Zimbabwe Women Willing to Use Diaphragms to Prevent Disease

July 09, 2002
News Office: Jeff Sheehy (415) 597-8165

Zimbabwean women who were unable to persuade their male partners to use condoms were willing to use diaphragms as an alternative method of contraception and disease prevention -- although their effectiveness against HIV is unknown -- according to UCSF researchers.

"There is substantial evidence to suggest that protecting the cervix could offer some protection against HIV, but attempts to study physical barriers that protect the cervix such as diaphragms have been stymied by the issue of acceptability," said co-author Dr. Tsungai Chipato, University of Zimbabwe professor of obstetrics and gynecology at the UZ-UCSF Collaborative Research Programme in Women's Health. "Western researchers simply have not believed that women will use them. Now that we know that they are acceptable, diaphragms need to be tested for efficacy in preventing HIV."

Chipato is presenting the findings at the XIV International AIDS Conference in Barcelona, Spain.

"The cervix appears to be a 'hot spot' in terms of susceptibility to HIV," said the study's principal investigator, Nancy Padian, UCSF professor of obstetrics, gynecology and reproductive services and director of international programs at UCSF's AIDS Research Institute. "It is very thin and fragile and has more cells with HIV specific receptor sites than the vagina. Also, the peristalic contractions of the uterus actually draw fluids up into the upper genital track -- an area that is very susceptible to HIV and other sexually transmitted diseases (STDs). This rapid upward movement of fluid is thought to enhance fertility but also transports HIV and STD causing pathogens."

Data from observational studies show that protecting the cervix protects against bacterial STDs, and these STDs are proven to facilitate transmission of HIV. Also, diaphragms, which also can be vehicles to hold spermicides, may increase the effectiveness of new microbicides that are designed to prevent HIV acquisition, Padian said.

"Given the urgent need for HIV prevention methods that a woman can use without her partner knowing about or needing to consent to use, the potential of this existing product can no longer languish unexplored," said Padian, who also is director of the Women's Global Health Imperative at UCSF.

The study -- which took place in Zimbabwe where 30 percent of the population is estimated to be HIV-infected -- first enrolled women in a two-month program to teach and encourage male condom use. Women who were unable to negotiate consistent condom use by their male partners were then enrolled into the diaphragm acceptability phase. One hundred and fifty-six women took part in the study, which is ongoing. Ninety-eight percent of the women whose partners wouldn't use condoms consistently used the diaphragms. Ninety-seven percent are married and 70 percent have had only one partner in their lives. Before entering the study, only 1 percent had ever used a diaphragm. KY jelly was used in addition to diaphragms by almost all of the women.

Co-authors of the study are Ariane van der Straten, academic coordinator at UCSF's department of obstetrics and gynecology; Samuel F. Posner at the Centers for Disease Control (CDC); Owen Mapfumo, project coordinator, and Gertrude Khumalo-Sakutukwa, senior social scientist, both from the University of Zimbabwe-UCSF Collaborative Research Programme in Women's Health, Harare, Zimbabwe; and Marianne Callahan, at the Contraceptive Research and Development Program, (CONRAD) Arlington, Virginia.

The study was funded by grants from the CDC and CONRAD.

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