Use of Withdrawal (Coitus Interruptus) for Both Pregnancy and HIV Prevention among Young Adults in Rakai, Uganda

IntroductionAlthough understudied in the context of AIDS, use of withdrawal (coitus interruptus) with or in place of other prevention methods affects exposure to both pregnancy and human immunodeficiency virus (HIV). AimWe used mixed methods to assess use of withdrawal among 15-24-year-olds in a rural Ugandan setting with considerable HIV prevalence. MethodsWe measured withdrawal reporting among (i) sexually active 15-24-year-olds enrolled in a quantitative community survey (n=6,722) and (ii) in-depth qualitative interview participants systematically selected from the latest round of the community survey (N=60). Respondents were asked about family planning and HIV prevention practices, including a direct question about withdrawal in the in-depth interviews. Main Outcome MeasuresThe main outcome measures were reports of current use of withdrawal on the quantitative survey (general question about family planning methods) and reports of current or recent use withdrawal in qualitative interviews (specific question about withdrawal). Qualitative interviews also probed for factors associated with withdrawal use. ResultsAlthough less than 1% of quantitative survey participants spontaneously named withdrawal as their current family planning method, 48% of qualitative interview respondents reported current or lifetime use of withdrawal. Withdrawal was often used as a pleasurable alternative to condoms, when condoms were not available, and/or as a placeholder method before obtaining injectable contraception. A few respondents described using withdrawal to reduce HIV risk. ConclusionQualitative findings revealed widespread withdrawal use among young adults in Rakai, mainly as a condom alternative. Thus, withdrawal may shape exposure to both pregnancy and HIV. Future behavioral surveys should assess withdrawal practices directlyand separately from other contraceptives and HIV prevention methods. Further clinical research should further document withdrawal's association with HIV risk. Higgins JA, Gregor L, Mathur S, Nakyanjo N, Nalugoda F, and Santelli JS. Use of withdrawal (coitus interruptus) for both pregnancy and HIV prevention among young adults in Rakai, Uganda. J Sex Med 2014;11:2421-2427.