Comparing patterns of sexual risk among adolescent and young women in a mixed‐method study in Tanzania: implications for adolescent participation in HIV prevention trials

Tolley, Elizabeth E.; Kaaya, Sylvia; Kaale, Anna; Minja, Anna; Bangapi, Doreen; Kalungura, Happy; Headley, Jennifer; Baumgartner, Joy Noel

doi:10.7448/ias.17.3.19149

Cited by 15 publications

(8 citation statements)

References 17 publications

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“…The same issues hinder parents’ and healthcare providers’ acceptance of adolescent girls’ sexuality and need for information and HIV protection. Moreover, developmentally adolescents may have difficulties accurately assessing their risk [ 77 ], planning ahead or controlling impulses. Results from FACTS 001 and VOICE showed that young women had more challenges with adherence than older women, especially when they did not have a single/primary partner and when they lived with their parents [ 78 ].…”

Section: Resultsmentioning

confidence: 99%

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

Doggett

Lanham

Wilcher

et al. 2015

Journal of the International AIDS Society

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IntroductionMicrobicides were conceptualized as a product that could give women increased agency over HIV prevention. However, gender-related norms and inequalities that place women and girls at risk of acquiring HIV are also likely to affect their ability to use microbicides. Understanding how gendered norms and inequalities may pose obstacles to women's microbicide use is important to inform product design, microbicide trial implementation and eventually microbicide and other antiretroviral-based prevention programmes. We reviewed published vaginal microbicide studies to identify gender-related factors that are likely to affect microbicide acceptability, access and adherence. We make recommendations on product design, trial implementation, positioning, marketing and delivery of microbicides in a way that takes into account the gender-related norms and inequalities identified in the review.MethodsWe conducted PubMed searches for microbicide studies published in journals between 2000 and 2013. Search terms included trial names (e.g. “MDP301”), microbicide product names (e.g. “BufferGel”), researchers’ names (e.g. “van der Straten”) and other relevant terms (e.g. “microbicide”). We included microbicide clinical trials; surrogate studies in which a vaginal gel, ring or diaphragm was used without an active ingredient; and hypothetical studies in which no product was used. Social and behavioural studies implemented in conjunction with clinical trials and surrogate studies were also included. Although we recognize the importance of rectal microbicides to women, we did not include studies of rectal microbicides, as most of them focused on men who have sex with men. Using a standardized review template, three reviewers read the articles and looked for gender-related findings in key domains (e.g. product acceptability, sexual pleasure, partner communication, microbicide access and adherence).Results and discussionThe gendered norms, roles and relations that will likely affect women's ability to access and use microbicides are related to two broad categories: norms regulating women's and men's sexuality and power dynamics within intimate relationships. Though norms about women's and men's sexuality vary among cultural contexts, women's sexual behaviour and pleasure are typically less socially acceptable and more restricted than men's. These norms drive the need for woman-initiated HIV prevention, but also have implications for microbicide acceptability and how they are likely to be used by women of different ages and relationship types. Women's limited power to negotiate the circumstances of their intimate relationships and sex lives will impact their ability to access and use microbicides. Men's role in women's effective microbicide use can range from opposition to non-interference to active support.ConclusionsIdentifying an effective microbicide that women can use consistently is vital to the future of HIV prevention for women. Once such a microbicide is identified and licensed, positioning, marketing and delivering mic...

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Section: Resultsmentioning

confidence: 99%

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

Doggett

Lanham

Wilcher

et al. 2015

Journal of the International AIDS Society

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“…Young adults and women tend to have a high incidence of HIV, and play an important role in the ongoing transmission of HIV [26,27]. This strengthens the need for HIV vaccine trials and willingness to participate studies to target the largest number of women and young volunteers [28][29][30]. Our population consisted of young adults most-at-risk for HIV infection, of whom almost half were women, identified and recruited from the general community, in contrast to other HIV vaccine preparedness studies which specifically targeted populations that are vulnerable and socially stigmatized such as MSM and FSW [17,22,23,31].…”

