Family planning providers' perspectives on dual protection

CONTEXT : Family planning providers can play an important role in helping women to identify their risk of HIV and other sexually transmitted diseases (STDs) and to adopt preventive measures. In-depth investigation of providers' attitudes about approaches to STD risk assessment, contraceptive counseling and dual protection–concurrent protection from STDs and unintended pregnancy–has been limited.
METHODS : In semistructured interviews conducted in 1998, 22 health care providers from a large New York City agency offering contraceptive and STD services described how they balanced STD and pregnancy concerns, viewed risk assessment and assessed various contraceptive methods.
RESULTS : STD prevention was seen as an integral part of family planning counseling, and most providers believed that risk assessment should be conducted universally. Providers viewed dual protection as use of condoms along with an effective contraceptive; few advocated use of the male or female condom alone. The female condom was believed to be a disease prevention method of last resort and was considered appropriate only for specific groups of women. Although providers lacked understanding about the effectiveness of the female condom and how to counsel clients concerning its use, they expressed interest in learning more.
CONCLUSIONS : Training is needed to reduce providers' negative perceptions of the female condom and to reinforce the importance of individualized counseling tailored to women's specific circumstances. Studies are needed on how to encourage family planning providers to promote male and female condoms as effective contraceptive methods.     

Lea''s Shield®: A study of the safety and efficacy of a new vaginal barrier contraceptive used with and without spermicide

The purpose of this study was to evaluate the safety, efficacy and acceptability of Lea's Shield^®, a new vaginal contraceptive barrier device, when used with either spermicidal or non-spermicidal lubricant.

One-hundred-eighty-five (185) women enrolled at six centers. Half were randomized to use the device with spermicide and half with a non-spermicidal lubricant. To be eligible, volunteers had to be 18–40 years old (inclusive), in good health with regular menses, sexually active in an ongoing relationship and at risk for pregnancy, and willing to use Lea's Shield^® as their sole means of contraception for six months. Participants were seen at admission, one week, one month, three months and six months. Gross cumulative life table rates were calculated for pregnancy and others reasons for discontinuation. Adverse experiences and responses to an acceptability questionnaire were evaluated.

One-hundred-eighty-two (182) volunteers contributed data to the analysis of safety and 146 to that of contraceptive efficacy. The unadjusted six-month life table pregnancy rate was 8.7 per 100 women for spermicide users and 12.9 for non-spermicide users (p = 0.287). After controlling for age, center, and frequent prior use of barrier methods, the adjusted six-month life table pregnancy rate was 5.6 for spermicide users and 9.3 for non-spermicide users (p = 0.086), indicating that use of spermicide lowered pregnancy rates, although not significantly, during typical use.

For purposes of comparison, it is important to note that this study differed from the cap/diaphragm and sponge/diaphragm studies in that a high percentage (84%) of volunteers were parous. For reasons that are unclear, pregnancy rates among parous women using barrier contraceptives tend to be higher than among nulliparous women. Indeed, in this study there were no pregnancies among nulliparous users of Lea's Shield^®. Standardization of parity of this study population on those of the cap/diaphragm and sponge/diaphragm studies suggests that unadjusted pregnancy rates for this device would have been considerably lower (2.2 and 2.9 per 100 users of spermicide and nonspermicide, respectively) had the study been done using the populations of earlier studies. Since no directly comparative study has been done, these figures provide a tentative estimate of the relative efficacy of Lea's Shield^® compared with the sponge, cap, and diaphragm.

There were no serious adverse experiences attributed to the use of Lea's Shield^®. Acceptability was very good. Seventy-five percent (75%) of women responded to an end-of-study questionnaire; 87% of these reported that they would recommend Lea's Shield^® to a friend.

Lea's Shield^® is a new vaginal contraceptive that does not require clinician fitting. Pregnancy rates in this study compare favorably with other studies of barrier contraceptive methods including the cervical cap, diaphragm, and sponge, even though this study was done with greater rigor and with a greater percentage of parous women than previous barrier studies. Lea's Shield^® appears to be safe and very acceptable to study volunteers.     

