1. A public cervix announcement: CERVICAL BARRIERS in seven minutes
Katy R. Backes
Ibis Reproductive Health
March 28, 2004
Microbicides Advocates Meeting

2. 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.

3. 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
Some researchers are hopeful that cervical barriers may offer some degree of protection against HIV and other STIs. There is a large and growing body of evidence that supports their optimism.
-First, the cervix is extremely fragile. The entrance to the cervix is lined with delicate cells which are only 1 layer thick. The vagina, on the other hand, is lined with a tough skin that is cell layers thick.
-Secondly, the cervix is the preferential site of infection for many STIs, including bacterial pathogens such as gonorrhea and chlamydia as well as human papilloma virus.
-Also, new evidence shows a concentration of HIV receptor sites at the entrance to the cervix.
-Finally, the cervix is the entryway to the upper genital tract (uterus and fallopian tubes), and covering the cervix will also protect these vulnerable areas from infection
Moench T, Chipato T, Padian N Preventing disease by protecting the cervix:  the unexplored promise of internal vaginal barrier devices.  AIDS, 15(13):

4. 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 is currently underway to investigate whether or not diaphragm use may reduce transmission of HIV and other STIs. This study is called the Methods for Improving Reproductive Health in Africa (MIRA) trial. Ibis is collaborating with UCSF, UZ, MRC, PHRU to work on this trial.
(read responses to questions above)

5. 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 ; 13:
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 May;63(5):
Brazil
do Lago TD et al. Acceptability of the Diaphragm Among Low-Income Women in Sao Paulo, Brazil. International Family Planning Perspectives Sep:21(3):
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)
Research into the topic of diaphragm acceptability has been conducted both in the United States and in developing country contexts.
In the US, Marie Harvey led a study on the acceptability of the diaphragm among current and former users. She concluded that product characteristics influence continued use and have implications for improving the acceptability of current and future female-controlled HIV prevention methods.
Additionally, studies in developing countries such as Columbia, Turkey, Philippines, Brazil, and India have shown that many women find the diaphragm to be an acceptable contraceptive method.
In Zimbabwe, the UZ-UCSF collaborative programme in Women's health conducted a study of diaphragm acceptability among sexually active urbanized women who were inconsistent condom users. Their study concluded that, if proven effective against STI/HIV, DA used alone or in combination with a microbicide could provide an acceptable alternative to male condoms in at risk Zimbabwean women. 

6. Products Diaphragms Cervical caps Other cervical barriers
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)

7. **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:
To share information and connect people who are interested in cervical barrier methods, a new organization called the Cervical Barrier Advancement Society has been founded. CBAS aims to raise the profile of cervical barriers both for preventing pregnancy and potentially HIV and other STIs.
We plan to launch the CBAS website ( sometime in May. We hope that you will visit the site and consider joining the organization, if you are interested.
The issue of female controlled HIV prevention is a critical policy issue as well as a critical personal issue. We look forward to continued research on microbicides and cervical barriers and hope that there will soon be more options for women who are at risk.