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CDC HIV/AIDS/Viral Hepatitis/STD/TB Prevention News Update
SOUTH AFRICA; ZIMBABWE: Diaphragm No Defense Against HIV,
Sabin Russell
July 17, 2007
San Francisco Chronicle (07.13.07) - Tuesday, July 17, 2007

A recent study found no additional protective effect against HIV for women using a latex diaphragm and lubricant gel during sex when compared with condom use alone. The three-year randomized study enrolled about 5,000 women ages 18-49 in Durban and Johannesburg, South Africa, and in Harare, Zimbabwe. Average follow-up was 18 months.

Half the group received diaphragms and a lubricant, and both groups received condoms and HIV/AIDS counseling, especially on how to have their partners use condoms. Among the diaphragm- condom-lubricant group, there were 158 infections, compared to 151 infections among women given condoms and counseling only. About 4 percent became infected in each group.

The diaphragm participants admitted using the device only 70 percent of the time, surprising and disappointing researchers, said Nancy Padian, executive director of the University of California-San Francisco Women's Global Health Improvement. The diaphragm group also admitted male partners used condoms only 54 percent of the time, compared to 85 percent male condom use for the condoms-only trial participants.

"It's very, very disappointing, of course," said Padian, the study's leader. "We were hoping to find a protective effect. It's taken me a long time to get over how devastating this is." Padian said the study was not designed to assess the protective efficacies of diaphragms compared with condoms against HIV infection. The Bill & Melinda Gates Foundation was a strong backer of the trial, which was meant to develop female-controlled HIV prevention methods, as females face a higher infection risk.

The full study, "Diaphragm and Lubricant Gel for Prevention of HIV Acquisition in Southern African Women: A Randomized Controlled Trial," was published online in The Lancet (2007; doi: 10.1016/S01040-6736(07)60950-7).

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