Birth control method choice and use of barrier methods for sexually transmitted disease prevention among low-income African-American women

In a prospective study of 1122 women attending a sexually transmitted disease (STD) clinic in Alabama, consistent use of the male condom and vaginal microbicide/spermicides was promoted to reduce STD risk. This analysis evaluated: 1) baseline characteristics that may influence birth control method choice; and 2) the association of birth control method and other baseline characteristics with consistency of barrier use during follow up. Birth control method was associated with sociodemographic variables, sexual, and reproductive history. Women who adopted user-independent methods (tubal ligation, implants, injectable hormones) appear to have completed their family plan. Oral contraceptive users were of higher socioeconomic status and at lower STD risk. Barrier method users and women who used no method were young and at higher STD risk. Consistency of condom/spermicide use increased in all groups. Barrier method users were more likely than other women to use condoms and spermicides during the study. Women who used no birth control method at baseline experienced the largest increase in barrier use during follow up, although their barrier use rates were lower than in other groups. The synergism between the intention to prevent pregnancy and the intention to prevent STD should be considered in the design of interventions promoting condom use.     

Consistency of condom use among low-income hormonal contraceptive users

CONTEXT: Hormonal contraceptive users may be at increased risk for HIV and other STDs. An understanding of their decisions and abilities to use condoms is needed to focus intervention programs aimed at improving their protective behaviors. METHODS: Between 1999 and 2001, 426 new users of depot medroxyprogesterone acetate (DMPA) and oral contraceptives were recruited from public clinics providing family planning services to low-income women and surveyed when they began their method and again three months later. Bivariate analyses examined the consistency of condom use across subgroups, and multivariate analyses assessed associations between consistent use and various characteristics. RESULTS: Among women who had used condoms consistently before starting on DMPA or the pill, 54% discontinued consistent use after taking these contraceptives. Overall, 20% of women consistently used condoms with their hormonal method, and such use did not vary significantly by contraceptive type. Seventy-five percent of women in non-monogamous relationships were inconsistent users, though nearly a third had been consistent users prior to beginning a hormonal method. Factors associated with an elevated likelihood of consistent use were the male partner's positive opinion of condoms (odds ratio, 3.3) and the woman's strong belief that condom use is important for vaginal intercourse (3.5) and even if the couple is using another form of birth control (4.1). CONCLUSIONS: Many women at highest risk for disease have a decreased likelihood of using condoms, and disease prevention programs should be customized to target these women. Educational efforts focusing on women's attitudes and negotiation skills may be the best means of increasing dual method use.     

Family planning, sexually transmitted diseases and contraceptive choice: a literature update--Part I.

Couples who use contraceptives not only protect themselves against unwanted pregnancies, but also may reduce their risk of becoming infected with a sexually transmitted disease (STD). No currently available method, however, is highly effective in protecting simultaneously against pregnancy and infection. Thus, couples who place high priority on minimizing both risks may have to use two methods. The need for contraceptive methods that provide effective protection against both pregnancy and STDs has been intensified by the HIV epidemic, but progress has been slowed by the lack of integration between the STD and family planning fields. The first part of this two-part article discusses the similarities and differences between the two fields, examines the impact of STDs on contraceptive use and services, and reviews the scientific literature dealing with the effects of condoms, spermicides and barrier-and-spermicide methods on the risk of STD transmission. Part II (which will appear in the next issue) examines what is known about the effects of oral contraceptives, the IUD, tubal sterilization and abortion on reproductive tract infections. The second part also includes a discussion of the trade-offs involved in choosing a contraceptive and presents estimates of the first-year rates of unplanned pregnancy and gonorrhea infection (given an infected partner) that would occur among women using various contraceptive methods.     

Dual protection against unwanted pregnancy and HIV / STDs

"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.     

Contraception and STDs

Since behavioral research indicates that assumption of less risky sexual practices is unlikely, prevention of sexually transmitted diseases (STDs) by alteration in contraceptive practice is more realistic. Condoms, known from laboratory tests to be impermeable to semen, body fluids, and all STD organisms except hepatitis B fragments, only reduce transmission of most STD infections by 50% in actual use. Those who use condoms more consistently achieve better protection, while condom failure due to breakage is concentrated among some users. Spermicides, including nonoxynol-0, benzalkonium chloride, menfegol, and octoxynol, act as lipid solvent, killing sperm and all STD agents. Most studies suggest about a 50% reduction in transmission, with perhaps a 33 less transmission of chlamydia. There is one report of possible enhancement of transmission of HIV by use of spermicides, among prostitutes in Africa. Neither condoms nor spermicides protect against extragenital transmission, especially for organisms transmitted by skin contact, i.e., syphilis, herpes, or chancroid. Oral contraceptives provide clear protection, about 50%, against pelvic inflammatory disease (PID), while they may facilitate cervical ectopy, and associated cervical chlamydia and gonorrhea. IUDs, once believed to heighten the risk of PID, now are considered increase this risk only a few days or months after insertion. Such insertion-related infection can be controlled with a single dose of a broad-spectrum antibiotic. Unfortunately those methods which are most effective in preventing pregnancy, pill and IUDs, are not particularly useful in preventing STDs, as are the less effective barriers and spermicides.     

