The use of the diaphragm instead of condoms in a phase III diaphragm trial.
The MIRA trial assessed whether providing diaphragm, lubricant gel, and condoms (intervention) compared with condoms alone (control) could reduce HIV incidence among 5,039 Southern African women. Compared with the control group, the cumulative proportion of last sex acts protected by any method was higher in the intervention group (OR = 1.33; 95% CI 1.18, 1.49); however, only 36.3% of last sex acts were protected by both a male condom and a diaphragm, whereas 36.6% were protected by a diaphragm only. Product substitution (ever deciding to use a diaphragm instead of a condom in the previous 3 months) was reported at every visit by 22.4%, at some visits by 60.7%, and at none of the visits by 16.8% of these women. Women at greater risk for infection through their own or their partner's behavior or who believed the diaphragm protected against HIV were more likely to report product substitution at every visit.
van der Straten
Ariane
A
Women's Global Health Imperative, RTI International, 114 Sansome Street, Suite 500, San Francisco, CA 94104, USA. ariane@rti.org
Cheng
Helen
H
Moore
Jie
J
Kacanek
Deborah
D
Blanchard
Kelly
K
De Bruyn
Guy
G
Ramjee
Gita
G
Chipato
Tsungai
T
Montgomery
Elizabeth T
ET
Padian
Nancy
N
D000293:Adolescent; D000328:Adult; D000353:Africa, Southern; D003075:Coitus; D017280:Condoms / Q000706:statistics & numerical data*; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003274:Contraceptive Devices, Female / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance / Q000706:statistics & numerical data*; D021841:Safe Sex; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D014622:Vaginal Creams, Foams, and Jellies; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology
D014622:Vaginal Creams, Foams, and Jellies