Diaphragm Put to Test Against HIV

Taking a new, low-tech tack in the battle against AIDS, the Bill and Melinda Gates Foundation plans to spend $28 million in southern Africa to test whether the simple latex diaphragm used for birth control also can reduce a woman's risk of HIV infection. The grant ends an eight-year quest by University of California-San Francisco researcher Nancy Padian to win funding for a never-tried approach that, in theory, could block the virus about as effectively as a much more expensive AIDS vaccine. The goal is to achieve at least a 33 percent reduction in new infections among women in developing countries.

Padian's project will get the lion's share of $48 million in new Gates grants, which also will support a study in Uganda to test whether male circumcision -- another low-cost intervention -- can cut the risk of HIV infection among males by at least 50 percent, as some earlier research suggests. The concept of using a diaphragm to protect against HIV infection was first raised in 1989 by AIDS research pioneer Dr. Jay Levy of UCSF. "I felt certain that if you could block virus-infected cells from the cervix, you could reduce transmission dramatically," he said.

The Gates Foundation already has committed $100 million to research on the elusive AIDS vaccine. The four-year diaphragm study, which will enroll 4,500 women in Zimbabwe and South Africa, was approved after Padian presented research at the 14th International AIDS Conference in Barcelona showing that women in Zimbabwe who could not get their partners to wear condoms would use latex diaphragms as an HIV-prevention tool. Perhaps the most valuable attribute of the diaphragm is that women may often be able to use it without their sexual partner's knowledge. Padian insists that many of the women in the study in Zimbabwe successfully used the devices clandestinely -- meeting the test of a long-sought "female-controlled" barrier to HIV.

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