The authors conducted a systematic review of articles that examined the disease-prevention effectiveness of at least one female-controlled barrier method and reviewed conference abstracts that presented clinical and preclinical microbicide data. Their purpose was to evaluate evidence for the effectiveness of female-controlled physical and chemical barrier methods in preventing STD/HIV transmission, to examine reviews on microbicide development, to highlight promising research directions, and to discuss challenges to effectiveness research and to translating research results to public health interventions.

The investigators found that randomized controlled trials showed evidence that female condoms confer as much STD protection as male condoms. Observational studies suggested that the diaphragm protects against STD pathogens. They found that several microbicide effectiveness studies are underway and new directions, such as adoption of therapeutic agents as preventive products, are being pursued. "Substantial attention is now given to product formulation and novel delivery strategies," the authors found. "Combining microbicide products with different mechanisms of action as well as combining chemical and physical barriers will be necessary to maximize prevention effectiveness."

The authors concluded that increased investment in the development and identification of female-controlled barrier methods suggests additional products will be available in the future. They note an urgent need for female-controlled barrier methods that allow women the chance to take an active role in reducing their STD/HIV risk and that such methods "constitute an essential tool to prevent continued spread of these infections."

The investigators also said, "generalizing trial results to a community setting, promoting products that may be less effective than male condoms, and bringing an effective product to scale introduce public health challenges that warrant attention."

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