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. 2005 Dec;81(6):472–476. doi: 10.1136/sti.2005.015107

Acceptability and feasibility of continuous diaphragm use among sex workers in Madagascar

F Behets 1, A Turner 1, K Van Damme 1, N Rabenja 1, N Ravelomanana 1, K Zeller 1, J Rasolofomanana 1
PMCID: PMC1745057  PMID: 16326849

Abstract

Objectives: The diaphragm, a woman controlled, reusable contraceptive device, might prevent some sexually transmitted infections (STIs). We assessed the acceptability and feasibility of use of silicone Wide-Seal Arcing Diaphragms (Milex Products, Chicago, IL, USA) by sex workers in Madagascar.

Methods: Over 8 weeks, we evaluated method acceptability by examining patterns of and problems with women's diaphragm use. We also evaluated several measures of study feasibility, including recruitment and follow up methods.

Results: 91 women from three cities (Antananarivo, Tamatave, and Mahajanga) participated, and 87 (96%) completed follow up. At enrolment, participants reported a median of six sex acts with five clients in the previous week. During the follow up period, participants reported a median of three sex acts with three clients during the previous 2 days, and self reported continuous diaphragm use during the previous day increased from 87% to 93%. Seven women became pregnant (incidence 53 pregnancies per 100 woman years). Self reported use of male condoms and diaphragms was fairly constant over the study period: women reported condom use in 61% to 70% of acts and diaphragms in 95% to 97% of acts. The number of participants reporting diaphragm problems decreased from 15 (16%) at the first visit to six (7%) at the final visit. 20 women (22%) needed replacement devices during follow up because their original diaphragms were lost, were the wrong size, or became seriously damaged.

Conclusions: Given the high use and steady decrease in reported problems during the study, we believe diaphragms are acceptable and feasible in this resource poor, low education sex worker population.

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Selected References

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  1. Austin H., Louv W. C., Alexander W. J. A case-control study of spermicides and gonorrhea. JAMA. 1984 Jun 1;251(21):2822–2824. [PubMed] [Google Scholar]
  2. Behets F., Andriamiadana J., Rasamilalao D., Ratsimbazafy N., Randrianasolo D., Dallabetta G., Cohen M. Sexually transmitted infections and associated socio-demographic and behavioural factors in women seeking primary care suggest Madagascar's vulnerability to rapid HIV spread. Trop Med Int Health. 2001 Mar;6(3):202–211. doi: 10.1046/j.1365-3156.2001.00690.x. [DOI] [PubMed] [Google Scholar]
  3. Behets Frieda M. T. F., Rasolofomanana Justin Ranjalahy, Van Damme Kathleen, Vaovola Georgine, Andriamiadana Jocelyne, Ranaivo Adeline, McClamroch Kristi, Dallabetta Gina, Van Dam Johannes, Rasamilalao Désiré. Evidence-based treatment guidelines for sexually transmitted infections developed with and for female sex workers. Trop Med Int Health. 2003 Mar;8(3):251–258. doi: 10.1046/j.1365-3156.2003.01017.x. [DOI] [PubMed] [Google Scholar]
  4. Bird Sheryl Thorburn, Harvey S. Marie, Maher Julie E., Beckman Linda J. Acceptability of an existing, female-controlled contraceptive method that could potentially protect against HIV: a comparison of diaphragm users and other method users. Womens Health Issues. 2004 May-Jun;14(3):85–93. doi: 10.1016/j.whi.2004.03.003. [DOI] [PubMed] [Google Scholar]
  5. Cohen M. S. Sexually transmitted diseases enhance HIV transmission: no longer a hypothesis. Lancet. 1998;351 (Suppl 3):5–7. doi: 10.1016/s0140-6736(98)90002-2. [DOI] [PubMed] [Google Scholar]
  6. Corbett Elizabeth L., Steketee Richard W., ter Kuile Feiko O., Latif Ahmed S., Kamali Anatoli, Hayes Richard J. HIV-1/AIDS and the control of other infectious diseases in Africa. Lancet. 2002 Jun 22;359(9324):2177–2187. doi: 10.1016/S0140-6736(02)09095-5. [DOI] [PubMed] [Google Scholar]
  7. Fleming D. T., Wasserheit J. N. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect. 1999 Feb;75(1):3–17. doi: 10.1136/sti.75.1.3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Kelaghan J., Rubin G. L., Ory H. W., Layde P. M. Barrier-method contraceptives and pelvic inflammatory disease. JAMA. 1982 Jul 9;248(2):184–187. [PubMed] [Google Scholar]
  9. Kuyoh M. A., Toroitich-Ruto C., Grimes D. A., Schulz K. F., Gallo M. F. Sponge versus diaphragm for contraception: a Cochrane review. Contraception. 2003 Jan;67(1):15–18. doi: 10.1016/s0010-7824(02)00434-1. [DOI] [PubMed] [Google Scholar]
  10. Magder L. S., Harrison H. R., Ehret J. M., Anderson T. S., Judson F. N. Factors related to genital Chlamydia trachomatis and its diagnosis by culture in a sexually transmitted disease clinic. Am J Epidemiol. 1988 Aug;128(2):298–308. doi: 10.1093/oxfordjournals.aje.a114970. [DOI] [PubMed] [Google Scholar]
  11. Moench T. R., Chipato T., Padian N. S. Preventing disease by protecting the cervix: the unexplored promise of internal vaginal barrier devices. AIDS. 2001 Sep 7;15(13):1595–1602. doi: 10.1097/00002030-200109070-00001. [DOI] [PubMed] [Google Scholar]
  12. Rosenberg M. J., Davidson A. J., Chen J. H., Judson F. N., Douglas J. M. Barrier contraceptives and sexually transmitted diseases in women: a comparison of female-dependent methods and condoms. Am J Public Health. 1992 May;82(5):669–674. doi: 10.2105/ajph.82.5.669. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Stein Z. A. HIV prevention: the need for methods women can use. Am J Public Health. 1990 Apr;80(4):460–462. doi: 10.2105/ajph.80.4.460. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Wølner-Hanssen P., Eschenbach D. A., Paavonen J., Kiviat N., Stevens C. E., Critchlow C., DeRouen T., Holmes K. K. Decreased risk of symptomatic chlamydial pelvic inflammatory disease associated with oral contraceptive use. JAMA. 1990 Jan 5;263(1):54–59. doi: 10.1001/jama.1990.03440010052029. [DOI] [PubMed] [Google Scholar]
  15. van der Straten Ariane, Kang Mi Suk, Posner Samuel F., Kamba Mavis, Chipato Tsungai, Padian Nancy S. Predictors of diaphragm use as a potential sexually transmitted disease/HIV prevention method in Zimbabwe. Sex Transm Dis. 2005 Jan;32(1):64–71. doi: 10.1097/01.olq.0000148301.90343.3a. [DOI] [PubMed] [Google Scholar]

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