Microbicide acceptability and utility study : investigating perceptions of men and women across urban and rural settings in Durban and Nelspruit.

Abstract

Women remain disproportionately infected by HIV, accounting for more than half of the global infected population. Biologically women are more susceptible to HIV infection than men, however, their vulnerability is aggravated by various socio-cultural, structural and economic factors. Women in Sub-Saharan Africa carry a significant burden of the epidemic, making up 56% of all adult infections in the region, and up to 70% of all global infections. Young women aged 15-24 (AGYW) are hardest-hit by HIV, reportedly making up 25% of all new infections in the region, despite constituting only 17% of the adult population. Despite the alarming infection rates, prevention options for women remain limited. Available methods such as the male and female condom have proven to be impractical for women, disregarding gender power dynamics that deny women the power to initiate or negotiate safe sex practices. Given the limitation of these prevention methods, the field of HIV has shifted focus to developing prevention methods that allow women autonomy over their protection against sexually acquired HIV. Microbicides are female-initiated biomedical prevention technologies designed to reduce women’s reliance on male partner’s cooperation or consent for use. Currently, there is no licensed microbicide product for public use, however, a couple of microbicide agents (the tenofovir gel and dapivirine ring) have demonstrated efficacy in clinical trials. Various microbicide agents are still undergoing clinical trials, coupled with a large volume of complimentary qualitative studies that examine possible barriers and facilitators for acceptance and utilisation in real life settings. This study investigates the perceptions of microbicides amongst men and women across urban and rural settings in Durban and Nelspruit, South Africa. The study aims to identify the factors that may impede or facilitate microbicide use amongst women. The study also builds on a paucity of literature on studies assessing the impact of male involvement, and its impact on acceptance and uptake of microbicides amongst women. This study aims to contribute to the body of knowledge on the various contextual factors to consider when introducing microbicides across diverse populations. The study employed a qualitative research approach, using focus group discussions as a data collection method. The data was collected from purposively selected men and women aged 18-55 from eight urban and rural settings in KwaZulu-Natal and Mpumalanga; provinces with the highest HIV prevalence in South Africa. The data was transcribed and analysed through thematic analysis, which was used to develop themes that emerged. Drawing from the Social Ecological Model of Communication and Health Behaviour (SEMCHB), identifying the community as an interrelated entity that has great influence in shaping an individual’s health behaviour. The study applied the Culture-Centred Approach (CCA), which proposes that health intervention programmes should be designed in a way that is consistent with a community’s cultural framework. The study found that even with initiatives to empower women, societal structures and masculinity still hold great influence on women’s decisions to adopt new prevention methods as they find it necessary to consult with men regarding decisions about their sexual health. Male involvement is questionable, demonstrating potential for acceptance and male partner support, while also posing a threat on women’s autonomy for protection against sexually acquired HIV. The study argues that while male involvement can promote acceptance and adherence to microbicides in some contexts, this may be detrimental in other contexts, affecting sustainable adherence and subjecting women to social harms such as intimate partner violence.