Contraceptives also must protect against AIDS, expert says

Norplant, an implant that can prevent pregnancy for up to five years, will not be an ideal contraceptive because it does not protect against sexually transmitted disease, particularly AIDS, says the researcher whose work led to the development of the device.

Dr. Sheldon Segal, the director of Population Services at the Rockefeller Foundation in New York, said he already is at work on a new form of Norplant that will provide this protection by including a vaginal protective cream with spermicide.


"Somewhere in the not too distant future, this will be the first choice, particularly of young women who have episodic sex and need a high level of protection against pregnancy," he said this week in Baltimore.

In 1966, Segal started the research that resulted in the Norplant implant, which could be approved by the U.S. Food and Drug Administration within the next few months, he said.


"At that time, we were not as aware as perhaps we should have been to the needs of linking contraception protection with sex," Segal said during a "Crisis in Contraception" conference at Johns Hopkins Medical Institutions.

It was one of six conferences held around the country by Planned Parenthood Federation of America, which "is exploring the frontier of new birth control," according to Faye Wattleton, its president since 1978.

"Our hope is that out of these conferences we will be able to build a national network of Americans who are very deeply and uncompromisingly committed to advancing fertility control with the recognition that to do so in this country is to advance it worldwide," she said.

Judy Norsigian, co-director of the Boston Women's Health Book Collective and a member of the National Research Council's Committee on Contraception Development, agreed there is a critical need to tie contraception to the prevention of AIDS and other sexually transmitted diseases.

"As we enter an era in which HIV-positivity is becoming more and more important and men and women are very concerned about sexually transmitted disease, we have to look much more carefully at barrier methods of contraception," she said. "We cannot look at contraception alone, in isolation, anymore."

Norplant is on the market in 12 countries and being tested in another 40 countries.

The implant, which is inserted through a quarter-inch incision just under the skin of a woman's upper arm, consists of six tiny tubes that release progestin -- a hormone -- into the bloodstream. The implant can be removed at any time and after removal, full fertility should be restored, the experts say.

Norsigian stressed the importance of making sure that every program that offers Norplant continues to offer removal services "so that women have a true choice." She said that in the end the real problem with Norplant will be having qualified personnel, noting that in developing countries "when a woman wants the implant removed, she can't find someone to remove it."


Initially, she believes that older American women will use Norplant but that it will in time be "very attractive" to any woman who wants "very effective" contraception, doesn't want to be sterilized and has trouble remembering to take the pill.

There is a crisis in cost, methods and accessibility of contraceptives because "we tend to look at women as having single needs," said Wattleton.

"There is no single contraceptive that is appropriate for every woman and there is no single contraceptive that is appropriate for every phase of her lifestyle," she said.