Optimizing HIV Prevention for Women: A Review of Evidence from Microbicide Studies & Considerations for Gender-Sensitive Microbicide Introduction

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)

  

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'HIV Has a Woman's Face': Vaginal Microbicides & a Case of Ambiguous Failure

The case is a primary unit of knowledge production in the field of HIV research, yet the work that is done to construct cases often goes unremarked. In this paper, the case takes centre stage in an analysis of a set of apparent failures in HIV prevention research, namely a series of clinical trials to test vaginal microbicides. Returning to the genesis of the microbicide concept in the early 1990s, I examine how the discourse of women's empowerment was linked to HIV prevention in a way that mobilized a particular vision of the case, which was both politically and scientifically expedient. Drawing on an in-depth empirical study of one particular trial, I show the success of the case in mobilizing funds and interest in the research, as well its success in accounting for the failure of the pharmaceutical technology. Drawing in alternative scientific accounts of the failure of microbicides, however, a different version of events is indicated, in which what can ultimately be said to have failed is not the technology itself, but the act of casing upon which its testing was founded. 

Purchase full article at: http://goo.gl/ECMDL0

By: Montgomery CM1.

• 1a Amsterdam Institute for Social Science Research , University of Amsterdam , the Netherlands. 

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