Use of Norplant for teen-agers could pose AIDS problem.

Baltimore Maryland may be the first city in the US to promote Norplant in schools. Just promoting Norplant is far less challenging for physicians teachers and school nurses than promoting both Norplant and condom use to prevent teenager pregnancy and to stem the spread of AIDS and sexually transmitted diseases (STDs). Some community leaders and health workers fear that teenagers will be so attracted to this 5 year effective contraceptive that any efforts to promote condoms no matter how persuasive will not be heeded by teenagers. The city health commissioner replies to expressions of fear that Norplant poses the same threat to condom use as do oral contraceptives which also do not protect against STDs. He stresses that the health departments strategy is to require at least 7 counseling sessions centering on condom use and the side effects of Norplant e.g. irregular bleeding. 2 sessions would occur before insertion of the 6 capsules; 1 session the day of implantation; and 1 session 1 week 3 months 6 months and 12 months after implantation. The commissioner reports that city health clinics are noting an increase in condom use. Yet a nationwide survey reports just 17% of individuals with multiple partners and 12.6% of those with partners at high risk e.g. drug users regularly use condoms. Not everyone using condoms uses them properly or all the time. A study shows that the condom failure rate among 15 to 19 year olds is 19.3%. Teenagers seeking Norplant tend to be those who would use a contraceptive anyhow i.e. already motivated to be responsible. yet this motivation to prevent pregnancy does not necessarily translate into motivation to prevent AIDS and STDs. Perhaps Norplant evades the real need for education specifically information about the physiology of sex disease transmission and how adolescents can become pregnant.