Factors associated with use of the contraceptive sponge

A study of 264 current sponge users, 266 pill users and 45 diaphragm users shows that women who adopted the sponge were older, more educated and more likely to be married, to have higher incomes and to have had more pregnancies and children than were women who had used oral contraceptives. Compared with diaphragm users, sponge users were more likely to be never-married, had had fewer children and were more likely to be Protestant. Users of all three methods cited physicians as being the greatest source of influence in the decision to adopt their current method; however, sponge users were the least likely to cite physicians, and they were more likely to have been favorably influenced by the media than were pill or diaphragm users. Sponge users were more likely than pill users to have ever relied on other contraceptive methods and to have correctly answered more questions on contraceptive knowledge. Sponge users and diaphragm users were similar in the range of methods they had ever used and in contraceptive knowledge. However, sponge users reported more consistent use than did diaphragm users.     

Female condom use among women at high risk of sexually transmitted disease

CONTEXT: Whereas the female condom has been evaluated in many hypothetical acceptability or short-term use studies, there is little information about its suitability for the prevention of sexually transmitted diseases (STDs) or HIV over extended periods of time. METHODOLOGY: As part of a six-month prospective follow-up study of 1,159 STD clinic patients, clients were interviewed during their initial visit, exposed to a behavioral intervention promoting condoms, given a physical examination and provided with instructions on completing a sexual diary. Potential predictors of trying the female condom were evaluated using logistic regression, and three condom-use groups (exclusive users of female condoms, exclusive users of male condoms and users of both types of condoms) were compared using multinomial regression. RESULTS: Among 895 women who reported having engaged in vaginal intercourse during the study period, one-half had sex with only one partner, while one-quarter each had two partners or three or more partners. A total of 731 women reported using the female condom at least once during the follow-up period--85% during the first month of follow-up. Multiple logistic regression analyses indicated that employed women and those with a regular sexual partner at baseline were significantly more likely to try the female condom. By the end of the follow-up period, 8% of participants had used the female condom exclusively, 15% had used the male condom exclusively, 73% had used both types of condom and 3% had used no condoms. Twenty percent of women who tried the female condom used it only once and 13% used it twice, while 20% used 5-9 female condoms and 32% used 10 or more. Consistent condom users (N=309) were predominantly users of both types of condom (75%), and were less often exclusive users of the male condom (18%) or the female condom (7%). According to a multivariate analysis, women who used the female condom exclusively or who mixed condom types were more likely to be black, were more likely to be employed and were more likely to have a regular partner than were users of the male condom. CONCLUSIONS: Women at risk of STDs find the female condom acceptable and will try it, and some use it consistently. Mixing use of female condoms and male condoms may facilitate consistent condom use. The female condom may improve an individual's options for risk reduction and help reduce the spread of STDs.     

Contraceptive practice and ectopic pregnancy

The relationships between contraceptive practice and ectopic pregnancy were examined for users of barrier contraceptives, sterilization, steroidal contraceptives, and IUDs. Clinical studies on the outcome of pregnancy among diaphragm users indicated that they were not at any increased risk of ectopic pregnancy and may be at a reduced risk. Except for diaphragm users, there were insufficient published data to assess the risks of ectopic pregnancy for users of other barrier contraceptives. For all sterilization approaches, the International Fertility Research Program reported 6.9% ectopic pregnancies in over 20,000 voluntary sterilizations. Data provided by the United States Food and Drug Administration regarding rates of ectopic pregnancy for different types of IUDs suggested that copper-bearing IUDs were associated with a lower rate of ectopic pregnancy and that progesterone-releasing IUDs were associated with a higher rate than the non-medicated IUDs. No evidence as yet has demonstrated that IUDs cause ectopic pregnancy. Compared to women who use no contraceptive method, the use of IUDs greatly reduced the probability of intrauterine pregnancy but only somewhat reduced the probability of ectopic pregnancy. Recent data on the association between the duration of IUD use and the risk of ectopic pregnancy provided conflicting results. Women who have discontinued oral contraceptive or barrier contraceptive methods have not appeared to be at any increased risk of ectopic pregnancy.     

