Outdated Contraceptive May Help in Third World

Some researchers and activists are making a concerted push to resurrect the diaphragm to prevent AIDS among the people now most threatened by the disease: women in developing countries. More than half of the world's people now infected with HIV are women, most of them in developing countries, epidemiologists at the UN and the World Health Organization have reported in recent weeks.

The diaphragm protects the cervix, a newly discovered "hot spot" for HIV infection. New designs and novel materials could make diaphragms cheaper, more comfortable and easier to use. The diaphragms probably would be used with microbicides -- gels or creams that help prevent HIV infection. No such microbicide yet exists, but scientists are studying a number of promising candidates. Researchers believe that diaphragms could help keep microbicides near the cervix, where they could do the most good.

Some AIDS experts caution that while using diaphragms to prevent AIDS is an intriguing and potentially lifesaving proposal, it's also a risky one: the scientific basis for diaphragms preventing AIDS is more theoretical than clinically proven. Experts worry that women and their partners may eschew condoms in favor of diaphragms before they are shown to truly help.

Pressure for AIDS prevention methods that women can control themselves is growing. Biologically, women are four times more vulnerable to HIV infection than men, and women in some cultures are unable to refuse sex or force men to use condoms. The female condom has not gained wide acceptance. Cervical caps have also been discussed for HIV prevention, but some scientists believe they are less feasible than diaphragms because they are more difficult to fit properly and can dislodge more easily.

"Women in developing countries are extremely motivated" to protect themselves, said Jerry Florence, CEO of New Jersey-based SILCS, which is working on a more user-friendly diaphragm made of silicon, rather than latex. "If you can make diaphragms inexpensively enough, I think they could be mass-produced and mass-distributed to developing countries. The condom really has not been as effective as it was supposed to be. You're asking men to take responsibility for this. Clearly they haven't."

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