased risk for disease exposure.

Using multiple regression analysis to examine the association between condom use and various characteristics, researchers found that factors associated with condom use were:

• younger age;

• black ethnicity;

• unmarried;

• previous STD;

• no steady partner;

• higher number of previous sexual partners;

• use of condoms for disease protection in the past;

• lack of partner involvement in the decision to undergo sterilization.

Although the study does not track actual condom use after sterilization, the results show that more women plan to put disease prevention into practice following the procedure, says Sangi-Haghpeykar.

"Counseling does make an effect. It has been shown in other work,4 and I’m sure it applies to this population as well, that if women are really counseled about the importance of condom use, they are more likely to use it," she says.

Family planners may want to consider encouraging women to return to the clinic for condom supplies after sterilization, Sangi-Haghpeykar suggests. By placing a basket of free condoms in the waiting room, women can stop by for supplies at their convenience.

"Somehow, we must provide access to this prophylactic method," she says. "Women have to understand that they have to continue to use condoms, and not just for a while."

References

1. Sangi-Haghpeykar H, Poindexter AN 3rd. Planned condom use among women undergoing tubal sterilization. Sex Transm Dis 1998; 25:335-341.

2. HIV-risk behaviors of sterilized and nonsterilized women in drug-treatment programs — Philadelphia, 1989-1991. MMWR 1992; 41:149-152.

3. Tulandi T. Tubal sterilization. N Engl J Med 1997; 336:796-797.

4. Contraceptive practices before and after an intervention promoting condom use to prevent HIV infection and other sexually transmitted diseases among women — selected U.S. sites, 1993-1995. MMWR 1997; 46:373- 377.