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African women at the epicentre of the HIV pandemic urgently need a way to protect themselves from infection. They have inadequate control over the only two preventive interventions that work—condoms and male circumcision—and a disappointing trial has just reported that cervical diaphragms don't give extra protection when added to a comprehensive package including condomscondoms.
All 4948 HIV negative women were given intensive counselling, treatment of sexually transmitted diseases, and condoms. Half were also given diaphragms and told how to use them. They developed HIV at the same rate as control women without the diaphragms (4.1 per 100 women years v 3.9 per 100 women years, relative hazard 1.05, 95% CI 0.84 to 1.32). Perhaps worse, women with diaphragms used condoms significantly less often than other women, although this did not affect their risk of infection in this study.
HIV prevention trials are notoriously difficult and expensive, say the researchers. Perhaps that's why 21 of the last 25 have had negative results. It is possible, even likely, that cervical diaphragms can work, but perhaps not as well as these researchers were expecting. This trial was powered to detect a drop in incidence no less than 33%.