{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T06:56:56Z","timestamp":1773298616556,"version":"3.50.1"},"reference-count":33,"publisher":"CSIRO Publishing","issue":"4","license":[{"start":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T00:00:00Z","timestamp":1746403200000},"content-version":"vor","delay-in-days":6744,"URL":"https:\/\/doi.org\/10.1071\/journalslicense"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2006,11,17]]},"abstract":"<jats:p>Background: Women in sex work stand to benefit if the contraceptive diaphragm alone or combined with a microbicide proves to be an effective barrier method against HIV and sexually transmissible infection (STI). Currently, contraceptive diaphragm users are advised to leave the diaphragm in situ without concomitant use of other intravaginal substances for at least 6 h after intercourse. Methods: We conducted in-depth interviews on sexual behaviour including post-coital intravaginal practices with 36 women in sex work and 26 of their clients and held two focus-group discussions, each with 10 women. Results: The women described adapting several potentially harmful substances, such as cloth and soapy water, for post-coital vaginal use to ensure personal hygiene, disease prevention and client pleasure. Some wanted to clean themselves and remove the diaphragm early, fearing exposure to HIV infection for themselves and their subsequent clients. Clients indicated their desire for \u2018dry sex\u2019, vaginal cleanliness and reduced risk of infection through vaginal cleaning. Conclusions: The diaphragm as a female-controlled barrier method for HIV\/STI prevention may have limited acceptability among women in sex work if its effectiveness depends on a 6-h post-coital wait before removal, along with avoidance of concomitant use of intravaginal substances. In keeping with the beliefs of the the female sex workers and their needs and practices, alternative intravaginal substances and modes of insertion that will not disrupt vaginal flora, injure vaginal epithelium, damage the diaphragm or counteract potentially beneficial effects of microbicides are needed. The possibility of removing the diaphragm sooner than the recommended 6 h for contraception should be further studied.<\/jats:p>","DOI":"10.1071\/sh06021","type":"journal-article","created":{"date-parts":[[2006,11,16]],"date-time":"2006-11-16T23:37:01Z","timestamp":1163720221000},"page":"261-268","source":"Crossref","is-referenced-by-count":13,"title":["Sex preparation and diaphragm acceptability in sex work in Nairobi, Kenya"],"prefix":"10.1071","volume":"3","author":[{"given":"Anjali","family":"Sharma","sequence":"first","affiliation":[{"name":"ACentre for Microbiology Research, Kenya Medical Research Institute, Kenyatta National Hospital, PO Box 19464-00202, Nairobi, Kenya."},{"name":"BDepartment of Obstetrics and Gynecology, University of Washington School of Medicine, 1959 NE Pacific St, Box 356460, Seattle, WA 98195, USA."},{"name":"HPresent address: Suite 311, 3"},{"name":"ICorresponding author. Email: asharma@csrtkenya.org"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Bukusi","sequence":"additional","affiliation":[{"name":"ACentre for Microbiology Research, Kenya Medical Research Institute, Kenyatta National Hospital, PO Box 19464-00202, Nairobi, Kenya."},{"name":"BDepartment of Obstetrics and Gynecology, University of Washington School of Medicine, 1959 NE Pacific St, Box 356460, Seattle, WA 98195, USA."},{"name":"CDepartment of Obstetrics and Gynecology, University of Nairobi, Kenyatta National Hospital, PO Box 19676, Nairobi, Kenya."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel","family":"Posner","sequence":"additional","affiliation":[{"name":"DCenters for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas","family":"Feldman","sequence":"additional","affiliation":[{"name":"EDepartment of Anthropology, State University of New York College, 350 New Campus Drive, Brockport, NY 14420, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Ngugi","sequence":"additional","affiliation":[{"name":"FDepartment of Community Health Sciences, University of Nairobi, Kenyatta National Hospital, PO Box 19676, Nairobi, Kenya."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig R.","family":"Cohen","sequence":"additional","affiliation":[{"name":"GDepartment of Obstetrics, Gynecology, Reproductive Sciences, University of California, 50 Beale St, San Francisco, CA 94105, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"67","published-online":{"date-parts":[[2006,11,17]]},"reference":[{"key":"2025102418561500300_R1"},{"key":"2025102418561500300_R2"},{"key":"2025102418561500300_R3"},{"key":"2025102418561500300_R4"},{"key":"2025102418561500300_R5"},{"key":"2025102418561500300_R6"},{"key":"2025102418561500300_R7"},{"key":"2025102418561500300_R8"},{"key":"2025102418561500300_R9"},{"key":"2025102418561500300_R10"},{"key":"2025102418561500300_R11"},{"key":"2025102418561500300_R12"},{"key":"2025102418561500300_R13"},{"key":"2025102418561500300_R14"},{"key":"2025102418561500300_R15"},{"key":"2025102418561500300_R16"},{"key":"2025102418561500300_R17"},{"key":"2025102418561500300_R18"},{"key":"2025102418561500300_R19"},{"key":"2025102418561500300_R20"},{"key":"2025102418561500300_R21"},{"key":"2025102418561500300_R22"},{"key":"2025102418561500300_R23"},{"key":"2025102418561500300_R24"},{"key":"2025102418561500300_R25"},{"key":"2025102418561500300_R26"},{"key":"2025102418561500300_R27"},{"key":"2025102418561500300_R28"},{"key":"2025102418561500300_R29"},{"key":"2025102418561500300_R30"},{"key":"2025102418561500300_R31"},{"key":"2025102418561500300_R32"},{"key":"2025102418561500300_R33"}],"container-title":["Sexual Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/connectsci.au\/sh\/article-pdf\/3\/4\/261\/143775\/sh06021.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/connectsci.au\/sh\/article-pdf\/3\/4\/261\/143775\/sh06021.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T22:56:16Z","timestamp":1761346576000},"score":1,"resource":{"primary":{"URL":"https:\/\/connectsci.au\/sh\/article\/3\/4\/261\/20866\/Sex-preparation-and-diaphragm-acceptability-in-sex"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006,11,17]]},"references-count":33,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2006,11,17]]}},"URL":"https:\/\/doi.org\/10.1071\/sh06021","relation":{},"ISSN":["1448-5028","1449-8987"],"issn-type":[{"value":"1448-5028","type":"print"},{"value":"1449-8987","type":"electronic"}],"subject":[],"published":{"date-parts":[[2006,11,17]]}}}