AIDS and Behavior

, 13:564 | Cite as

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

  • Ariane van der Straten
  • Helen Cheng
  • Jie Moore
  • Deborah Kacanek
  • Kelly Blanchard
  • Guy De Bruyn
  • Gita Ramjee
  • Tsungai Chipato
  • Elizabeth T. Montgomery
  • Nancy Padian
  • The MIRA Team
Original Paper


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 diaphragm Condoms HIV/STI prevention Product substitution Africa Female-initiated methods 



We would like to thank the women who participated in this study. For A. van der Straten, H. Cheng, N. Padian and E. Montgomery, most work for this study was conducted at the University of California San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences. Special thanks to Stephen Shiboski for statistical advice, and Caitlin Gerdts for review and editorial assistance. The MIRA trial was funded through a grant from the Bill and Melinda Gates Foundation (#21082).


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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Ariane van der Straten
    • 1
    • 2
  • Helen Cheng
    • 1
  • Jie Moore
    • 3
  • Deborah Kacanek
    • 4
  • Kelly Blanchard
    • 4
  • Guy De Bruyn
    • 5
  • Gita Ramjee
    • 6
  • Tsungai Chipato
    • 7
  • Elizabeth T. Montgomery
    • 1
  • Nancy Padian
    • 1
  • The MIRA Team
    • 8
  1. 1.Women’s Global Health ImperativeRTI InternationalSan FranciscoUSA
  2. 2.Center for AIDS Prevention Studies, Department of MedicineUniversity of California San FranciscoSan FranciscoUSA
  3. 3.Department of OBGYNUniversity of California San FranciscoSan FranciscoUSA
  4. 4.Ibis Reproductive HealthCambridgeUSA
  5. 5.Perinatal HIV Research UnitUniversity of the WitwatersrandJohannesburgSouth Africa
  6. 6.HIV Prevention Research UnitMedical Research CouncilDurbanSouth Africa
  7. 7.UZ-UCSF Collaborative Research ProgrammeUniversity of ZimbabweHarareZimbabwe
  8. 8.San FranciscoUSA

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