Barcelona 2013
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| Abstract #454 - Biomedical Prevention | ||||
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Session: 40.4: Biomedical Prevention (Parallel) on Tuesday @ 16.30-18.30 in Raval Chaired by Olive Shisana, Chinese Authors: Presenting Author: Dr Mitzy Gafos - Medical Research Council, United Kingdom |
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| Additional Authors: Dr. Prashant Sharma, Dr. Manorama Bhargava, | ||||
| Aim: The majority of women in microbicide trials discuss microbicide gels with their partners prior to use. Male engagement is thought to be an important element in microbicide adherence. In this analysis, we explore why and how women use microbicides without their partner?s knowledge and consider the implications for adherence. | ||||
| Method / Issue: We collected quantitative and qualitative data as part of the Microbicides Development Programme trial at the Africa Centre in KwaZulu-Natal from 2006 to 2009. Of 1177 enrolled women, 1092 who attended the first 4-weekly follow-up visit and reported sexual activity in the last 4 weeks, were included in the analysis. We conducted univariate and multivariate logistic regression in STATA 10. We conducted in-depth interviews with 79 enrolled women shortly after attending the first 4-weekly follow-up visit. We thematically coded text relating to sexual communication and partner involvement in gel use in NVivo8. | ||||
| Results / Comments: By week 4, 40% of women were using gel (pre-sex) without their partner?s knowledge, although this halved by the end of the trial (week 52). Of 79 women interviewed at week 4, 23 were using gel without their partner?s knowledge although the majority thought it was preferable to discuss gel with their partner. Women gave four main reasons for using gel without telling their partner, which in order of reporting were: 1) they had not yet found the right time to discuss the gel, 2) they thought their partner would object to the gel, 3) they thought their partner would interpret the suggestion of gel use as a sign of mistrust or infidelity, or 4) they did not think it was important to discuss the gel with their partner. In scenarios 2 and 3, women thought it would be harder to use gel discretely after their partner had overtly objected. Women were creative in finding ways to use gel without their partner?s knowledge, for example by keeping the gel hidden in the children?s room or claiming to use a product to prevent cervical cancer. A partner?s lack of knowledge about the gel mainly affected women?s use between sex acts. In multivariate analysis, at week 4, older women (AOR: 0.98 95%CI: 0.97, 0.99), women enrolled at the township clinic (AOR 0.65 95%CI: 0.48, 0.88 compared to a clinic in town) and women who lived in households that own cattle (AOR 0.72 95%CI: 0.55, 0.95) were less likely to discuss gel use with their partners (owning cattle is a proxy for being a traditional household). Self-reported gel adherence did not differ between women who had or had not discussed gel with their partners (p=0.405). | ||||
| Discussion: The findings suggest that women who were using gel without their partner?s knowledge, were women who felt least able to discuss gel use with their partner. Women adopt strategies that best suit the dynamics of their relationships in order to use microbicides. We need to consider a range of relationship-dynamics when developing future microbicide counselling strategies in order to support women who do or do not want to involve partners in microbicide use. | ||||
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