Almost all (98 percent) Zimbabwean women who were unable to persuade their male partners to use condoms consistently, used the diaphragm as an alternative method of contraception and disease prevention, though its effectiveness against HIV remains unknown, UCSF researchers have found."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.

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," said co-author Tsungai Chipato, MD, University of Zimbabwe professor of obstetrics and gynecology at the UZ-UCSF Collaborative Research Programme in Women's Health.

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. It is very thin and fragile and has more cells with HIV specific receptor sites than the vagina. Also, the peristaltic 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," said the study's principal investigator, Nancy Padian, PhD, UCSF professor of obstetrics, gynecology and reproductive services and director of international programs at UCSF's AIDS Research Institute.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 can also be vehicles to hold spermicides, may thus 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 women 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 is also director of the Women's Global Health Imperative at UCSF.

The study--which took place in Zimbabwe where thirty 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-seven percent are married and seventy percent have had only one partner in their life. Before entering the study, only one 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, PhD, academic coordinator at UCSF's department of obstetrics and gynecology; Samuel F. Posner, PhD, at the Centers for Disease Control (CDC); Owen Mapfumo, MA, project coordinator, Gertrude Khumalo-Sakutukwa, MSc(Medicine), senior social scientist, both at the University of Zimbabwe-UCSF Collaborative Research Programme in Women's Health, Harare, Zimbabwe; and Marianne Callahan, PhD, at the Contraceptive Research and Development Program, (CONRAD) Arlington, Virginia.

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