Introduction
Microbicides 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.
Methods
We 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 discussion
The 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.
Conclusions
Identifying 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 microbicides in a way that takes into
account the gendered norms and inequalities we have identified would help
maximize access and adherence. It also has the potential to improve
communication about sexuality, strengthen relationships between women and men
and increase women's agency over their bodies and their health.
Full article at: http://goo.gl/IWGjkK
By: Elizabeth G Doggett,§,1 Michele Lanham,2 Rose Wilcher,1 Mitzy Gafos,3 Quarraisha A Karim,4,5 and Lori Heise6
1Research Utilization Department, FHI 360,
Durham, NC, USA
2Social and Behavioral Health Sciences
Department, FHI 360, Durham, NC, USA
3Medical Research Council Clinical Trials
Unit at University College London, Institute of Clinical Trials and
Methodology, London, UK
4CAPRISA, Nelson Mandela School of
Medicine, University of KwaZulu-Natal, Durban, South Africa
5Department of Epidemiology, Columbia
University, New York, NY, USA
6Department of Global Health and
Development, London School of Hygiene and Tropical Medicine, London, UK
§Corresponding author: Elizabeth G
Doggett, 359 Blackwell St., Durham, NC 27707, USA. Tel: +1 919 944 7040. (Email:gro.063ihf@tteggode)
More at: https://twitter.com/hiv_insight
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