A study of Zimbabwean women who were unable to persuade their male partners to use condoms consistently has found that 98 percent of the women used the diaphragm as an alternative method of contraception and disease prevention, University of California-San Francisco researchers reported at the 14th International AIDS Conference in Barcelona.

"The cervix appears to be a 'hot spot' in terms of susceptibility to HIV. It is also very thin and fragile and has more cells with HIV-specific receptor sites than the vagina. Also, the peristalic contractions of the uterus actually draw fluids up into the upper genital tract -- an area that is very susceptible to HIV and other sexually transmitted diseases. This rapid upward movement of the fluid is thought to enhance fertility but also transports HIV and STD-causing pathogens," said 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 that can facilitate HIV transmission. And because diaphragms can be used as vehicles to hold spermicides, they may thus increase the effectiveness of new microbicides to prevent HIV transmission, Padian said.

In Zimbabwe, where the study took place, 30 percent of the population is estimated to be HIV-infected. Women first enrolled in a two-month program to teach and encourage male condom use. Women who were unable to negotiate consistent condom use were then enrolled into the diaphragm acceptability phase. Ninety- seven percent of the on-going study's 156 women are married, and 70 percent have had only one partner. Before entering the study, only 1 percent had ever used a diaphragm. Almost all the women used KY Jelly in addition to diaphragms.

"Given the urgent need for HIV prevention methods that a woman 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. Coauthor Tsungai Chipato, MD, said there is "substantial evidence to suggest that protecting the cervix could offer some protection against HIV.... Now that we know they are acceptable [to women], diaphragms need to be tested for efficacy in preventing HIV."

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