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Journal of the International AIDS Society

, 13:39

First Online: 19 October 2010Received: 31 March 2010Accepted: 19 October 2010


BackgroundWe examined the use of male condoms and the diaphragm following completion of a clinical trial of the diaphragm-s HIV prevention effectiveness. In the trial, called Methods for Improving Reproductive Health in Africa MIRA, women were randomized to a diaphragm group diaphragm, gel and condoms or a condom-only control group. At trial exit, all women were offered the diaphragm and condoms.

MethodsOur sample consisted of 801 Zimbabwean MIRA participants who completed one post-trial visit median lapse: nine months; range two to 20 months. We assessed condom, diaphragm and any barrier method use at last sex act at enrolment, final MIRA and post-trial visits. We used multivariable random effects logistic regression to examine changes in method use between these three time points.

Results and discussionIn the condom group, condom use decreased from 86% at the final trial visit to 67% post trial AOR = 0.20; 95% CI: 0.12 to 0.33. In the diaphragm group, condom use was 61% at the final trial visit, and did not decrease significantly post trial AOR = 0.77; 95% CI: 0.55 to 1.09, while diaphragm use decreased from 79% to 50% post trial AOR = 0.18; 95% CI: 0.12 to 0.28. Condom use significantly decreased between the enrolment and post-trial visits in both groups. Use of any barrier method was similar in both groups: it significantly decreased between the final trial and the post-trial visits, but did not change between enrolment and the post-trial visits.

ConclusionsHigh condom use levels achieved during the trial were not sustained post trial in the condom group. Post-trial diaphragm use remained relatively high in the diaphragm group given its unknown effectiveness, but was very low in the condom group. Introducing -new- methods for HIV prevention may require time and user skills before they get adopted. Our findings underscore the potential benefit of providing a mix of methods to women as it may encourage more protected acts.

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Autor: Ariane van der Straten - Helen Cheng - Alexandra M Minnis


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