Latex diaphragms no defence against HIV

15 July, 2007:

The idea of what may be called female-controlled prevention of HIV/AIDS has taken a beating after a study conducted in Africa found that women who used a latex diaphragm for possible protection against the dreaded disease had the same infection rates as those who did not.

Using diaphragms in addition to condoms provides no extra protection against the AIDS virus, researchers reported online in advance of the July 14, 2007, edition of the British medical journal Lancet.

In the three-year, multimillion-dollar study conducted in Africa, researchers gave 5,045 women in South Africa and Zimbabwe an HIV-prevention package that included condoms; some received diaphragms, too. However, the incidence of the human immunodeficiency virus (HIV) that causes AIDS was the same in both groups – around 4%.

It was hoped that diaphragms would give women extra protection against the virus, especially since so many men are reluctant to use condoms.

The researchers concluded that they could not recommend use of a diaphragm as a low-cost intervention that women could use as a means of reducing their risk of HIV infection.

The study was the most closely watched HIV prevention trial for women since January 2007, when researchers abruptly ended studies of a vaginal gel meant to block the virus after early results showed the women who used it had a slightly higher risk of becoming infected.

A similar trial testing whether the contraceptive jelly nonoxynol-9 might work as an anti-HIV microbicide failed in 2000, when the study showed that sex workers in South Africa who used it had a considerably higher infection rate than those who were given an inactive, placebo gel.

Nancy Padian, executive director of the UCSF Women’s Global Health Imperative and lead investigator of the study on diaphragm, said, “it is very, very disappointing. We were hoping to find a protective effect.”

Researchers are desperately seeking a low-cost method that women could use – without the consent of male partners – to protect themselves against HIV.

Nearly 20% of adults are infected in Zimbabwe and South Africa, where the experiment was conducted, and women there run twice the risk of infection as men. In cultures where women are traditionally subservient to men, they have less say in matters of sex – when to have it, whom to have it with, and whether condoms or other safer sexual practices will be used.

Dr Nick Hellmann, interim director of HIV and tuberculosis programs for the Bill and Melinda Gates Foundation, said the disappointing results of the diaphragm trial are simply part of the scientific process.

The Bill and Melinda Gates Foundation was a major funder of the research, having spent $37 million for the study. It also had been a key funder of the microbicide trial, which was stopped in January 2007.

Dr Hellmann said the results of the latest study would not deter the Foundation from continuing to pay for research in the field.