Barcelona 2013
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| Abstract #331 - Gender in the Equation: Not Just Treatment as Prevention | ||||
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Session: 20.3: 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 Elizabeth Montgomery - RTI International, United States |
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| Additional Authors: | ||||
| Aim: There is widespread evidence that male partners (MP) influence women?s ability and willingness to join HIV prevention trials, and to use female-initiated products such as microbicide gels. VOICE-C was an ancillary study to the Microbicide Trial Network VOICE trial at the Johannesburg site that explored factors influencing women?s use of study tablets and vaginal gel, including relationship factors. | ||||
| Method / Issue: Qualitative data from 22 MP of female VOICE participants captured in 14 in-depth interviews (IDI) and 2 focus group discussions (FGD); and 102 randomly-selected VOICE participants from IDI (n=41); ethnographic interviews (n=21) or FGD (n=40) were analyzed. Following female participants? (FP) permission for contact (50%), MP were recruited. We explored MP?s multifaceted roles and the pathways of influence on women?s product use. Data were audiotaped, transcribed, translated and coded in Nvivo 9 using a structured codebook applied by an analytic team with >80% intercoder reliability. | ||||
| Results / Comments: MP averaged 31 years of age (range 22-45); 60% were unmarried; 73% were living with their primary sex partner, and the majority (82%) were earning an income. The FP sample was younger (mean 27); 78% were unmarried, and only 45% were living with partners; 57% earned an income. Men and women?s narratives depicted several direct mechanisms through which MP supported women during VOICE by allowing her to participate, reminding her to take products, and dispelling rumours/?defending? her participation to others. However, MP described their day-in-day-out involvement in limited terms, and were often unaware if product had actually been used. Most MP interviewed described having no, or only transitory, problems with FP?s product use, and a desire to be supportive of her decisions, suggesting that some women?s descriptions of MP?s negative influence may be overstated, or even projections of her own attitudes. Nevertheless, almost all MP mentioned: a) temporary or ongoing fears about potential long-term adverse effects of the products (eg. infertility, death, HIV acquisition); and b) initial apprehensions about the motives and validity of research in general, and specifically of this study. MP?s lack of understanding of the study purpose and how the products worked was a predominant theme that MP described as both 1) shaping their own attitudes and behaviors (e.g. refusing FP?s product use) and 2) a potentially important reason that other women in the trial had suboptimal adherence. Attitudes and experiences regarding research and product use differed little in relation to oral or vaginal application, with the exception that MP of gel users complained about the added wetness changing the feeling of sex, although this was often overcome through behavioral modifications (e.g. changed insertion time, wiping), also, the lubrication improved sex for some. At an aggregate level, FP narratives regarding MP attitudes roles and influence on product use echoed what MP reported. | ||||
| Discussion: MP play many roles, with differing influences on FP?s product use. Efforts to increase MP understanding of research goals, study design and products? mechanisms of action could ameliorate distrust, empower men to serve as product advocates, adherence buddies, and foster greater support for women?s consistent product use. | ||||
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