Zimbabwean women value diaphragm as clandestine method to possibly prevent HIV

By Jeff Sheehy

Almost half of Zimbabwean women in a UCSF study say that the ability to use a diaphragm clandestinely was very or extremely important—a number that rises to 80 percent if their partners have other sexual partners or if getting their partners to use condoms is difficult.

“We found that if a woman distrusted her partner or if she has had bad experiences getting her partner to use condoms, she attached much greater importance to the clandestine use of the diaphragm,” said the study’s presenter, Mi Suk Kang, MPH, statistician with the UCSF Women’s Global Health Imperative (WGHI).

Kang presented the findings today (July 29) at 15th Biennial Congress of the International Society for Sexually Transmitted Diseases in Ottawa, Canada.

The study participants were 181 sexually active Zimbabwean women previously identified as inconsistent condom users.  Almost all were married and they ranged in age from 16 to 45. Almost all had used the diaphragm in the previous two months and just over 20 percent told their partners every time they used it.  Free condoms were also provided to every study participant.

“This study adds to the promise of the diaphragm as a potential tool to prevent HIV transmission because it shows that it can be used without one’s partner knowing it is being used. Women urgently need an HIV prevention tool that they control,” said WGHI director and study co-author, Nancy Padian, PhD, UCSF professor of obstetrics, gynecology and reproductive services and director of international programs at the UCSF AIDS Research Institute.

Padian is in the initial stages of conducting a study funded a year ago by the Bill and Melinda Gates Foundation to determine if diaphragms can prevent the transmission of HIV.  The cervix is a “hot spot” in terms of HIV susceptibility and protecting it with a physical barrier offers promise. Data from observational studies show that protecting the cervix protects against bacterial sexually transmitted diseases.

WGHI is a global research program based at the UCSF AIDS Research Institute and UCSF Department of Obstetrics, Gynecology and Reproductive Sciences. Scientists at WGHI conduct research and training related to HIV/AIDS, gender and reproductive health. This research is used to design and rapidly implement practical and effective prevention and treatment strategies for women at risk for or living with HIV.

Co-authors of the study are Ariane van der Straten, PhD, academic coordinator in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences; Owen Mapfumo, MA, project coordinator, and Gertrude Khumalo-Sakutukwa, MSc(Medicine), senior social scientist, both at the University of Zimbabwe-UCSF Collaborative Research Programme in Women’s Health, Harare, Zimbabwe.

Funding for this research was provided by grants from the Centers for Disease Control and Prevention and the Contraceptive Research and Development Program.