Communication About Microbicide Use Between Couples in KwaZulu-Natal, South Africa

Abstract

The ways in which couples communicate about microbicides is likely to influence microbicide uptake and usage. We collected quantitative data about whether women in a microbicide trial discussed microbicides with their partners and explored communication about microbicides during 79 in-depth-interviews with women enrolled in the trial and 17 focus-group discussions with community members. After 4 weeks in the trial, 60 % of 1092 women had discussed microbicides with their partners; in multivariate analysis, this was associated with younger age, clinic of enrolment and not living in households that owned cattle. After 52 weeks, 84 % of women had discussed microbicides; in multivariate analysis, this was associated with not living in households that owned cattle, not living in a household that relied on the cheapest water source, allocation to 0.5 % PRO2000 gel and consistent gel adherence. Qualitative findings highlighted that women in committed relationships were expected to discuss microbicides with their partners and preferred to use microbicides with their partner’s knowledge. Women had different reasons for, and ways of, discussing microbicides and these were influenced by the couple’s decision-making roles. Although there was tolerance for the use of microbicides without a partner’s knowledge, the women who used microbicides secretly appeared to be women who were least able to discuss microbicides. In KwaZulu-Natal, socio-cultural norms informing sexual communication are amenable to microbicide introduction.

The influence of social constructs of hegemonic masculinity and sexual behaviour on acceptability of vaginal microbicides in Zambia

“…M. Montgomery et al, 2010), some men increasingly regulated their partners' sexual lives and the use of the gel because of their fear that their partners may use it with other men for sexual pleasure. The findings are consistent to some extent with Gafos et al (2015)'s study in South Africa in as far as women in long term relationships are concerned. However, Gafos et al (2015)'s study suggests that young couples reported more autonomous use of gel because they were more likely to be in less established relationships where issues of trust and informing the male partners were less important.…”

Optimizing HIV prevention for women: a review of evidence from microbicide studies and considerations for gender‐sensitive microbicide introduction

“…However, study findings also suggest that many women will likely talk with their partners about using microbicides. In all clinical trials and surrogate studies that asked about partner communication, participants typically talked with steady partners about their microbicide use at some point during study participation [ 12 , 14 , 30 , 32 , 37 , 42 , 61 , 66 , 69 ].…”

“…Deciding whether to talk to a partner about microbicide use may be more complicated for women in violent or abusive relationships. If a woman tries to use a gel product without her partner's knowledge and her partner finds out, he may react violently [ 13 , 30 , 61 , 69 , 71 ]. Some women may decide to communicate with their partner about microbicide use because they fear a negative or violent reaction if their partner discovers they have been using a product without discussing it first [ 20 , 69 ].…”

Impact of the Dapivirine Vaginal Ring on Sexual Experiences and Intimate Partnerships of Women in an HIV Prevention Clinical Trial: Managing Ring Detection and Hot Sex

“…Gender dynamics and expectations for sexual relationships and experiences are vital aspects of the context within which sex occurs [7, 13, 14] and, as such, for understanding women’s experience of the ring. In sub-Saharan Africa, where young women are at especially high risk for contracting HIV [15], there is increasing exposure to and emphasis on “modern,” powerful and independent women, especially in urban centers.…”

“…In sub-Saharan Africa, where young women are at especially high risk for contracting HIV [15], there is increasing exposure to and emphasis on “modern,” powerful and independent women, especially in urban centers. Nonetheless, predominant feminine identities are associated with “traditional” female roles that accept male authority and comply with requests and desires of male partners [13, 14, 16–18], which extends to male decision making in regard to sexual activity and methods to prevent HIV transmission [14, 19]. …”