Double protection doesn't improve HIV prevention

Double protection doesn't improve HIV prevention


NEW YORK (Reuters Health) - For prevention of HIV infection, there's no advantage to using a diaphragm as well as a condom during sex, according to investigators hoping for an effective female-controlled method of avoiding AIDS.

Dr. Nancy S. Padian and her colleagues tested the theory that covering the cervix with a diaphragm and still using a condom would enhance protection against HIV, in a medical trial involving some 5000 sexually active women living in South Africa and Zimbabwe.

Those randomly assigned to the "intervention" group were given diaphragms and lubricating gel along with condoms, while condoms alone were dispensed to the "control" group.

The women were re-evaluated and counseled about risk reduction and "condom negotiation" during quarterly follow-up visits for up to 24 months.

Despite those efforts, HIV infection rates were high in both groups, the investigators report in an early online issue of The Lancet medical journal. The infection rate was the equivalent of 4.1 cases per 100 women per year in the intervention group and 3.9 cases per 100 woman-years in the control group.

Padian, from the University of California in San Francisco, and her team found, unexpectedly, that fewer women in of the intervention group used condoms than in the control group -- 53.5 versus 85.1 percent.

"Female-controlled methods of HIV prevention are urgently needed," Dr. Ronald H. Gray and Dr. Maria J. Wawer, at Johns Hopkins University in Baltimore, write in an accompanying commentary.

Decades after the start of the HIV epidemic, the only proven prevention methods in adults depend on male cooperation. For that reason, the editorialists emphasize that the "disappointing results" reported from the current study "must not discourage the testing of other novel approaches."

SOURCE: Lancet, online July 13, 2007.