An assessment of the likely acceptability of vaginal microbicides for HIV prevention among women in rural Ghana

Abstract

BackgroundThe findings of the CAPRISA tenofovir studies have raised expectations that soon an approved microbicide would be available. However it is in only a limited number of countries in sub-Saharan Africa that the acceptability of microbicides has been evaluated. We conducted a study to assess the acceptability of vaginal microbicides among women in rural Ghana.MethodsThe study employs a mixed method design, using cross-sectional survey and focus group discussions to further understand issues related to awareness and attitudes towards microbicide development, acceptability and perceived partner attitudes among pregnant women attending antenatal clinic in two health facilities in the Kintampo North municipality of Ghana. We used logistic regression to identify possible predictors of microbicide acceptability among the women surveyed.ResultsAlthough only 2% of the 504 women were aware of the development of microbicides, 95% were willing to use one when it became available. The cost of a microbicide that will be considered affordable to 50% of women was US$0.75. Although there were concerns about possible wetting effect, gel or creams were the most preferred (68% of women) formulation. Although 71% thought their partners will find microbicide acceptable, apprehensions about the feasibility of and consequences of failed discreet use were evident. 49% of women were concerned about possible negative effect of microbicide on sexual pleasure. Perceived partner acceptability (O.R. =17.7; 95%C.I. 5.03-62.5) and possibility of discreet use (O.R. =8.9 95%C.I. 2.63-30.13) were the important predictors of microbicide acceptability.ConclusionAchieving microbicide acceptability among male partners should be made a part of the promotive interventions for ensuring effective use among women in rural Ghana.

Hypothetical Rectal Microbicide Acceptability and Factors Influencing It among Men Who Have Sex with Men in Tianjin, China

“…Due to the sensitivity and specificity of MSMs, participant recruitment and interview were conducted by the staff of Shenlan as the role of peers which could largely improve the authenticity of information[ 28 ]. MSMs we interviewed showed a high acceptability to rectal microbicides, and positive acceptability to microbicides had been revealed in HIV/AIDS high-risk populations in many studies [ 13 , 18 , 29 , 30 ].…”

“…Although the above results showed a positive response to microbicides among MSMs and FSWs in China, they would definitely prefer not to tell their partners their use of microbicides. However, a number of studies from foreign countries reported that participants, including MSMs and FSWs, would prefer to tell their partners the use of microbicides to preclude their partners from thinking they were unfaithful [ 13 , 35 – 37 ]. The difference suggested that Chinese special social and cultural background and partner relationship would affect the microbicide use.…”

“…With the development of microbicides research, scientists have focused on microbicide acceptability, particularly on vaginal microbicides. The acceptability of vaginal microbicides has been explored globally over the past few years [ 13 – 20 ], but the acceptability of rectal microbicides has been insufficiently studied. Recently, with MSMs becoming the serious high-risk population of HIV infection, scientists have been paying more attention to the rectal microbicides, which are applicable for MSMs to prevent HIV spread [ 21 ].…”

Sexual Pleasure, Partner Dynamics And Contraceptive Use in Malawi

“…A few studies on microbicide acceptability and condom use for HIV prevention raise concerns about sexual pleasure and the broader structural issues that affect it. [11][12][13][14] Although sexual pleasure was not their key focus, these studies touch upon the importance of sexual pleasure in relation to contraceptive method choice. Moreover, as in the West, these studies highlight that considerations of sexual pleasure, especially for women, are interconnected with broader structural realities.…”

Male condom use, multiple sexual partners and HIV: a prospective case-control study in Kinshasa (DRC)

“…To achieve the maximum protective effect, condoms must be used consistently and correctly (Centers for Disease Control and Prevention, 2014;Food and Drug Administration;Workowski, & Bolan, 2015) but in SSA use is still low and mostly inconsistent (MacQuarrie, Bradley, Gemmill, & Staveteig, 2014;Mutevedzi, & Newell, 2014;Papo, Bauni, Sanders, Brocklehurst, & Jaffe, 2011;UNAIDS, 2014). Objections to condoms are widespread due to culture, religion misconceptions, stigma and other factors (Abdool Karim et al, 2012;Abdulai et al, 2012;Amo-Adjei, 2012;Carlos et al, 2015;Earnshaw et al, 2014;Exavery et al, 2011;Exavery et al, 2012;Hawkes et al, 2013;Hearst et al, 2013;Kajubi et al, 2005;Mantell et al, 2011;Maticka-Tyndale, 2012;Namisi et al, 2015;Padian, Buvé, Balkus, Serwadda, & Cates, 2008;Rwenge, 2013;Skovdal, Campbell, Nyamukapa, & Gregson, 2011;Ukwuani, Tsui, & Suchindran, 2003;UNAIDS, 2004;UNAIDS, 2014b). Moreover, programs that address and provide free condoms, do not always give instructions on their correct use, or about breakage and slippage that can occur (Grasso, et al, 2016;Remis, Alary, Liu, Kaul, & Palmer, 2014;Sanders, et al, 2012;Spaar, et al, 2010;Walsh, et al, 2004).…”