The Diaphragm as HIV Barrier

The HIV epidemic in Africa affects more women than men, probably reflecting both sociocultural constraints and differences in anatomic susceptibility. Condoms protect against HIV acquisition and transmission, but women need methods of protection that they can control and perhaps use surreptitiously. To determine whether diaphragm use can prevent heterosexual transmission of HIV, investigators randomized 5045 HIV-negative women in South Africa and Zimbabwe to receive a clinician-fitted diaphragm and lubricant gel in addition to condoms (intervention group) or condoms alone (control group). All women were counseled about risk reduction with an emphasis on condom negotiation and were followed quarterly to assess HIV and sexually transmitted in…