Achieving safer sex with choice: Studying a women's sexual risk reduction hierarchy in an STD clinic

A flexible, risk-reduction approach, as compared with a single method appro ach, may increase sexually transmitted disease (STD)/HIV protection for wom en attending STD clinics. A brief intervention was tested in an observation al study of 292 STD clinic patients in three distinct cohorts. These includ ed subjects counseled on (1) the "women's safer sex hierarchy of prevention methods" (hierarchy cohort, n = 118), including the female condom (FC), ma le condom (MC), diaphragm, cervical cap, and spermicides, (2) MC only (n = 62), or (3) FC (n = 112) only. We evaluate method use and level of protecti on achieved at 6-month follow-up among the women in the hierarchy cohort an d compare the level of unprotected sex across the three cohorts, using ordi nal logistic regression analyses and an imputation procedure to account for attrition. In the hierarchy cohort, the MC, FC, spermicidal film, foam, su ppository, and diaphragm were used with main partners by 80%, 46%, 37%, 28% , 17%, and 5% of women, respectively. Spermicides were used frequently, mai nly in conjunction with condoms. As compared with hierarchy subjects, both MC cohort subjects (OR = 2.3, p = 0.01) and FC cohort subjects (OR = 1.6, p = 0.11) were more likely to report 100% unprotected sex. The tendency for subjects to move toward higher levels of protection was observed most stron gly in the hierarchy group. Hierarchical-type counseling, compared with sin gle method counseling, leads to increased protection during sex among women at high risk of STD/HIV infection and should be implemented in STD clinics .