Re-framing microbicide acceptability: findings from the MDP301 trial

Abstract

Microbicides are most usually conceptualised within a disease prevention framework and studies usually define acceptability in terms of product characteristics, willingness to use and risk reduction. This starting point has led to assumptions about microbicides which, rather than being challenged by empirical studies, have tended to foreclose the data and subsequent conceptual models. Few studies take an emic ('insider') perspective or attempt to understand how microbicides fit into the broader context of women's and men's everyday lives. As part of the integrated social science component of the MDP301 Phase III microbicide trial, in-depth interviews were conducted with female trial participants in South Africa, Zambia, Tanzania and Uganda. Women's experiences of the gel challenge several assumptions that have commonly been reiterated about microbicides. Our analysis suggests that current definitions and conceptual frameworks do not adequately account for the range of meanings that women attribute to gel. Even within the context of a clinical trial, it is possible to obtain a richer, ethnographic and cross-cultural concept of acceptability based on women's practice and emic interpretations. We now need to move beyond limited notions of acceptability and consider how microbicides fit into a more holistic picture of women's and men's sexuality and sexual health.

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

“…This study also provided an important contribution to the study of microbicides acceptability because it shows that consistent gel use goes beyond the individual to include negotiated social constructs of masculinity, gender roles and sexual behaviour. Further, this study showed that because of the increased sexual pleasure associated with gel, which has also been found in other studies (Gafos et al, 2011;C. 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.…”

“…This study suggests that by men getting actively involved in decisions to use the gel, whether it be out of the fear that women can use it with other men, or for their own sexual needs, it became a means for controlling women's sexuality. Even if this study and others (C. M. Montgomery et al, 2010;C. Woodsong et al, 2013) suggested that men play a positive role in gel use, this study also suggested that hegemonic masculinity compromise women's ability to make autonomous decisions on gel use.…”

“…Questions on why and how male partners have influence in microbicides acceptability have not been fully explored in the context of social constructs and practices of masculinity and gender (Coly & Gorbach, 2008;Domanska & Teitelman, 2012;Mantell et al, 2005). Some studies that have attempted to do so have limited their analysis to the level of the couple and in the context of sexual relationships, rather than the broader social norms on sexuality, hegemonic masculinity and gender (Kelly et al, 2015;Lanham et al, 2014; C. M. Montgomery et al, 2010; C. M. Montgomery et al, 2008;C. Woodsong et al, 2013).…”

“…Woodsong et al, 2013). One prominent issue from these studies is the role male partners play in the use of vaginal microbicide (Doggett et al, 2015;Jones, Weiss, Chitalu, Bwalya, & Villar, 2008;Koo, Woodsong, Dalberth, Viswanathan, & Simons-Rudolph, 2005;Lanham et al, 2014; C. M. Montgomery et al, 2010; C. M. Montgomery et al, 2008;Moon, Khumalo-Sakutukwa, Heiman, Mbizvo, & Padian, 2002;Venables & Stadler, 2012;C. Woodsong & Alleman, 2008;Cynthia Woodsong & Holt, 2015; C. Woodsong et al, 2013).…”

Secrecy, empowerment and protection: positioning PrEP in KwaZulu-Natal, South Africa

“…The diversity of messages, yet the collective voice of protection, secrecy and empowerment, echoes that women ultimately want to have agency over their own sexual choices. Further research will need to explore ways of understanding the complexities and diversity of women's preferences (Montgomery et al 2010). More specifically, research that helps us understand how women will relate to a product can influence acceptance and adherence (Morrow and Ruiz 2008).…”