DUAL-METHOD USE AMONG AN ETHNICALLY DIVERSE GROUP OF WOMEN AT RISK OFHIV-INFECTION

Context: Few U.S. women protect themselves against both pregnancy and sexually transmitted diseases (STDs) by using an efficient contracepti ve method and a condom. Understanding the factors that influence dual- method use could help improve interventions aimed at encouraging prote ctive behaviors. Methods: Interviews were conducted with 552 low-incom e women at risk of HIV who attended public health or economic assistan ce facilities in Miami in 1994 and 1995. Multinomial legit analyses we re used to determine the influence of women's background characteristi cs, perceived vulnerability to pregnancy and AIDS, and relationship ch aracteristics on the odds of dual-method use. Results: Overall, 20% of the women used dual methods. Women who were not married, who worried about both pregnancy and AIDS, who had ever had an STD, who were confi dent they could refuse a sexual encounter in the absence of a condom a nd who made family planning decisions jointly with their partner were the most likely to use dual methods rather than a single method (odds ratios, 2.0-3.5); those who considered the condom only somewhat effect ive in preventing AIDS or who shared economic decision-making with the ir partner were the least likely to use dual methods rather than a sin gle method (0.5-0.6). The results were generally similar in analyses e xamining the odds of dual-method use involving an efficient contracept ive, except that black and Hispanic women were significantly more like ly than whites to use condoms in conjunction with efficient contracept ives (3.3-7.1). Conclusions: Both women's individual characteristics a nd the context of their sexual relationships influence whether they si multaneously protect themselves from pregnancy and HIV. The involvemen t of male partners in family planning decision-making and women's cont rol over economic decision-making ensure greater protection against HI V infection.