AIDS and Behavior

, 13:564

The Use of the Diaphragm Instead of Condoms in a Phase III Diaphragm Trial


    • Women’s Global Health ImperativeRTI International
    • Center for AIDS Prevention Studies, Department of MedicineUniversity of California San Francisco
  • Helen Cheng
    • Women’s Global Health ImperativeRTI International
  • Jie Moore
    • Department of OBGYNUniversity of California San Francisco
  • Deborah Kacanek
    • Ibis Reproductive Health
  • Kelly Blanchard
    • Ibis Reproductive Health
  • Guy De Bruyn
    • Perinatal HIV Research UnitUniversity of the Witwatersrand
  • Gita Ramjee
    • HIV Prevention Research UnitMedical Research Council
  • Tsungai Chipato
    • UZ-UCSF Collaborative Research ProgrammeUniversity of Zimbabwe
  • Elizabeth T. Montgomery
    • Women’s Global Health ImperativeRTI International
  • Nancy Padian
    • Women’s Global Health ImperativeRTI International
  • The MIRA Team
Original Paper

DOI: 10.1007/s10461-008-9504-z

Cite this article as:
van der Straten, A., Cheng, H., Moore, J. et al. AIDS Behav (2009) 13: 564. doi:10.1007/s10461-008-9504-z


The MIRA trial assessed whether providing diaphragm, lubricant gel, and condoms (intervention) compared with condoms alone (control) could reduce HIV incidence among 5,039 Southern African women. Compared with the control group, the cumulative proportion of last sex acts protected by any method was higher in the intervention group (OR = 1.33; 95% CI 1.18, 1.49); however, only 36.3% of last sex acts were protected by both a male condom and a diaphragm, whereas 36.6% were protected by a diaphragm only. Product substitution (ever deciding to use a diaphragm instead of a condom in the previous 3 months) was reported at every visit by 22.4%, at some visits by 60.7%, and at none of the visits by 16.8% of these women. Women at greater risk for infection through their own or their partner’s behavior or who believed the diaphragm protected against HIV were more likely to report product substitution at every visit.


Vaginal diaphragmCondomsHIV/STI preventionProduct substitutionAfricaFemale-initiated methods

Copyright information

© Springer Science+Business Media, LLC 2008