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Diaphragms No Help Against AIDS? No Kidding.

July 12, 2007

A new study in the journal The Lancet reports that adding diaphragms to condoms does not reduce HIV transmission. Honestly, I don’t know why this is a surprise. The diaphragm works as a cervical barrier, to prevent sperm from traveling to where they could meet up with an egg. It doesn’t do anything to provide a barrier for the rest of the vaginal canal, where small tears can occur and fluids can mix freely. In other words, a diaphragm is not made to do what needs to be done to protect against HIV – cover everything. The authors do explain that the cells around the cervix are thought to be more susceptible to HIV, but you had to know from the outset that this was not going to be a great method.

The researchers, working in South Africa and Zimbabwe, recruited HIV-negative sexually active adult women from clinics and community organizations. Each woman was given an “HIV prevention package consisting of pre-test and post-test counseling about HIV and sexually transmitted infections, testing, treatment of curable sexually transmitted infections, and intensive risk-reduction counseling.” Half (2,522) the women got condoms in their kit, and the other half (2,523) got condoms, a latex diaphragm, and lubricant gel. They checked the women’s HIV status quarterly for 1-2 years.

6.1% of women in the condoms-only group “seroconverted” to be HIV positive over the course of the study, as did 6.4% of the condoms+diaphragm group. These are not significantly different, so there was basically no difference amount of new HIV infection between the groups.

However, women in the diaphragm group only used the device 73% of the time. The two groups also used their condoms at different rates – use at last sex averaged 53.5% across all visits for women in the condoms+diaphragm group, and 85.1% for those in the condoms-only group. So, not only were women in the diaphragm group not using their diaphragms all the time, they were not using their condoms very often, either.

I completely support the need for female-controlled HIV prevention. However, this study doesn’t do much to further that aim, but to tell us that a device not intended for the purpose of HIV prevention doesn’t actually work for HIV prevention. Sigh.

Padian NS, van der Straten A, Ramjee G, Chipato T, de Bruyn G, Blanchard K, Shiboski S, Montgomery ET, Fancher H, Cheng H, Rosenblum M, van der Laan M, Jewell N, McIntyre J. Diaphragm and lubricant gel for prevention of HIV acquisition in southern African women: a randomized controlled trial. Lancet. 2007 Jul 13; early online publication.

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