Use of 'dual protection' and other combinations of contraceptive methods in Australia

OBJECTIVE: To examine the demographic profiles of contraceptive users in Australia, paying particular attention to the use of condoms with other methods. METHOD: Data from a specific section on contraceptive use in the 2005 Wave 5 of the nationwide, longitudinal Household Income and Labour Dynamics in Australia (HILDA) were analysed. The section was restricted to 2,221 women aged 18-44; women were excluded if they were pregnant or subfecund, or if they or their partner had been sterilised. RESULTS: Two-thirds of respondents were using contraception, including more than 15% who indicated use of more than one method. The contraceptive pill (39%) was the most widely used method, followed by the condom (28%). Women using sex-related methods were more likely to be using more than one method. More than one-quarter of pill users (28%) were using condoms as well. The combination of pill and condom was significantly associated with age, being a student, and country of birth. Less than 3% of women reported using rhythm methods and of these two-thirds were using another method. CONCLUSIONS: Dual protection provided by the combination of the condom with the pill or other methods has become an important factor in the prevention of sexually transmitted infections and unwanted pregnancies, but continuing education on dual protection and better access to treatment is still necessary for both men and women, particularly among at-risk groups.     

Acceptability of an existing, female-controlled contraceptive method that could potentially protect against HIV: a comparison of diaphragm users and other method users.

OBJECTIVE: The diaphragm, an internal barrier contraceptive device, is a candidate for a female-controlled method for preventing human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). This study's objective was to examine how women who use the diaphragm differ from women using the pill and/or condoms with respect to factors hypothesized to influence the acceptability of contraceptive methods. Our goal was to increase understanding of who finds the diaphragm acceptable and why. METHODS: We conducted a cross-sectional telephone survey with selected female members of a managed care organization. For this analysis, we limited the sample to 585 women currently using the diaphragm (n = 196), pill (n = 200), condoms (n = 132), or pill and condoms (n = 57). We conducted bivariate analyses and multinomial logistic regression analyses to assess the associations between selected characteristics and diaphragm use. RESULTS: Diaphragm use was significantly associated with several variables. Of particular interest, placing less importance on hormonal method characteristics was significantly associated with diaphragm use (versus use of the pill, condoms, or both). Placing more importance on barrier method attributes was significantly associated with diaphragm use (versus pill use, alone or with condoms). In addition, lower condom use self-efficacy was significantly associated with diaphragm use (versus condom use, alone or with pill). Lack of motivation to avoid HIV/STIs was significantly associated with using the diaphragm versus condoms (only). CONCLUSION: These results have important implications for future research, interventions, counseling strategies for providers, and product development. Our findings suggest that if the diaphragm protects against HIV, it could be a desirable option for some women.     

Factors associated with contraceptive choice and inconsistent method use, United States, 2004

CONTEXT: Pregnancies among contraceptive users account for nearly half of all unintended pregnancies and are almost entirely due to inconsistent or incorrect contraceptive use. Understanding what factors contribute to inconsistent contraceptive behavior can help efforts to reduce unintended pregnancy. METHODS: In 2004, a nationally representative sample of women aged 18-44 using reversible contraceptive methods were surveyed to examine factors associated with contraceptive choice and with inconsistent use of the pill and condoms. Bivariate and multivariate analyses were used to examine the data. RESULTS: Contraceptive choice was associated with a range of socioeconomic and partnership characteristics, and with pregnancy-, method- and provider-related experiences and attitudes; inconsistent pill or condom use was associated mainly with partnership, experiential and attitudinal factors. For example, not having a college education was negatively associated with pill use (odds ratio, 0.6) and positively associated with use of long-acting methods (1.8-1.9). Women for whom avoiding pregnancy was only a little or not important had reduced odds of using the pill (0.4) and elevated odds of using other methods, such as withdrawal or periodic abstinence (4.4), and of using condoms inconsistently (2.6). Use of a method chosen mostly out of dislike of other methods was positively associated with condom use (4.0) and negatively associated with use of the pill or long-acting methods (0.4 for each). Women who were not completely satisfied with their method were more likely than others to use their method inconsistently (1.6 for pill users and 1.9 for condom users). CONCLUSIONS: Greater efforts are needed to provide women and their partners with a range of method options, to facilitate selection of methods that best suit their needs and circumstances, and to identify and assist users who are dissatisfied or are having difficulties using contraceptives effectively.     

