A public cervix announcement: CERVICAL BARRIERS in seven minutes Katy R. Backes Ibis Reproductive Health March 28, 2004 Microbicides Advocates Meeting
Cervical barriers (CBs) • What are CBs? • Cervical barriers (diaphragms and cervical caps) are latex or silicone cups that fit at the upper end of the vaginal tract, covering the cervix. • CBs have a long history as contraceptives. When used with spermicide, they are • 60-94% effective against pregnancy.
CBs and HIV/STI prevention • The cervix is fragile • Entrance lined with delicate cells • This layer is only 1 cell thick • Preferential site of infection for many STI • Bacterial pathogens (gonorrhea, chlamydia) • Human papilloma virus • Concentration of HIV receptor sites • Protection of the upper genital tract • Limitations - No protection for the vulva, urethra, and vagina Moench T, Chipato T, Padian N. 2001. Preventing disease by protecting the cervix: the unexplored promise of internal vaginal barrier devices. AIDS, 15(13):1595-1602.
MIRA Trial • What is it? A randomized, controlled trial to measure the effectiveness of the diaphragm used with lubricant gel in preventing HIV infection among women • How does it work? • All participants receive condoms, safe sex counseling, and STI treatment • Half also receive a diaphragm and gel and counseling on use • We will compare outcomes between these groups • Where is it happening? South Africa and Zimbabwe • When will we know the results? By 2007
Research on diaphragm acceptability • United States Harvey SM et al. Who continues using the diaphragm and who doesn’t: implications for the acceptability of female-controlled HIV prevention methods. Women’s Health Matters. 2003; 13:185-93. • Developing Countries • Colombia, Turkey, Philippines Bulut A et al. Assessing the acceptability, service delivery requirements, and use-effectiveness of the diaphragm in Colombia, Philippines, and Turkey. Contraception. 2001 May;63(5):267-75. • Brazil do Lago TD et al. Acceptability of the Diaphragm Among Low-Income Women in Sao Paulo, Brazil. International Family Planning Perspectives. 1995 Sep:21(3):114-118. • India Ravindran TKS and Rao SS, Is the diaphragm a suitable method of contraception for low-income women: a user perspectives study, Madras India. • Zimbabwe (UZ-UCSF)
Products • Diaphragms • All-Flex, Coil Spring, Semina, Wide Seal • Cervical caps • Prentif, Oves, FemCap, (Vimule, Dumas) • Other cervical barriers • Lea’s Shield • Female condom – protects against HIV/STI • Sponges • Products under development • (SILCS, BufferGel cup)
**CBAS** • The Cervical Barrier Advancement Society (CBAS) aims to raise the profile of cervical barriers both for preventing pregnancy and potentially HIV and other STIs • Coming soon: www.cervicalbarriers.org