Prevention, Partners, and Power Imbalances: Women's Views on How Male Partners Affected Their Adherence to Vaginal Microbicide Gels During HIV Prevention Trials in Africa

Overview

Journal J Acquir Immune Defic Syndr

Specialty Infectious Diseases

Date 2020 Nov 2

PMID 33136745

Citations 6

Authors

Lori Miller

Neetha Morar

Saidi Kapiga

Gita Ramjee

Richard Hayes

Affiliations

Soon will be listed here.

Abstract

Background: Low adherence has contributed to disappointing results for trials testing vaginal microbicides for HIV prevention. This study engaged former gel trial participants to understand the reasons behind low adherence and seek suggestions on how to improve products and adherence to microbicides. This analysis examines the impact of participant perceptions of male partners on participant adherence and suggestions on how to address those issues.

Methods: Eight focus group discussion workshops were conducted with 46 former microbicide trial participants in South Africa and Tanzania. Participants provided feedback on why women join trials, barriers to using gels and reporting adherence accurately, and how adherence and adherence reporting can be improved.

Results: Participants reported that male partners can affect women's ability to use gels. For some, the lubricating effects caused relationship conflicts due to suspicion of male partners about infidelity. Needing to provide sex to partners on demand was a barrier to gel use. Participants suggested a gel formulation which was thicker and less noticeable, and explicit male partner engagement to enhance understanding of the purpose of the gels.

Conclusions: The imbalance of power in intimate relationships affects the ability of women to use microbicides as directed. To improve adherence to HIV prevention methods within trials and for successful rollout of proven HIV prevention methods in populations, it is important that the complicated dynamics of sex and relationships be taken into greater consideration and that women receive targeted support to navigate product use and communication within the context of these gender dynamics.

Citing Articles

HIV Prevention Product Acceptability and Preference Among Women in Sub-Saharan Africa to Inform Novel Biomedical Options in Development: A Systematic Review.

Makoni W, Lorenzetti L, Mancuso N, Luecke E, Dinh N, Deshpande A AIDS Behav. 2024; 29(1):257-293.

PMID: 39422786 DOI: 10.1007/s10461-024-04529-2.

Men's perceptions and perceived acceptability of their female partner's use of self-administered intravaginal therapies for treatment of cervical precancer in Kenya.

Mungo C, Adewumi K, Ellis G, Rop M, Adoyo E, Zou Y Ecancermedicalscience. 2024; 18:1719.

PMID: 39021542 PMC: 11254395. DOI: 10.3332/ecancer.2024.1719.

Men's perceptions and perceived acceptability of their female partner's use of self-administered intravaginal therapies for treatment of cervical precancer in Kenya.

Mungo C, Adewumi K, Ellis G, Rop M, Adoyo E, Zou Y medRxiv. 2024; .

PMID: 38370772 PMC: 10871376. DOI: 10.1101/2024.02.06.24302397.

Hidden heterogeneity: Uncovering patterns of adherence in microbicide trials for HIV prevention.

Miller L, Prieto Merino D, Baisley K, Hayes R PLoS One. 2022; 17(5):e0267011.

PMID: 35551324 PMC: 9098085. DOI: 10.1371/journal.pone.0267011.

Women's Perceptions of HIV- and Sexuality-Related Stigma in Relation to PrEP: Qualitative Findings from the Masibambane Study, Durban, South Africa.

Bergam S, Harrison A, Benghu N, Khumalo S, Tesfay N, Exner T AIDS Behav. 2022; 26(9):2881-2890.

PMID: 35218452 PMC: 9378426. DOI: 10.1007/s10461-022-03632-6.

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