Skip to main content

Advertisement

SpringerLink
Log in

The Importance of Discreet Use of the Diaphragm to Zimbabwean Women and their Partners

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

We conducted a 6-month acceptability study of diaphragms as a potential HIV/STI prevention method among Zimbabwean women. We examined partner involvement in diaphragm use, and importance of discreet use (use without partner awareness). Of the 181 women who completed the study, 45% said discreet use was “very or extremely important” and in multivariate logistic regression, women were more likely to value discretion if their partners: had other partners; drank alcohol; or were believed to prefer condoms to diaphragms. Qualitative data confirmed these findings. Both women and their partners reported that diaphragms can be used discreetly and saw this as advantageous, for both sexual pleasure and female control. However, many were concerned that use without partner approval could lead to marital problems. Discreet use should be considered in development of barrier methods and in diaphragm promotion, if proven effective against HIV/STI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Allen, R. E. (2004). Diaphragm fitting. American Family Physician, 69(1), 97–100.

    PubMed  Google Scholar 

  • Bentley, M. E., Fullem, A. M., Tolley, E. E., Kelly, C. W., Jogelkar, N., Srirak, N., Mwafulirwa, L., Khumalo-Sakutukwa, G., & Celentano, D. D. (2004). Acceptability of a microbicide among women and their partners in a 4-country phase I trial. American Journal of Public Health, 94(7), 1159–1164.

    PubMed  Google Scholar 

  • Bounds, W., Guillebaud, J., Dominik, R., & Dalberth, B. T. (1995). The diaphragm with and without spermicide. A randomized, comparative efficacy trial. Journal of Reproductive Medicine, 40(11), 764–774.

    PubMed  CAS  Google Scholar 

  • Buck, J., Kang, M., van der Straten, A., Khumalo-Sakutukwa, G., Posner, S., & Padian, N. (2005). Barrier method preferences and perceptions among Zimbabwean women and their partners. AIDS and Behavior, 9(4) 415–422.

    Article  PubMed  Google Scholar 

  • Bulut, A., Ortayli, N., Ringheim, K., Cottingham, J., Farley, T. M., Peregoudov, A., Joanis, C., Palmore, S., Brady, M., Diaz, J., Ojeda, G., & Ramos, R. (2001). Assessing the acceptability, service delivery requirements, and use-effectiveness of the diaphragm in Colombia, Philippines, and Turkey. Contraception, 63(5), 267–275.

    Article  PubMed  CAS  Google Scholar 

  • El-Sadr, W. M., Mayer, K. H., Maslankowski, L., Hoesley, C., Justman, J., Gai, F., Mauck, C., Absalon, J., Morrow, K., Masse, B., Soto-Torres, L., & Kwiecien, A. (2006). Safety and acceptability of cellulose sulfate as a vaginal microbicide in HIV-infected women. AIDS, 20(8), 1109–1116.

    Article  PubMed  CAS  Google Scholar 

  • Elias, C., & Coggins, C. (2001). Acceptability research on female-controlled barrier methods to prevent heterosexual transmission of HIV: Where have we been? Where are we going? Journal of Women’s Health and Gender Based Medicine, 10(2), 163–173.

    Article  PubMed  CAS  Google Scholar 

  • Ferreira, A. E., Araujo, M. J., Regina, C. H., Diniz, S. G., & Faundes, A. (1993). Effectiveness of the diaphragm, used continuously, without spermicide. Contraception, V48(N1), 29–35.

  • Gollub, E. L. (2000). The female condom: Tool for women’s empowerment. American Journal of Public Health, 90(9), 1377–1381.

    PubMed  CAS  Google Scholar 

  • Green, G., Pool, R., Harrison, S., Hart, G. J., Wilkinson, J., Nyanzi, S., & Whitworth, J. A. (2001). Female control of sexuality: Illusion or reality? Use of vaginal products in south west Uganda. Social Science and Medicine, 52(4), 585–598.

    Article  PubMed  CAS  Google Scholar 

  • Hart, G. J., Pool, R., Green, G., Harrison, S., Nyanzi, S., & Whitworth, J. A. (1999). Women’s attitudes to condoms and female-controlled means of protection against HIV and STDs in south-western Uganda. AIDS Care, 11(6), 687–698.

    Article  PubMed  CAS  Google Scholar 

  • Hatcher, R. A., Trussell, J., Stewart, F., Stewart, G. K., Kowal, D., Guest, F., Cates, W., & Policar, M. S. (1994). The diaphragm, contraceptive sponge, cervical cap and female condom. In Contraceptive technology (16th revised edition ed., pp. 191–222). New York: Irvington Publishers.

  • Heise, L. L. (1997). Beyond acceptability: Reorienting research on contraceptive choice. In Beyond acceptability: users’ perspectives on contraception, [compiled by] World Health Organization [WHO], Reproductive Health Matters (pp. 6–14). London, England, Reproductive Health Matters.

  • Mantell, J. E., Dworkin, S. L., Exner, T. M., Hoffman, S., Smit, J. A., & Susser, I. (2006). The promises and limitations of female-initiated methods of HIV/STI protection. Social Science and Medicine, 63(8), 1998–2009.

