Integration of Contraceptive and STD/HIV Services for Young Women in the United States

Background:
Little is known about the extent to which young women receive integrated contraceptive (counseling or prescription for birth control, pregnancy testing, or abortion) and STD/HIV (counseling, testing, or treatment) services in the United States.

Objective:
To identify contraceptive and STD/HIV services among 15-24 year-old women, the extent to which they receive both and where they access services, by age.

Method:
Weighted data from 1,328 unmarried, sexually active 15-24 year-old women from the 2002 National Survey of Family Growth were used to estimate prevalence of service receipt in the preceding year.

Result:
Overall, 82% (95% CI: 79-84%) of 15-24 year-old women reported receipt of contraceptive or STD/HIV services in the previous year (median: 4 types of services, range 0-11). Young women are more likely to receive contraceptive (79%) than STD/HIV (42%) services. Only 39% receive both types of services; with 15-22 year-olds receiving both types (41%) more often than 23-24 year-olds (32%; p=0.03). Of the 38% of young women receiving services suggestive of unprotected intercourse (pregnancy testing, abortion or emergency contraception prescription), 38% did not receive STD/HIV counseling, testing or treatment. Young women access most services at doctors' offices (51%) or community (20%) or family planning clinics (16%). Compared to 18-24 year-olds, 15-17 year-olds access services more often at community (29% vs. 19%; p=0.03) and Title X clinics (35% vs. 21%, p=0.02) and less often at doctors' offices (48% vs. 62%, p=0.02).

Conclusion:
Many sexually active 15-24 year old women receive contraceptive or STD/HIV services, but few receive both. Findings suggest that providers at doctors' offices and community/family planning clinics miss opportunities to provide integrated services.

Implications:
Interventions to change clinic policies, increase provider cross-training, and prime patients to discuss reproductive and sexual health with providers may help further integrate contraceptive and STD/HIV services for young women.