Section: Plos Onementioning

confidence: 91%

Young at risk-people in Maputo City, Mozambique, present a high willingness to participate in HIV trials: Results from an HIV vaccine preparedness cohort study

et al. 2021

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Introduction Vaccine efficacy testing requires engagement of willing volunteers with high disease incidence. We evaluated factors associated with willingness to participate in potential future HIV vaccine trials in Maputo, Mozambique. Methods Adults aged 18–35 years without HIV and who reported at least two sexual partners in the 3 months prior to screening were enrolled into a 24-month observational study. They were asked at screening and exit if they would be willing to participate in a theoretical HIV vaccine study. Bivariate and multivariate logistic regression analyses were done between willingness to participate, demographic, sexual behavior, and motivational factors for screening visit data. Logistic regression with generalized estimating equations (GEE) was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for factors potentially associated with willingness to participate for data from both visits. Results A total of 577 participants without HIV were eligible, including 275 (48%) women. The mean age was 22.2 (SD ± 3.9) years. At screening 529 (92%) expressed willingness to participate and the proportion remained stable at 378 (88%) of the 430 participants retained through the exit visit (p = 0.209). Helping the country (n = 556) and fear of needles (n = 26) were the top motive and barrier for willingness to participate, respectively. Results from the GEE binary logistic regression (screening visit and exit visit) showed that wanting to learn how to avoid risk behaviors (aOR 3.33, 95% CI: 1.61–6.86) and feeling protected against HIV infection (aOR 2.24, 95% CI: 1.07–4.7) were associated with willingness to participate in HIV vaccine studies. Conclusion The majority of our study population in Mozambique expressed willingness to participate in a theoretical HIV vaccine trial. Participation in a HIV vaccine trial was seen as a way to contribute to the fight against HIV but was associated with some unrealistic expectations such as protection against HIV. This reinforces the need for continuous mobilization and awareness of potential participants to HIV vaccine trial.

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“…Several papers in this supplement report on research targeting various groups of women for whom microbicides are thought to be appropriate in specific contexts. First, Tolley and her colleagues [ 20 ] make the case for including adolescent girls aged 15–17 in HIV prevention trials based on the results of a mixed methods study in Tanzania. She and her colleagues found girls in this age range to be at similar or higher risk of infection to their 18- to 21-year-old counterparts but perceiving themselves at lower risk and under-utilizing prevention services.…”

Section: Understanding Needs Of Specific Groups Of End-usersmentioning

confidence: 99%

Women and ARV-based prevention: opportunities and challenges

Geary¹,

Bukusi²

2014

Journal of the International AIDS Society

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ARV-based HIV prevention methods available in pill, gel or ring formulations (broadly referred to as microbicides) offer the possibility of protection against HIV for women who find it difficult because they cannot ask their partners to use condoms or even refuse sex. Partial efficacy of ARV-based medications has been demonstrated in a number of clinical trials around the world among various populations, building the evidence that ARV-based technologies will contribute to reducing the AIDS epidemic worldwide. Disappointing results, however, from two trials in sub-Saharan Africa, where poor adherence contributed to study closure due to futility, have raised questions about whether women at the centre of the epidemic are able to effectively use products that require routine use. Also, there are fears by some of risk compensation by decreased condom use because of the availability of microbicides when only partial efficacy has been demonstrated in microbicide trials to date. Of note, sub-analyses of biologic measures of adherence in trials where this was possible have shown a strong correlation between good adherence and efficacy, reinforcing the necessity of good adherence. Research conducted in conjunction with clinical trials and post-trials in advance of possible rollout of ARV-based products have examined social and cultural factors, gender-related and otherwise, influencing adherence and other aspects of women's use of products. These include HIV stigma, women's perception of risk, partner and community influences and the differing needs of women in various stages of life and in different circumstances. It is the purpose of this supplement to give voice to the needs of women who can benefit from woman-initiated methods by presenting research results and commentary to contribute to the global conversation about optimizing women's experience with ARV-based prevention.

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Comparing patterns of sexual risk among adolescent and young women in a mixed‐method study in Tanzania: implications for adolescent participation in HIV prevention trials

Cited by 15 publications

References 17 publications

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

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

Young at risk-people in Maputo City, Mozambique, present a high willingness to participate in HIV trials: Results from an HIV vaccine preparedness cohort study

Women and ARV-based prevention: opportunities and challenges

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