Strategies for Managing the Dual Risk of Sexually Transmitted Infections and Unintended Pregnancy Among Puerto Rican and African American Young Adults

Although young adults in the United States are at increased risk for sexually transmitted infections (STIs) and unintended pregnancy, they do not report high rates of dual-method use (condoms plus other contraception) for prevention. We used prospective qualitative data from 69 urban Puerto Rican and African American individuals aged 18 to 25 years to determine how they managed these risks in their heterosexual relationships during a 4- to 8-week period. Hormonal or long-acting contraceptive use, condoms, and withdrawal were the most common unintended pregnancy prevention strategies; condoms, STI testing, and perceived fidelity were dominant among STI prevention strategies. We need to shift the focus from dual-method use toward a broader concept of dual protection to be more responsive to young adults’ concerns, perceptions, and priorities.The dual burden of unintended pregnancy and sexually transmitted infections (STIs) among adolescents, young adults, and ethnic minority groups in the United States is well documented. In 2002, among women aged 20 to 24 years, 45% of pregnancies were mistimed or unwanted, with higher prevalence among African American and Hispanic women compared with White women (52.9% and 46.5%, respectively, vs 41%).1 Young people aged 25 years or younger are also at high risk for nearly all major STIs, and African American and Hispanic populations are at higher risk compared with White populations.2,3 For example, in 2009, the rate of HIV diagnosis was 144.7 per 100 000 for African American, 38.3 per 100 000 for Hispanic, and 11.2 per 100 000 for White young adults aged 20 to 24 years.4 These disparities have been a steady cause for concern within the STI and reproductive health fields.5,6The co-occurrence of unintended pregnancy and STIs has prompted a relatively new body of research and interventions to focus on dual protection, which generally refers to behaviors that protect from both outcomes simultaneously. Work on dual protection to date almost exclusively has focused on dual-method use or the concurrent use of a condom (male or female) for STI prevention and a hormonal or long-acting contraceptive for unintended pregnancy prevention.7 National surveillance on dual-method use at last sexual intercourse shows that it is increasing but still fairly low. For example, females aged 15 to 19 showed a positive trend in the reported use of condoms and a hormonal contraceptive method at last sexual intercourse: 8% in 1995, 20% in 2002, and 21% in 2006 to 2008.8 The latest available data (2002) for women aged 20 to 24 years showed that the prevalence of dual-method use was about half that for adolescents.9Studies on dual-method use are mostly quantitative, tend to analyze dual use at a single point in time (e.g., at last sexual intercourse), and vary in their samples and predictors of dual protection, with mixed results. For example, race/ethnicity was not associated with dual-method use in one study but was associated in different directions in others.10–12 Other researchers have found positive associations between dual-method use and having higher educational attainment, being younger, feeling more at risk for STIs, being strongly motivated to avoid pregnancy, communicating with partners or parents about condom use, having positive attitudes about condoms, having a history of condom use, and having more than 1 partner in the previous 12 months, among other correlates.10–17 Conceptually, the determinants of dual use are multifaceted, involving the various barriers and facilitators of hormonal or long-acting contraceptive and condom use, such as side effects, health knowledge, service access, and relationship context.13,18,19 Finally, interventions aimed at increasing dual-method use are few and have had modest results.10,20,21More research is needed on dual-method use because it is generally agreed to be the most effective way to prevent both outcomes among sexually active persons.22,23 However, focusing exclusively on dual-method use has important limitations. Cates and Steiner22 emphasized the need to modify each person’s dual-protection approach according to both epidemiological and individual characteristics. Berer7 called for an expanded definition of dual protection that moves beyond dual-method use to include other methods and approaches to risk reduction and prevention, such as abstinence, consistent condom use, and condom use plus emergency contraception. She encouraged the sexual health field to overcome the disciplinary divide between STI prevention and unintended pregnancy prevention and to be more creative in understanding and promoting dual protection.7We built on this work and examined how young adults manage the simultaneous risks of unintended pregnancy and STIs in their sexual relationships by looking at not only dual-method use (classic dual protection) but also other strategies and perceptions that they draw on to minimize or address the risks they face. We used prospective qualitative data from 69 sexually active Puerto Rican and African American young adults to create an expanded list of dual-protection approaches like those Berer proposed yet one based on what young adults actually reported doing and thinking over a 4- to 8-week period. Our goal was to help identify alternative ways to view, research, and ultimately promote dual protection in this high-risk population.     

Ethno-Veterinary Practices Amongst Livestock Farmers in Ngamiland District,Botswana

We carried out a study to determine ethno-veterinary knowledge used to treat and prevent livestock diseases in Toteng Village in Ngamiland District, northwestern Botswana. Primary data were collected through simple random sampling of 45 households in Toteng. Respondents were either livestock owners or cattle herders. Respondents were interviewed using a structured questionnaire which had both open and closed-ended questions. Cattle ownership or herdership in Toteng is an inter-generational occupation with people ranging from 15 to 94 years old. Cattle were acquired either through inheritance, buying, mafisa (reciprocal exchange) system or government scheme. Women in the study area were more involved in livestock farming activities. Eleven livestock diseases were reported to be prevalent in the study area. The top six diseases were tlhako le molomo -foot and mouth disease (FMD), matlho -eye infections, letshololo-diarrhea, madi -pasteurollosis, mokokomalo -aphosphorisis and pholoso-contagious abortion. At least nine medicinal plant species having ethno-veterinary applications were recorded in the study area. Single plants are mostly used rather than a combination of plants. A number of social strategies were mentioned such as ‘go fetola mafudiso’ - to change grazing areas, and ‘go thaa lesaka’ - to ritualistically ‘protect a kraal’ or livestock against evil spells and predators (lions). Although the intervention of conventional veterinary medicine is pervasive in Toteng, and many livestock owners are resorting to it, there is evidence, however, of generalized ethno-veterinary knowledge used to treat and prevent livestock diseases. Local farmers and their herders in Ngamiland are not only knowledgeable and experienced in treating a range of livestock diseases, but also in performing other veterinary tasks such as assisting in births, treating fractures and range management strategies to mitigate particular threats from their local environment. The efficacy of ethno-veterinary knowledge for preventing and treating livestock diseases and range management strategies identified in this study need to be fully investigated and integrated in veterinary extension services.     

What makes a space safe? Consumers' perspectives on a mental health safe space

The provision of community-based space for people experiencing a mental health crisis is regarded as a favourable alternative to the emergency department. However, the only non-emergency department safe spaces in Western Australia are located within hospitals or hospital grounds. This qualitative study asked mental health consumers in Western Australia with experience of presentation at the emergency department during a mental health crisis to describe what a safe space would look and feel like. Data were collected through focus groups and thematically analysed. The findings present the voices of mental health consumers through the framework of health geography and the therapeutic landscape. These participants articulated important physical and social features of a therapeutic safe space and their symbolism as inclusive, accessible places where they would experience a sense of agency and belonging. Participants also expressed a need for trained peer support within the space to complement the skilled professional mental health team. Participants' experiences of the emergency department during mental health crises were described as contrary to their recovery needs. The research reinforces the need for an alternative to the emergency department for adults who experience mental health crises and provides consumer-led evidence to inform the design and development of a recovery-focused safe space.