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Infectious Diseases in Obstetrics and Gynecology
Volume 2009, Article ID 420196, 11 pages
Research Article

Adherence to Diaphragm Use for Infection Prevention: A Prospective Study of Female Sex Workers in Kenya

1Center for Microbiology Research, Kenya Medical Research Institute, Mbagathi Rd., P.O. Box 54840-00200, Nairobi, Kenya
2Department of Obstetrics and Gynecology, University of Nairobi, P.O. Box 30197, G.P.O, Nairobi, Kenya
3Department of Global Health, University of Washington, 1959 N.E. Pacific St., Box 356355 Seattle, WA 98195-6355, USA
4Department of Obstetrics and Gynecology, Department of Obstetrics & Gynecology, University of Washington, Box 356560, Seattle, WA 98195-6460, USA
5Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, Mail Stop K-34, Atlanta, GA 30341-3724, USA
6International Training and Education Center on HIV (I-TECH), University of Washington, 901 Boren Ave., Suite 1100, Seattle, WA, 98104, UK
7School of Mathematics, University of Nairobi, P.O. Box 30197, G.P.O, Nairobi, Kenya

Received 26 August 2009; Revised 16 November 2009; Accepted 21 December 2009

Academic Editor: Susan Cu-Uvin

Copyright © 2009 Elizabeth A. Bukusi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective. To assess adherence to and acceptability of the diaphragm among 140 female sex workers in Kenya in a 6-month prospective study. Methods. At baseline and bimonthly visits, participants were interviewed on diaphragm knowledge, attitude, and practices. We used principal component analysis and logistic regression to identify predictors of consistent use. Results. At 50% of 386 bimonthly visits, women reported consistently using a diaphragm with all partners during the preceding 2 weeks. Consistent use was significantly higher at the 6-month than the 2-month visit. Women reported less covert use with “helping” (regular sex partners to whom she could go for help or support) than with “other” partners. Perceptions that diaphragms are easier to use than condoms and that their lack of coital interruption is important were associated with consistent diaphragm use with both partner types. Partner support of diaphragm use is correlated with consistent use with “helping” partners only while higher parity, consistent condom use, and perceived lack of need of condoms as a benefit of diaphragms were associated with consistent use with “other” partners. Conclusions. Diaphragm acceptance among female sex workers in Nairobi was high. Future studies should distinguish between partner types when evaluating diaphragm adherence.