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Preventing disease by protecting the cervix: The unexplored promise of internal vaginal barrier devices

Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States
AIDS (Impact Factor: 6.56). 10/2001; 15(13):1595-602. DOI: 10.1097/00002030-200109070-00001
Source: PubMed
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    • "Limited evidence from observational studies suggests that the diaphragm protects against STI and their sequelae, including gonorrhoea (Austin et al. 1984, Rosenberg et al. 1992), pelvic inflammatory disease (Wolner-Hanssen et al. 1990) and cervical dysplasia (Becker et al. 1994). This is biologically plausibleā€”the cervix being a primary entry site for STIs such as HIV, Neisseria gonorrhoeae, Chlamydia trachomatis and the human papilloma virus (Moench et al. 2001). Ongoing trials aim to determine its protective efficacy against HIV. "
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    • "Although no longer popular, having been displaced by more effective hormonal methods, when used together, the diaphragm and spermicide have contraceptive efficacy rates similar to other barrier methods, like male or female condoms [6]. Researchers hypothesized that by preventing sperm and semen from reaching the cervix or the upper reproductive tract, which have high concentrations of HIV-susceptible cells and thinner epithelial linings than the vagina, the diaphragm could also potentially reduce the risk of HIV transmission [7] [8] [9]. In the MIRA trial the Ortho All-flex diaphragm was used with ReplensĀ®, a noncontraceptive lubricant gel. "
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    ABSTRACT: There is little data on contraceptive effectiveness or use patterns from sub-Saharan Africa. We analyzed data from women at risk of pregnancy (n=4905) in the Methods for Improving Reproductive Health in Africa trial of the diaphragm for HIV prevention. We described reported contraceptive method use and calculated rates of pregnancy by contraceptive method. We compared time to first pregnancy by study arm (condoms or condoms plus diaphragm), and estimated a Cox proportional hazards model to identify predictors of pregnancy. Condoms (25.8%), injectables (25.4%) and OC (21.6%) were the most commonly used methods; long-acting method use was rare. During the trial, 51.6% of women used the same method, 27.4% switched to a more effective method and 20.9% switched to a less effective method; 21.4% of women became pregnant. Pregnancy rates by contraceptive group mirrored published estimates; frequency of study product use was not associated with pregnancy. Long-acting methods of contraception should be made available in HIV prevention trials and to women in Southern Africa.
    Contraception 06/2011; 83(6):556-63. DOI:10.1016/j.contraception.2010.10.018 · 2.93 Impact Factor
    • "A diaphragm is a shallow, domeshaped rubber disk with a flexible rim that fits within the vagina to cover the cervix. Although traditionally used for pregnancy prevention, the diaphragm is also being potentially considered for protection against HIV (Moench, Chipato, and Padian 2001). Microbicides are compounds formulated as gels, creams, foams or tablets that are inserted into the vagina (often with an applicator) to provide HIV protection (Ramjee et al. 2001). "
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    ABSTRACT: Women in sub-Saharan Africa are at high risk of HIV infection and may struggle to negotiate condom use. This has led to a focus on the development of female-controlled barrier methods such as the female condom, microbicides and the diaphragm. One of the advantages of such products is their contribution to female empowerment through attributes that make covert use possible. We used focus groups to discuss covert use of barrier methods with a sample of South African women aged 18-50 years from Eastern Johannesburg. Women's attitudes towards covert use of HIV prevention methods were influenced by the overarching themes of male dislike of HIV and pregnancy prevention methods, the perceived untrustworthiness of men and social interpretations of female faithfulness. Women's discussions ranged widely from overt to covert use of barrier methods for HIV prevention and were influenced by partner characteristics and previous experience with contraception and HIV prevention. The discussions indicate that challenging gender norms for HIV prevention can be achieved in quite subtle ways, in a manner that suits individual women's relationships and previous experiences with negotiation of either HIV or pregnancy prevention.
    Culture Health & Sexuality 07/2009; 11(5):485-97. DOI:10.1080/13691050902803537 · 1.55 Impact Factor
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