The global syndemic of HIV and unintended pregnancy has prompted research on dual protection, the simultaneous protection against HIV and unintended pregnancy. Dual protection can be achieved through single method use (condoms) or dual method use (condoms + another contraceptive method). Studies find that the use of a modern contraceptive method (other than condoms) may affect whether condoms are used and condom use consistency. Various individual-level factors and relationship context are thought to influence this dynamic and to exacerbate the risk socially disadvantaged women have of experiencing both HIV and unintended pregnancy. Furthermore, studies find that as romantic partners transition into a more committed and stable relationship, condoms are replaced with non-barrier contraception for increased trust, pleasure, and intimacy. However, women in committed relationships are the hardest hit by the HIV epidemic and bear the burden of unintended pregnancy.
The overall goal of this study is to understand how women in Brazil use dual protection through single method use (condoms) and dual method use (condoms + another contraceptive method). The primary aims of this study are to: 1) describe the level of consistent condom use among women in Brazil, 2) to examine how individual-level socio-demographic factors, early sexual risk, fertility, and relationship context affect dual protection, and 3) to examine the indirect effects of individual-level factors on condom use and contraception via relationship context. This study uses data from the 2006 PNDS, a nationally representative household survey of women of reproductive age in Brazil. Using this data, I apply the theory of gender and power, social exchange theory, and the concept of women's empowerment to elucidate how social inequalities influence contraception and condom use consistency. I address the study aims in three distinct, but sizeable, sub-groups of women in the Brazilian population: 1) fecund women in the general population, 2) fecund women who use dual protection (comparing condom use consistency in dual methods users versus single method users), 3) and in sterilized women.
This study has three main findings. First, this study identifies formal education and risk at sexual debut as key factors that promote condom use consistency across all three sub-groups of women in Brazil. Additionally, region was a salient positive indicator of use of a modern contraceptive method and age was a salient negative indicator of condom use consistency. Second, this study tests the dual methods hypothesis to understand how consistent condom use is affected by the use of another modern method of contraception. Findings from this study support that women who use another modern form of contraception in addition to condoms have lower odds of consistent condom use than women who use condoms only. This study also finds that sterilized women do not use condoms nearly as consistently as women who use dual methods (condoms + another method of contraception). Third, this study finds that relationship context is a critical consideration when studying condom use consistency. Relationship status is a strong predictor of dual protection consistency in women of the general population and in sterilized women. Women in more committed relationships (e.g. in civil union and married) report much less condom use and more exclusive contraceptive use (aside from condoms) than women who were not in relationships (e.g. single and separated). In addition, relationship status and educational asymmetry mediate the association between individual-level factors and consistent condom use.
