HIV This Week

Beksinska M, Smit J, Mabude Z, Vijayakumar G, Linda J. Male partner involvement and assistance in female condom use. Eur J Contracept Reprod Health Care. 2008;13(4):400-3.

Beksinska and colleagues investigated how males assist their partners in using the female condom. A multi-site, randomized, cross-over trial was conducted to test the performance and acceptability of the Reality® female condom compared to a prototype similar in design and appearance but made of synthetic latex (FC2). In this study, women were asked about male partner assistance in female condom use. Partner assistance in female condom use was similar across female condom type. Of the women who returned for the first follow-up visit (n = 233), just over a third (35.2%) reported that the male partner assisted in the insertion compared to 26.4% of the 201 women who returned for the second visit. In most cases where the partner assisted, the device was inserted using the inner ring, as recommended in the instructions for use. A small number (6%) mentioned that partners assisted in removal. Men have a role to play in the use of the female condom and are willing to assist their partners in using it.

Editors’ note: Most women in this study indicated that their partner liked the female condom and about a third reported partner assistance in its insertion and/or removal. Partners can check that the device is in place, ensure that it does not slip into the vagina, and avoid entering to the side of the condom rather than inside it, known as ‘misdirection’ or ‘penile misrouting’. Female condoms are rarely marketed to men and their participation is never emphasised in female condom promotion. It may be time to consider doing so, starting with discordant couple counselling.

van der Straten A, Cheng H, Moore J, Kacanek D, Blanchard K, De Bruyn G, Ramjee G, Chipato T, Montgomery ET, Padian N; The MIRA Team. The Use of the Diaphragm Instead of Condoms in a Phase III Diaphragm Trial. AIDS Behav. 2008 [Epub ahead of print]

The MIRA trial assessed whether providing diaphragm, lubricant gel, and condoms (intervention) compared with condoms alone (control) could reduce HIV incidence among 5,039 Southern African women. Compared with the control group, the cumulative proportion of last sex acts protected by any method was higher in the intervention group (OR = 1.33; 95% CI 1.18, 1.49); however, only 36.3% of last sex acts were protected by both a male condom and a diaphragm, whereas 36.6% were protected by a diaphragm only. Product substitution (ever deciding to use a diaphragm instead of a condom in the previous 3 months) was reported at every visit by 22.4%, at some visits by 60.7%, and at none of the visits by 16.8% of these women. Women at greater risk for infection through their own or their partner’s behaviour or who believed the diaphragm protected against HIV were more likely to report product substitution at every visit.

Editor’s notes: In the MIRA (Methods for Improving Reproductive health in Africa) study, while the proportion of last sex acts protected was high (91.3% in the intervention group and 85.1% in the condom-only control group), only 53.5% of last sex acts were protected by a condom in the intervention group. For some women, ‘prevention method optimism’ appeared to have prevailed despite intensive counselling. For others, they may have been compelled to use a method of unknown efficacy instead of a proven but possibly less acceptable method (the male condom). Such product substitution would be understandable after a product has been proven to be effective but was frustrating for the research team trying to test the added benefit of the diaphragm over condom use alone.