Adherence to Diaphragm Use for Infection Prevention: A Prospective Study of Female Sex Workers in Kenya

Elizabeth A Bukusi,Betty Njoroge,Maria F Gallo,Denise J Jamieson,April J Bell,David A Eschenbach,Anjali Sharma,Rosemary Nguti

doi:10.1155/2009/420196

Abstract

Objective. To assess adherence to and acceptability of the diaphragm among 140 female sex workers in Kenya in a 6-month prospective study. Methods. At baseline and bimonthly visits, participants were interviewed on diaphragm knowledge, attitude, and practices. We used principal component analysis and logistic regression to identify predictors of consistent use. Results. At 50% of 386 bimonthly visits, women reported consistently using a diaphragm with all partners during the preceding 2 weeks. Consistent use was significantly higher at the 6-month than the 2-month visit. Women reported less covert use with “helping” (regular sex partners to whom she could go for help or support) than with “other” partners. Perceptions that diaphragms are easier to use than condoms and that their lack of coital interruption is important were associated with consistent diaphragm use with both partner types. Partner support of diaphragm use is correlated with consistent use with “helping” partners only while higher parity, consistent condom use, and perceived lack of need of condoms as a benefit of diaphragms were associated with consistent use with “other” partners. Conclusions. Diaphragm acceptance among female sex workers in Nairobi was high. Future studies should distinguish between partner types when evaluating diaphragm adherence.

Highlights

Cervical barriers such as diaphragms may protect women against the acquisition of sexually transmitted infections (STIs)
Perceptions that diaphragms are easier to use than condoms and that their lack of coital interruption is important were associated with consistent diaphragm use with both partner types
Diaphragms have not been shown to be effective against HIV acquisition in a randomized controlled trial [10], observational data suggest that consistent diaphragm use could protect against STIs and their long-term sequelae [11]

Summary

Introduction

Cervical barriers such as diaphragms may protect women against the acquisition of sexually transmitted infections (STIs). Diaphragms could prevent N. gonorrhoeae and C. trachomatis from reaching the target columnar epithelial cells in the cervix [1] and protect against HIV acquisition by reducing the risk of the virus reaching HIV receptor-rich cells, which are present in larger numbers in the cervix than in the vagina [2,3,4,5,6]. Diaphragms may reduce HIV susceptibility indirectly by protecting against other STIs [7, 8] and could be an effective mechanism with which to deliver microbicide in the genital tract if a microbicide effective against HIV were identified [9]. Even if diaphragms were proven to be efficacious for STI prevention and safe for use in diverse populations, they would still have to be acceptable to potential users in order to be used consistently.

Methods

Results

Conclusion