Hindawi Publishing Corporation Infectious Diseases in Obstetrics and Gynecology Volume 2011, Article ID 107140, 5 pages doi:10.1155/2011/107140 Review Article Do Women Using Long-Acting Reversible Contraception Reduce Condom Use? A Novel Study Design Incorporating Semen Biomarkers Maria F. Gallo,1 Lee Warner,1 Denise J. Jamieson,1 and Markus J. Steiner2 1 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA 2 Clinical Sciences Division, FHI 360, Durham, NC 27713, USA Correspondence should be addressed to Maria F. Gallo, mgallo@cdc.gov Received 26 April 2011; Revised 2 June 2011; Accepted 17 June 2011 Academic Editor: Jessica M. Sales Copyright © 2011 Maria F. Gallo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Long-acting reversible contraceptive (LARC) methods are highly eﬀective against pregnancy. A barrier to their widespread promotion can include the concern they will lead reduced condom use and, thus, will put couples at higher risk for sexually transmitted infections (STIs). We review evidence from previous studies of condom “migration” associated with the use of LARC and propose a novel study design to address the two main methodological issues that have limited these earlier studies. Namely, we propose to use a randomized controlled trial design and to use a biological marker of semen exposure for measuring changes in condom use. 1. Introduction Because long-acting reversible contraception (LARC) meth- ods have very high eﬃcacy and low burden to users after their initiation, the American College of Obstetricians and Gynecologists recommends that women be oﬀered LARC as ﬁrst-line contraceptive methods [1]. These methods, which include intrauterine devices (IUD) or systems (IUS) and contraceptive implants, avoid the need for frequent visits for resupply, are highly cost eﬀective, and allow a rapid return to fertility after their removal. However, while LARC methods are extremely eﬀective against pregnancy, they oﬀer no protection against the transmission of HIV and other sexually transmitted infections (STIs). Thus, policy makers, funders, and providers might hesitate to support and promote the use of LARC, in part, because of concerns that women who initiate their use (or their male partners) could be less motivated to use condoms [2, 3]. Because women using LARC essentially are no longer at risk of pregnancy, they may choose not to use condoms or may no longer be able to convince their partner to use condoms solely for disease prevention. Because condoms, used consistently and correctly, remain the most eﬀective method of protection against HIV/STIs for sexually active individuals [4, 5], changes in condom use patterns from the introduction of LARC could put women and their partners at increased risk of infection. Similar concerns about condom “migration” related to the introduction of other interventions, such as microbicides, circumcision, and preexposure prophylaxis for HIV prevention, also have been raised [6, 7]. 1.1. Literature on Condom “Migration”. The available evi- dence—albeit limited—supports the possibility that LARC use could lead to reduced condom use. A multivariable analysis of a nationally representative survey of women in the US found that condom use was lower for women using injectables, intrauterine devices or implants compared to women using oral contraception [8], and a survey of reproductive-aged women in Baltimore revealed a signiﬁ- cantly lower prevalence of condom use among implant users than nonusers [9]. Similarly, a study among Hispanic and African-American female adolescents in Manhattan found condom use in the prior month was lower among women relying on the injectable or implant compared to those using