title: Dual protection to address the global syndemic of HIV and unintended pregnancy in Brazil.
abstract: BACKGROUND
  Syndemic HIV and unintended pregnancy is prevalent in Brazil, where 79% of female HIV cases occur in women of reproductive age and 55% of all pregnancies are unintended. Although increasing condom use to prevent HIV may decrease non-barrier contraception and increase unintended pregnancy, few studies focus on dual protection or dual methods (condoms with another modern contraceptive).
  
  
  OBJECTIVE
  To describe the correlates of dual method use and consistent condom use in women of reproductive age in Brazil.
  
  
  METHODS
  Data are from the 2006 Pesquisa Nacional de Demografia e Saúde da Mulher e da Criança, a decennial nationally representative household survey of women of reproductive age in Brazil. Multivariate logistic regression models identify the socio-demographic, sexual debut, fertility and relationship factors associated with dual method use and consistent condom use.
  
  
  RESULTS
  Two-thirds of contracepting women in Brazil used dual protection (40% exclusive condoms, 27% dual methods). Consistent condom use in the past year occurred among 61% of exclusive condom users and 27% of dual method users. Dual methods (vs exclusive condoms) was associated with some high school education [relative risk ratio (RRR)=1.69,p<0.05], living in the Southern region (RRR=1.59,p<0.01), and number of children (RRR=1.22,p<0.01), net of other factors. Consistent condom use was associated with condom use at sexual debut [adjusted odds ratio (AOR)=1.84,p<0.001], wants no (more) children (AOR=1.86,p<0.001), single/separated relationship status (AOR=2.77/2.45,p<0.001) and using exclusive condoms (vs dual methods: AOR=0.19,p<0.001).
  
  
  CONCLUSIONS
  Findings highlight that targeting and delivering integrated HIV and family planning services should focus on completed/large families. single/separated individuals, and promoting dual protection at sexual debut.
authors.affiliation: NIDA Post-doctoral Fellow, Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
authors.forename: Kiyomi
authors.initials: K
authors.lastname: Tsuyuki
authors.affiliation: Assistant Professor, Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles (UCLA), USA.
authors.forename: Jessica D
authors.identifier: http://orcid.org/0000-0001-8719-2081
authors.initials: JD
authors.lastname: Gipson
authors.affiliation: Assistant Professor, Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
authors.forename: Lianne A
authors.initials: LA
authors.lastname: Urada
authors.affiliation: Professor, Population Studies Center (NEPO), University of Campinas (UNICAMP), Campinas, Brazil.
authors.forename: Regina Maria
authors.identifier: http://orcid.org/0000-0002-3390-2137
authors.initials: RM
authors.lastname: Barbosa
authors.affiliation: Professor, Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles (UCLA), USA.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Morisky
keywords: Brazil; condom; dual method use; family planning service provision; hormonal contraception; human immunodeficiency virus