Sexual partnership patterns as a behavioral risk factor for sexually transmitted diseases

CONTEXT: Women's and men's number of sexual partners and protective practices such as condom use can have a direct effect on their risk of contracting sexually transmitted diseases (STDs), including HIV. METHODS: The 1988 and 1995 cycles of the National Survey of Family Growth and five rounds of the General Social Survey conducted from 1988 to 1996 are used to examine women's and men's numbers of recent sexual partners. Levels of direct risk for STDs (two or more partners in the past year) and the social and demographic correlates of multiple partnership are analyzed among women and men. In addition, women's indirect risk for STDs (their partners' involvement with other partners in the past year) is used to estimate their overall risk of STDs through multiple partnerships. RESULTS: At least three-quarters of sexually active U.S. women and men in the late 1980s and mid-1990s had had only one sexual partner in the preceding 12 months. Moreover, there is no indication that the proportion with more than one partner in the past year changed substantially over that period. Nevertheless, combining women's and men's partnership reports suggests that about 17 million women aged 15-44--34% of those sexually active in the past year--were at risk for STDs because of direct exposure to multiple partners (5.4 million), indirect exposure (6.3 million) or both direct and indirect exposure (5.5 million). In all, 21% of women were at direct risk and 23% were at indirect risk. In comparison, among men aged 18-44, 24% were at direct risk for STDs and an unknown proportion were at indirect risk. Multivariate analyses indicated that unmarried individuals, women younger than 40 and men aged 20-29, blacks and women in the South were all at elevated risk for STDs because of multiple partnership. Overall, in 1995, 19% of sexually active women aged 15-44 had used condoms to protect against STDs over the preceding year, and 19% of those sexually active in the three months before the survey were current condom users. Condom use specifically for STD prevention was more common among women reporting both direct and indirect risk for STDs (58%) and among those at direct risk (46%) than among other women; women whose partners put them at indirect risk only were less likely to be current or recent condom users than women who were not at risk or were only at direct risk. CONCLUSIONS: There is a continuing need to educate people regarding their risk for STDs, to increase the use of existing barrier methods and to develop new methods that protect against STD infection. In addition, if we are to develop a better understanding of the extent of STD risk through multiple partnership, the collection of information on number of partners and relationships between partners must be expanded and improved.     

How much do condoms protect against sexually transmitted diseases?

The UN 1994 International Conference on Population and Development has encouraged the provision of services for syndromic treatment for clients with symptoms or signs of infection, laboratory screening and sexually transmitted disease (STD) risk assessment to guide contraceptive counseling. This proposal was raised in the light of the growing HIV and STD global concern and the use of contraceptive methods for STD prevention. Despite recommendations on using barrier methods for STD/HIV prevention, many family planning providers hesitate about endorsing barrier methods because of lesser efficacy in preventing unintended pregnancies. However, several studies have demonstrated the effectiveness of male and female condoms when used consistently and correctly. In addition, accumulated data on condom use and HIV infection revealed that consistent use of male condoms protect against HIV acquisition (protection ranging from 50% to 100%). These findings underscore the effectiveness of condoms in preventing STD/HIV when used consistently and correctly and should be encouraged at every opportunity.     

Topical microbicides: missing link for HIV prevention

This article features intravaginal microbicides available in various forms, such as gel, suppository, cream, film or sponge, preventing HIV infections and other sexually transmitted disease (STD) pathogens. Microbicides also vary in their action by boosting the body's natural defense, by killing or inactivating STD pathogens, or by creating a protective barrier between the virus and the vaginal wall. Despite the potential of these products to prevent HIV and other STDs, large pharmaceutical companies are hesitant to invest in them because they assume that the only market would be in the developing world. The Global Campaign for Microbicides and HIV/STD Prevention Alternatives for Women was launched having the priority goal of educating individuals about female condoms and microbicides as promising technologies that deserve more attention and investment. While microbicides are not available yet, the use of condom still provides the best protection against HIV/STDs.     

