The cooccurrence of HIV and unintended pregnancy has prompted a body of work on dual protection, the simultaneous protection against HIV and unintended pregnancy. This study examines dual protection and dual methods as a risk-reduction strategy for women living with HIV. Data are from a cross-sectional sample of HIV-positive women attended in Specialized STI/AIDS Public Health Service Clinics in 13 municipalities from all five regions of Brazil 2003-2004 ( ). Descriptive techniques and logistic regression were used to examine dual protection among women living with HIV. We expand the definition of dual protection to include consistent condom use and reversible/irreversible contraceptive methods, we test the dual methods hypothesis that women who use dual methods will use condoms less consistently than women who use only condoms, and we identify predictors of dual protection. Dual protection is common in our sample. Women who use dual methods have lower odds of consistent condom use than women who only use condoms. Among dual method users, we find that women who use an irreversible method use condoms more consistently than women who use a reversible method. Women on ART and with an HIV-serodiscordant partner have greater odds of consistent condom use than their counterparts. 1. Introduction The cooccurrence of HIV and unintended pregnancy has prompted a relatively recent body of work on dual protection, the simultaneous protection against HIV and unintended pregnancy [1]. Dual protection can be achieved through single method use (condoms) or dual method use (condoms + another contraceptive method). Most studies measure dual protection with condom use, but dual protection definitions must expand to capture condom use consistency and a wider variety of contraceptive methods [1]. Thus far, dual protection studies have focused on samples of women from the general population, have concentrated on developed or African countries, and have not considered HIV-related factors as influential in dual protection behavior. Studies that have considered the benefits of dual protection for people living with HIV show that dual protection can be an effective strategy to prevent HIV transmission to partners and to promote safe childbearing [2–5], which warrants more research in this population. This paper aims to describe dual protection among women living with HIV in Brazil. Worldwide, HIV is the leading cause of death for women of childbearing age, and up to 64% of all pregnancies are unintended [6, 7]. Brazil has over a third of all people living with HIV in Latin
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