Women Using Latex Diaphragm With Condoms Had Same HIV Incidence

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Women who used latex diaphragms and condoms as an HIV preventionmethod had the same HIV incidence as those who only used condoms,according to a study published online on Thursday in advance of theJuly 14 issue of the journal Lancet, the Wall Street Journal reports (Chase, Wall Street Journal, 7/13).

For the study -- funded by a $37 million grant from the Bill & Melinda Gates Foundation -- Nancy Padian of the University of California-San Franciscoand colleagues enrolled nearly 5,000 women ages 18 to 49 in Durban andJohannesburg, South Africa, and in Harare, Zimbabwe. The researchersfollowed the study participants for an average of 18 months, the San Francisco Chroniclereports. Half the participants were given diaphragms, gel lubricant andcondoms, while the other half were provided with condoms only. Bothgroups also received extensive counseling on condom use, the Chronicle reports.

Thestudy found that HIV incidence between the two groups was almostidentical, with about 4% of women in both groups becoming HIV-positiveannually. According to the study, 158 women who were given diaphragms,lubricant, condoms and counseling became HIV-positive and 151 women whowere given condoms and counseling became HIV-positive. Padian said oneof the more disappointing and surprising results was that women givendiaphragms reported using them 70% of the time. The same group ofparticipants also reported that their partners used condoms 54% of thetime, compared with 85% condom usage in the group given condoms only.The almost identical HIV incidence between the two groups might suggestthat diaphragm use is at least as effective as condoms at preventingHIV, but because the trial was not designed to compare the two methods,there is no proof of equivalence, Padian said (Russell, San Francisco Chronicle, 7/13).

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Thestudy's findings should be investigated further, but they do not"warrant using [diaphragms] as a protective mechanism now," Padian said(Russell, San Francisco Chronicle, 7/13). She added, "Condoms remain the only proven barrier method for HIV prevention" (Reuters, 7/12).

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"It's very, very disappointing, of course," Padian said, adding, "We were hoping to find a protective effect" (San Francisco Chronicle,7/13). The study's findings are especially disappointing for women "whostill can't negotiate condom use by men," Padian said. Women worldwideurgently need HIV prevention methods they can control, an accompanying Lancet opinion piece said (Wall Street Journal, 7/13).

NickHellmann, interim director of HIV/AIDS and tuberculosis at the GatesFoundation, said although the results of the study are disappointing,they are simply part of the scientific process. He added that thefindings will not deter the Gates Foundation from continuing to fundfor research in the field. "There have been setbacks, but we know wecan do this," Hellmann said, adding, "It's a matter of finding theright intervention."

Zeda Rosenberg, CEO of the International Partnership for Microbicides,said the study provides valuable information for future investigationsinto such products. "These studies are incredibly difficult to do, butit is a difficulty that can and must be overcome," she said, adding,"Women are at high risk of [HIV] infection throughout the world, andthey don't have a means of protecting themselves under their control" (San Francisco Chronicle, 7/13).

Reprinted with permission from kaisernetwork.org. You can view theentire Kaiser DailyHIV/AIDS Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . TheKaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service ofThe Henry J. Kaiser Family Foundation.

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