Contraceptive failure, method-related discontinuation and resumption of use: results from the 1995 National Survey of Family Growth

This study computed life table probabilities of contraceptive failure, discontinuation of use, and return to contraceptive use in the US. Data were obtained from the 1995 National Survey of Family Growth (NSFG) among a nationally representative sample of 6867 contraceptive use intervals contributed by women 15-45 years old who began use or resumed use after discontinuation during 1991-95. Analysis was based on Kaplan-Meier product-limit single decrement life table probability methods. Findings indicate that the risk of failure during typical use of reversible methods was 9% within 1 year of starting. Women with continuous lifetime use will experience 1.8 contraceptive failures. Failure rates were 7% for the pill, 9% for the male condom, 8% for the diaphragm, 20% for periodic abstinence, and 15% for spermicides. Failure rates reflect imperfect use. 31% of women discontinued use within 6 months of starting use. 44% discontinued within 12 months. Women using reversible methods continuously will discontinue use nearly 10 times during the reproductive period. Most women resumed use shortly after discontinuation. Low income women had higher risk of unintended pregnancy for all methods and the pill and lower risk of resumption after discontinuation. Hispanics had a higher risk of contraceptive failure for all methods and the condom. Black women had a higher risk of discontinuation of oral pills and condoms.     

Protecting against both pregnancy and disease: predictors of dual method use among a sample of women

Although male condoms are the best form of protection against HIV/STDs, they are not the most effective method for preventing unintended pregnancy. Consequently, use of condoms and a highly effective contraceptive-referred to as dual use-is recommended as the optimal protection against both disease and pregnancy. However, little is known about the factors that promote dual use. This study examined associations of dual method use with women's background characteristics, intrapersonal factors, and relationship characteristics. Data are from a random sample of women selected from a large managed care organization in the Pacific Northwest. The analytic sample contained 371 women who completed a telephone survey and reported use of contraceptives in the past 3 months. Three mutually exclusive method use groups were constructed: effective contraceptive only (hormonal methods, intrauterine device, surgical sterilization) (59%), condom only (24%), and dual use (18%). Variables hypothesized to influence dual use were compared across the three groups in bivariate and multivariate analyses. Findings indicate that women who were younger, reported more than one sexual partner in the past year, and were highly motivated to avoid HIV/STDs--were more likely to use dual methods rather than condoms only or an effective contraceptive method. Women confident about using condoms without feeling embarrassed or breaking the sexual mood were more likely to use dual methods rather than a single effective method. Finally, women with confidence in their ability to use condoms correctly are more likely to rely solely on condoms. Policy and practice implications are discussed.     

Knowledge of contraceptives and sexually transmitted diseases and contraceptive practices amongst young people in Ho Chi Minh City, Vietnam

In this article, we examine knowledge of contraceptives and sexually transmitted diseases (STDs) and contraceptive practices amongst young Vietnamese people. We conducted a qualitative study on sexuality and abortion with young people in Ho Chi Minh City, Vietnam. Twelve female and 4 male young people were individually interviewed using an in-depth interview technique. We found that condoms and pills were contraceptives known by almost all young people, but their knowledge of condoms and pills was still inadequate. Fears of side effects of taking pills and rumors and beliefs regarding condoms were quite common among young people. The limitations in young people's knowledge of contraceptives and STDs were a reflection of limited sources of their knowledge. Sexual education provided by educational institutions and within families was very basic. It did not provide clear knowledge on the sensitive topics such as contraceptive methods, and other issues related to sexuality for unmarried people. From a gender perspective, there are two points to note here: While sex issues were discussed openly among unmarried men, most unmarried women felt uncomfortable or expressed difficulty when talking about these issues; and the passiveness of unmarried women in making the decision of using condoms as well as contraceptives was marked. Amongst young people, the use of contraceptives was based mainly on ineffective methods including withdrawal and periodic abstinence. Further, young people's understanding of these methods was neither clear nor adequate. For the young people who did not use any contraceptives, sexual relations occurred unexpectedly. We conclude that creating a climate in which sexual issues can be discussed openly is an important step for the improvement of sexual health for young people. This will inevitably improve knowledge and understanding of contraceptives and STDs and may lead to a safer sexual life among this group of young people.