Foundation funds UCSF research to test diaphragms as HIV prevention tool

The Bill & Melinda Gates Foundation has awarded $28 million to test whether the diaphragm can prevent the transmission of HIV, to UCSF's Women's Global Health Imperative (WGHI), directed by Nancy Padian, PhD. The diaphragm will be the first physical barrier tested in a randomized, controlled trial for effectiveness in preventing the sexual transmission of HIV.

"The foundation is demonstrating tremendous leadership and innovation in supporting research to examine women-controlled HIV prevention methods. Their foresight could potentially save many lives," said Padian, who is also UCSF professor of obstetrics, gynecology, and reproductive science, and director of international programs at UCSF's AIDS Research Institute (ARI). The study will enroll 4500 women at two sites in South Africa and one in Zimbabwe.

Because many people are skeptical that women would use the diaphragm, Padian first conducted an acceptability study among women in Zimbabwe, where close to a third of the population is infected with HIV.

"We asked women whose partners would not consistently use condoms if they would try using the diaphragm, even though we told them we did not know if it could prevent disease. Their enthusiasm to use a product that did not require negotiating with their male partner was overwhelming." said Padian.

Because it protects the cervix, the diaphragm holds enormous promise for preventing HIV transmission. The cervix is a "hot spot" in terms of susceptibility to HIV infection and other sexually transmitted diseases (STDs), and the majority of infections most likely occur there. The surface of the cervix is very thin and fragile whereas the vaginal walls are much thicker. The cervix also has more cells with HIV specific receptor sites than the vagina.

In addition, contractions of the uterus aspirate or draw fluids up into the upper genital track, which has also been shown to be very susceptible to HIV and STDs. Physical protection o

Contact: Jeff Sheehy
University of California - San Francisco

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