    Google Scholar 

  • Mason, T. H., Foster, S. E., Finlinson, H. A., Morrow, K. M., Rosen, R., Vining, S., Joanis, C. L., Hammett, T. M., & Seage, G. R. 3rd. (2003). Perspectives related to the potential use of vaginal microbicides among drug-involved women: focus groups in three cities in the United States and Puerto Rico. AIDS and Behavior, 7(4), 339–351.

    Google Scholar 

  • Miles, M., & Huberman, A. (1994). Qualitative data analysis: An expanded sourcebook (2nd Ed.). Thousand Oaks, CA/London/New Delhi: Sage Publications, Inc.

    Google Scholar 

  • Minnis, A. M., & Padian, N. S. (2005). Effectiveness of female controlled barrier methods in preventing sexually transmitted infections and HIV: current evidence and future research directions. Sexually Transmitted Infections, 81(3), 193–200.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • Morrow, K., Rosen, R., Richter, L., Emans, A., Forbes, A., Day, J., Morar, N., Maslankowski, L., Profy, A. T., Kelly, C., Abdool Karim, S. S., & Mayer, K. H. (2003). The acceptability of an investigational vaginal microbicide, PRO 2000 Gel, among women in a phase I clinical trial. Journal of Women’s Health, 12(7), 655–666.

    Article  PubMed  Google Scholar 

  • Pool, R., Hart, G., Green, G., Harrison, S., Nyanzi, S., & Whitworth, J. (2000a). Men’s attitudes to condoms and female controlled means of protection against HIV and STDs in south-western Uganda. Culture Health and Sexuality, 2(2), 197–211.

    Article  CAS  Google Scholar 

  • Pool, R., Whitworth, J. A., Green, G., Mbonye, A. K., Harrison, S., Wilkinson, J., & Hart, G. J. (2000b). An acceptability study of female-controlled methods of protection against HIV and STDs in south-western Uganda. International Journal of STD and AIDS, 11(3), 162–167.

    Article  CAS  Google Scholar 

  • Ray, S., van de Wijgert, J., Mason, P., Ndowa, F., & Maposhere, C. (2001). Constraints faced by sex workers in use of female and male condoms for safer sex in urban Zimbabwe. Journal of Urban Health, 78(4), 581–592.

    PubMed  CAS  Google Scholar 

  • Severy, L. J., & Spieler, J. (2000). New methods of family planning: Implications for intimate Behavior. Journal of Sex Research, 37(3), 258–265.

    Article  Google Scholar 

  • Stein, Z. A. (1995). More on women and the prevention of HIV infection [Editorial]. American Journal of Public Health, 85(11), 1485–1488.

    Article  PubMed  CAS  Google Scholar 

  • Stewart, F. (1998). Chapter 18: Vaginal barriers: The diaphragm, contraceptive sponge, cervical cap and female condom. In R. A. Hatcher, J. Trussell, F. Stewart, J. C. Willard, G. K. Stewart, F. Guest & D. Kowal (Eds.), Contraceptive technology (pp. Chapter 18): Arcent Media Inc.

  • Trussell, J., Strickler, J., & Vaughan, B. (1993). Contraceptive efficacy of the diaphragm, the sponge and the cervical cap. Family Planning Perspectives, 25(3), 100–105, 135.

    Google Scholar 

  • UNAIDS (2000). Table of country-specific HIV/AIDS estimates and data.

  • UNAIDS (2005). Evidence for HIV Decline in Zimbabwe.

  • van der Straten, A., Kang, M. S., Posner, S. F., Kamba, M., Chipato, T., & Padian, N. S. (2005). Predictors of diaphragm use as a potential sexually transmitted disease/HIV prevention method in Zimbabwe. Sexually Transmitted Disease, 32(1), 64–71.

    Article  Google Scholar 

  • WHO/CONRAD (2001). Technical consultation on nonoxynol-9 (summary report). Geneva: WHO.

  • Woodsong, C. (2004). Covert use of topical microbicides: Implications for acceptability and use. International Family Planning Perspectives, 30(2), 94–98.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by the Centers for Disease Control and Prevention (CDC) and Contraceptive Research and Development (CONRAD) Program (contract # CSA-99-269). We would like to gratefully acknowledge the participants without whom this study would not have been possible.

Author information

Authors and Affiliations

  1. UZ-UCSF Collaborative Research Programme in Women’s Health, Harare, Zimbabwe

    Mi-Suk Kang, Nancy Padian, Gertrude Khumalo-Sakutukwa & Ariane van der Straten

  2. Department of OBGYN, University of California, San Francisco, CA, USA

    Jessica Buck, Nancy Padian & Ariane van der Straten

  3. Centers for Disease Control and Prevention, Atlanta, GA, USA

    Sam F. Posner

  4. Women’s Global Health Imperative, 50 Beale street, suite 1200, San Francisco, CA, 94105, USA

    Mi-Suk Kang

Authors
  1. Mi-Suk Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jessica Buck
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nancy Padian
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sam F. Posner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gertrude Khumalo-Sakutukwa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ariane van der Straten
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mi-Suk Kang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kang, MS., Buck, J., Padian, N. et al. The Importance of Discreet Use of the Diaphragm to Zimbabwean Women and their Partners. AIDS Behav 11, 443–451 (2007). https://doi.org/10.1007/s10461-006-9190-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-006-9190-7

Keywords

Search

Navigation