Use of Norplant for Teen-Agers Could Pose AIDS Problem

December 13, 1992|By JONATHAN BOR

As Baltimore becomes the first city to promote Norplant in schools, educators will face a task far more difficult than interesting teen-agers in a device that provides five years of virtually worry-free birth control.

The biggest challenge will be to discuss this excellent birth control device without diminishing the battle against AIDS. Despite Norplant's impressive ability to prevent pregnancy -- no contraceptive does it better -- it is absolutely useless in halting the spread of disease.

The task for the doctors, school nurses and classroom teachers engaged in this distinctly 1990s experiment is this: To convince teen-agers that Norplant isn't enough, that a young woman armed with Norplant isn't having "safe sex" unless her boyfriend is wearing a condom.

Beneath the national hubbub raised by Baltimore's foray into Norplant education, some community leaders and health care workers are doubting that teen-age couples can be won over to the idea of approaching sex dually armed.

They fear that Norplant will prove so appealing as a birth control device that efforts to promote condoms as a barrier to infectious disease -- not just AIDS, but syphilis, gonorrhea, chlamydia and hepatitis B as well -- will appear less pursuasive.

Right or wrong, they are framing a debate that will be long with us.

"Teen-agers are not going to be sold on the idea they need to take further precautions," said Douglas Wilson, a minister associated with Clergy for the Renewal of East Baltimore. "Although we are supposed to couple the message -- protection and Norplant -- the males particularly are going to say. 'If you have Norplant, sweetheart, that's all we need.' "

The issue isn't whether city officials are serious about educating teen-agers about the need for two forms of protection. It's whether they can pull it off. Dr. Peter Beilenson, the city health commissioner whose Norplant strategy has suddenly won him national attention, intends to try hard.

"There will be a huge amount of counseling -- much more with Norplant than with other types of contraception," he said. "Part of the message will be: 'This is a great form of birth control. The only thing I have to worry about now is the condom.'

"We know that the adolescent's outlook on life is one of immortality. 'Nothing can happen to me.' It's living in the present. Adolescents are less likely to look long-term, less likely to use a condom."

Dr. Beilenson envisions at least seven counseling sessions focusing not only on condoms but on the side-effects associated with Norplant -- principally irregular bleeding and spotting. Plans call for at least two counseling sessions before the device is inserted; counseling the day of implantation, and counseling one week, three months, six months and a year after implantation.

Dr. Beilenson draws some optimism from impressions drawn at city health clinics that condom use is on the increase, not on the wane.

Also, he notes that Norplant poses no greater threat to condom )) use than does the oral contraceptive, which has remained the contraceptive of choice among teen-agers served by the city clinics.

The pill and Norplant are basically the same weapon in different packages. One is a daily pill; the other, a cluster of plastic tubes that trickle hormone without the user even thinking about it. Both are excellent contraceptives; neither wards off infection.

Even if it's true that condom use is on the increase, there appears little reason to rejoice.

A national survey, published recently in the journal Science, found that only 17 percent of people with multiple partners reported regular condom use. The figure was even lower -- 12.6 percent -- for people admitting to "risky" sexual partners such as intravenous drug users.

The sample group was 10,630 aged 18 to 75. It is not a big stretch to assume, at the very least, that a survey of sexually active teen-agers wouldn't be any more encouraging.

Also, it's dangerous to assume that people claiming to use condoms use them properly and all the time. There are many pregnancies among professed condom users -- and, it stands to reason, a fair amount of disease transmission.

The culprit is not the condom itself. It is guys donning condoms during intercourse, and guys leaving them on the bedpost on the mistaken assumption that "just this time" couldn't hurt.

A compelling study by the Alan Guttmacher Institute, a leading think-tank on family planning issues, found that when user error is taken into account, condoms have an actual failure rate of 19.3 percent among teen-agers 15 to 19. That means 19 pregancies each year for every 100 girls who claim their partners use condoms.

All this is a great argument for Norplant. In a city with one of the nation's highest teen pregnancy rates, where almost 1 out of 10 young women aged 15 to 17 gets pregnant each year, there is a desperate need for reliable birth control that doesn't depend on teen-agers bringing responsibility to their passion.

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