Barcelona 2013
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| Abstract #160 - Gender in the Equation: Not Just Treatment as Prevention | ||||
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Session: 20.4: Gender in the Equation: Not Just Treatment as Prevention (Workshop) on Monday @ 16.30-18.30 in Auditorium Chaired by Dr Wendee Wechsberg Authors: Presenting Author: Dr. Cynthia Woodsong - International Partnership for Microbicides, United States |
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| Additional Authors: | ||||
| Aim: This paper will overview important findings from social science research conducted within clinical trials of vaginal microbicides for HIV prevention, most of which have been conducted in sub-Saharan Africa. The trials have investigated vaginal gels, films, capsules and rings, and cervical barriers, some with coitally-associated use requirements and some requiring daily use. Key microbicide issues include vaginal practices for health and sexual performance, gender norms for sexual activity, expectations for partner infidelity, and denial of risk. Couple communication about the need for HIV prevention, and willingness to covertly engage in prevention strategies will also be discussed. | ||||
| Method / Issue: Social and behavioral science research is conducted lockstep with biomedical research on HIV prevention and treatment. Such research may be ancillary to a clinical trial, fully integrated within it or as stand-alone studies; these approaches have different implications for study design as well as primary objectives. Examples include important work done on male circumcision, pre-exposure prophylaxis and vaginal microbicides. The inclusion of social and behavioral science in clinical trials is often criticized as having limited utility, particularly with regard to social desirability bias that frequently results in over-reporting aspects of trial adherence. Calls for use of bio-markers and other so-called less subjective measures of adherence behavior can overshadow recognition and appreciation for the important contributions made by social and behavioral science. Similarly, treatment as prevention approaches can overlook the underlying social issues that continue to place women at a disadvantage with regard to HIV prevention. | ||||
| Results / Comments: Research that asks women to insert products into their vagina, and have these products in place during sexual activity has yielded a unique view of sexual practices, HIV risk perceptions, gender norms and body awareness. Although microbicides were initially seen as a prevention tool to give women more control over protecting themselves, it is clear that social and cultural norms for gender roles have influenced adherence in microbicide trials, and will likely do so if and when an effective product is introduced. It is ironic that a method that could help empower women has provided additional insights into the challenges they face. | ||||
| Discussion: While biomedical research is focused on bio-physical reactions to medical interventions, social and behavioral science focuses on the context of cultural and gender norms that influence individual behavior relevant to the use of the technology under investigation. The relevance of this knowledge transcends the specific biomedical research objective, and can be applied to broader efforts to improve the human condition. The paper will review social and behavior science considerations that are critical for future clinical and non-clinical microbicide research yet are also relevant to a broader array of HIV prevention strategies for behavior change, care and treatment adherence, domestic partner violence and contraceptive decision-making. HIV prevention microbicides have the potential to challenge gender norms, and by so doing, could have a larger effect than a technological fix. | ||||
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