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Diaphragm Acceptability

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Acceptability of Diaphragm Use in Zimbabwe



Contraceptive Research
  and Development (CONRAD)

Principal Investigator
Nancy Padian, PhD

In Zimbabwe, where it is recognized that most male partners control sexual activity and decision-making and some men prefer “dry and tight” sex, the majority of women have found it very difficult to negotiate safe sex, particularly consistent condom use. The female condom has been recently marketed as an alternative barrier method. However, its efficacy is not yet fully established, it still requires full consent and active co-operation of the male partner, is not reusable and therefore relatively expensive for the ordinary woman.

The diaphragm, on the other hand, is reusable, has low cost per use, can be inserted up to six hours before intercourse, can be left in place for 24 hours and it can be used without the knowledge of the partner. If proven acceptable and efficacious as a female controlled barrier method, the diaphragm would be an excellent option for women who desire to reduce their risk of acquiring HIV, sexually transmitted infections (STIs) and unintended pregnancy.

Specific Aims

  • To examine compliance with and acceptability of diaphragms with lubricant among women who are at risk of unintended pregnancy, HIV, and other STI’s and to identify predictors of use;
  • To determine the feasibility and desirability of conducting a trial, examining the effectiveness of diaphragms (with or without microbicide) in preventing HIV/STIs in this study population with a high incidence of such infections.

Study Description

Three hundred sexually active women between the ages of 16 and 48 and at high risk for unintended pregnancy, HIV and other STIs are being enrolled in the study over an eight-month period. The study design is two-phased and consists of a two-month condom intervention (Phase I), followed by a six-month Diaphragm Acceptability (Phase II). Diaphragms with lubricant are offered at entry into Phase II of the study. Male and female condoms are offered at each visit in Phase I and Phase II of the study. At the end of the condom promotion phase, women who do not use condoms for every act of sexual intercourse are introduced to the diaphragm. We plan to enroll about 195 women into the diaphragm acceptability phase.


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