Long-Acting Reversible Contraception Use and Sexually Transmitted Infection Acquisition during 12 Months of Follow-up Among Young African American Women

Background: Studies show lower levels of condom use among long-acting reversible contraception (LARC) users as compared to other contraceptive method users. This study aimed to examine sexually transmitted infection (STI) acquisition among young African American women who use LARC relative to other contraceptive methods and no contraceptive method.

Methods: From 2012 to 2015, African American women (n=560) aged 18-24 years participated in an HIV prevention trial. Participants provided self-reported data and vaginal swab specimens assayed for chlamydia and gonorrhea at baseline, 3-, 6-, 9-, and 12-months. Based on a single item assessing protection at last sex, participants were categorized as LARC (intrauterine device, implant), highly (shot, ring, patch, pills), moderately (condom), and least (withdrawal, spermicide, rhythm method) effective contraceptive users or non-contraceptors at each follow-up. STI acquisition was defined as a positive chlamydia or gonorrhea test result subsequent to a negative result or documented treatment. Generalized estimating equations compared the likelihood of STI acquisition among LARC users to other method users and non-contraceptors. Adjusted models controlled for age and baseline STI status.

Results: During follow-up, LARC use ranged from 5.2% to 6.8%, highly effective method use 12.1-18.8%, moderately effective method use 43.3-50.2%, least effective method use 6.3-8.5%, and non-contraception 21.2-26.4%. STI acquisition ranged from 20.0% to 26.9% among LARC users, 7.2-11.0% among highly, 4.7-10.3% among moderately, and 3.6-13.8% among least effective method users, and 10.4-15.6% among non-contraceptors. LARC users were more likely than highly (AOR: 2.9, 95% CI: 1.5, 5.8), moderately (AOR: 3.8, 95% CI: 2.1, 7.0), and least (AOR: 2.6, 95% CI: 1.1, 6.24) effective method users and non-contraceptors (AOR: 2.2, 95% CI: 1.2, 4.1) to acquire an STI.

Conclusions:  This study suggests a significant need for STI prevention among LARC users. STI prevention strategies should be promoted in the context of LARC scale-up.