AIDS and contraception Unanticipated effects of AIDS prevention campaigns NATHALIE BAJOS, JOSIANE WARSZAWSKI, ISABELLE GREMY, BEATRICE DUCOT • Background: This study addresses the effects of AIDS prevention campaigns on contraceptive practices among the general population in France. Comparisons of contraceptive practices and condom use by women aged 18-49 years were performed in two national population-based surveys (n=559 in 1994, n=731 in 1998). Results: A decrease in the proportion of women aged 2 0 - 2 4 with multiple partners reporting the use of contraception was observed between 1994 and 1998. In the same time, there was an increase in the use of condoms to prevent AIDS. Conclusion: Findings suggest that single-risk prevention campaigns on AIDS may lead some women to pay less attention to the risk of unwanted pregnancy. Keywords: ADDS, contraception, prevention campaigns I n most European countries, prevention campaigns dissociate the risk of HIV infection from other risks linked to sexual activity, particularly the risk of pregnancy. The underlying justification for this is that the severity of HIV infection is considered to warrant a specific approach.' In France, there have been annual AIDS prevention campaigns aimed at the general public since 1987. There was a national campaign on contraception in 1982. In 1992, for the first time in a national campaign, the condom has been presented both as a contraceptive and as a preventive method against AIDS. Because individuals do not handle the different risks associated with sexuality independently, 2 it is important to analyse the effects of HIV prevention campaigns on contra- ceptive behaviour. This article considers the changes in the contraceptive and preventive behaviour of women in France between 1994 and 1998. POPULATION AND METHODS Two national population-based KABP surveys (know- ledge, attitudes, beliefs and practices) were conducted by telephone in 1994 and 1998. Households were randomly selected from the national telephone directory and individuals between 18 and 69 years old were then randomly selected within each household (n= 1,501 in 1994 and n° 1,485 in 1998). The same protocol was used for the two surveys. The refusal rates were 27.8% in 1994 and 22.0% in 1998. Post-survey adjustment was per- formed to adjust each sample on age, gender, marital status, and region of residence according to the last French census. This method permits one to reduce non- • N. Bajos 1 , J Warszawsfcl', I. Grimy 2 . B. Ducot' 1 INSERM U292, H6pltal de Bkfrtre, Le Kremlin Bicetre, France 2 Observatcrfre regional de la a n t e d'lle de France, Paris, France CorrMpoodtncK N. Bajos, PhD, INSEflM U292. H6pltal de Bicetre, 94276 Le Kremlin Bketre, France, tel +33 1 45212273, fax +33 1 45212075, e-mail: bajosOvff lnserm.fr response bias. 4 Women were asked about their current contraceptive practices and about condom use during their first sexual intercourse, in the last twelve months and during their last sexual intercourse. Here, we present findings for women aged between 18 and 49 years. SAS and SUDAAN software were used for analysis taking into account the sampling design including unequal sampling probabilities. RESULTS In both years (1994 and 1998), condom use at first sexual intercourse decrease with the age of the respondent (p<0.001 in 1994; p<0.001 in 1998). The same trend is observed for condom use in the last twelve months (table I). Between 1994 and 1998 there was no change in the proportion of women reporting the use of contra- ception, except among those aged 20-24 for which a decrease was registered (table I), however long they had been sexually active (data not shown). This decrease was observed for women having had at least two sex partners in the previous twelve months, and was entirely due to the reduction in the reported use of condoms as contra- ceptives (33.4% versus 25.4%). At the same time, there was a global increase in the use of condoms for the first sexual encounter and an increase in the use of condoms during the last twelve months by women under 30. This increase was particularly apparent for 20 to 24-year-old women who reported not using a method of contra- ception, that is women who stated that they were not deliberately trying to block conception through the use of contraception, but who may have used condoms to prevent STD/AIDS (table I). Furthermore, between 1991 and 1995, the Ministere des Affaires Sociales (Social Affairs Ministry) reported a decrease in abortion rates in all age groups. However, between 1995 and 1996, a 12% increase was recorded in the number of elective abortions among women under the age of 20 years and a 4% increase among women of all Downloaded from https://academic.oup.com/eurpub/article-abstract/11/3/257/542304 by guest on 15 February 2019