NEW YORK (Reuters Health) - Giving sex workers diaphragm contraceptives does not seem to have the unintended effect of lowering their condom use, a new study suggests.
The study, which followed 140 female sex workers in Kenya, found that after the women received diaphragms, along with counseling on condom use and safer-sex practices, their sexual risk-taking declined over the next six months.
That included an increase in the frequency of condom use and a dip in the number of sex partners the women reported, according to researchers led by Dr. Maria F. Gallo of the U.S. Centers for Disease Control and Prevention in Atlanta.
At the outset, the women reported using condoms 56 percent of the time, on average; six months later, that figure was 68 percent. Their number of sex partners also declined from an average of five over the previous two weeks, to four by the study's end.
The findings, reported in the American Journal of Epidemiology, may help allay concerns that giving sex workers diaphragms could cause them to forgo condoms -- which are known to reduce the risk of HIV and other STDs.
Despite the effectiveness of condoms, researchers are looking for additional ways to curb the spread of HIV in areas like sub-Saharan Africa, where the AIDS epidemic is most acute. That includes studying the usefulness of "female-controlled" methods like the so-called female condom and diaphragms, to help protect women whose partners will not use condoms.
In theory, diaphragms could help keep the virus from reaching the cervix. And some observational studies have found that women who use diaphragms have lower rates of some STDs than women who do not use them, Gallo and her colleagues note.
However, the only clinical trial conducted so far found that giving African women diaphragms to use along with condoms had no effect on HIV transmission rates compared with condoms alone.
That study also found that women who received diaphragms had lower rates of condom use than those given condoms only; over the study period, an average of 54 percent reported using a condom the last time they had sex, versus 85 percent of the condoms-only group.
Those researchers pointed out that lack of an increased HIV risk in the diaphragm group -- despite their lower condom use -- warranted further research into whether diaphragms themselves offer some protection.
Future clinical trials, according to Gallo's team, should continue to look into whether diaphragms can help curb HIV transmission. The current findings, they say, suggest that giving women the contraceptives need not lower their use of condoms.
The researchers do acknowledge a number of limitations of the study, however. One is that it focused on sex workers, and the results may not be generalizable to other women. The study also relied on women's self-reported sexual practices, which means at least some may have overestimated their condom use or underestimated their number of sex partners.
In the future, Gallo and her colleagues write, it would be helpful for studies to try to verify condom use by testing women for objective markers of semen exposure.
SOURCE: http://link.reuters.com/kas53n American Journal of Epidemiology, online July 26, 2010.
