Combination of Microbicide and Diaphragm Could Prevent HIV Transmission

Combining a microbicide with a diaphragm could be an effective method of preventing HIV transmission, as the chemical and device would protect the "infection-susceptible cervix and upper reproductive tract" from the virus, Dr. Nancy Padian, director of international programs at the University of California-San Francisco's AIDS Research Institute, writes in an editorial published in the Sept. 7 issue of the journal AIDS. HivandHepatitis.com reports that Padian and colleagues state that the cervix is "far more vulnerable" to HIV infection than the surface of the vagina because the cervical columnar epithelium is "thinner and more friable" than that of the vagina. The receptors required for HIV infection are also concentrated in the cervix. Padian and colleagues state that a cervical barrier can prevent virus particles from being transported by uterine peristaltic contractions into the fallopian tubes and peritoneal cavity. Although the scientists acknowledge that it is unclear whether a diaphragm/microbicide combination is as effective as a condom in preventing HIV transmission, they add that diaphragms are more likely to be accepted by societies in which men might not want to wear a condom. Most men cannot tell when their partner is wearing a diaphragm, and Padian states that women seem to be amenable to the device. Padian and colleagues are conducting an acceptability study of the diaphragm in Zimbabwe, and write that the acceptability measured thus far "seems to be much greater than we thought it would be." They note that they are not promoting the diaphragm as a method of HIV prevention, but tell women who are "unable to use condoms" that the device "might offer protection" against the virus. They conclude, "Even in that very tenuous promotion of [the diaphragm], they're willing to use it. Women are desperate for methods they can use to protect themselves" (Gale, HivandHepatitis.com, 9/19).