Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan.
UNICEF Uganda Country Office, Kampala P.O. Box 7047, Uganda.
Int J Environ Res Public Health. 2020 Jul 12;17(14):5009. doi: 10.3390/ijerph17145009.
Dual-method use is the most reliable form of protection against unintended pregnancies and human immunodeficiency virus/sexually transmitted infections (HIV/STIs). Although dual-method use remains uncommon among women in stable relationships, some women do practice it. In this study, we explored the barriers that make dual-method use rare and the behaviors of women who practice dual-method use using a positive deviance framework in Uganda. We screened 150 women using highly effective contraceptives at five health facilities. We identified nine women who practiced dual-method use and 141 women who did not. In a qualitative study, we conducted in-depth interviews with all nine women practicing dual-method use and 10 women randomly selected out of the 141 who did not. We performed a thematic analysis using the positive deviance framework. Regardless of practicing dual-method use or not, women faced perceived barriers against dual-method use, such as partner's objection, distrust, shyness about introducing condoms into marital relationships, and limited access to condoms. However, women practicing dual-method use had higher levels of risk perception about unintended pregnancies and HIV/STIs. They also engaged in unique behaviors, such as influencing their partners' condom use by initiating discussions, educating their partners on sexual risks and condom use, and obtaining condoms by themselves. These findings will be useful in developing effective community-led and peer-based interventions promoting dual-method use to reduce the dual burden of unintended pregnancies and HIV/STIs among women in Uganda.
双重方法使用是预防意外怀孕和人类免疫缺陷病毒/性传播感染（HIV/STIs）最可靠的形式。尽管在稳定关系中的女性中，双重方法使用仍然不常见，但有些女性确实在使用。在这项研究中，我们使用积极偏差框架在乌干达探索了使双重方法使用变得罕见的障碍以及使用双重方法的女性的行为。我们在五个保健机构筛查了 150 名使用高效避孕方法的女性。我们确定了 9 名使用双重方法的女性和 141 名未使用的女性。在一项定性研究中，我们对所有 9 名使用双重方法的女性和随机选择的 141 名未使用的女性中的 10 名进行了深入访谈。我们使用积极偏差框架进行了主题分析。无论是否使用双重方法，女性都面临着对双重方法使用的感知障碍，例如伴侣的反对、不信任、对将避孕套引入婚姻关系的害羞，以及获得避孕套的机会有限。然而，使用双重方法的女性对意外怀孕和 HIV/STIs 的风险感知更高。她们还采取了独特的行为，例如通过发起讨论、教育伴侣有关性风险和避孕套使用、以及自行获取避孕套来影响伴侣使用避孕套。这些发现将有助于制定有效的社区主导和同伴为基础的干预措施，促进双重方法的使用，以减轻乌干达女性意外怀孕和 HIV/STIs 的双重负担。
