Communicating about microbicides with women in mind: tailoring messages for specific audiences

Abstract

IntroductionCurrent HIV prevention options are unrealistic for most women; however, HIV prevention research has made important strides, including on-going development of antiretroviral-based vaginal microbicide gels. Nevertheless, social-behavioural research suggests that women's ability to access and use new HIV prevention technologies will be strongly influenced by a range of socio-cultural, gender and structural factors which should be addressed by communications and marketing strategies, so that these products can be positioned in ways that women can use them.MethodsBased on an extensive literature review and in-country policy consultation, consisting of approximately 43 stakeholders, we describe barriers and facilitators to HIV prevention, including potential microbicide use, for four priority audiences of Kenyan women (female sex workers [FSWs], women in stable and discordant relationships, and sexually active single young women). We then describe how messages that position microbicides might be tailored for each audience of women.ResultsWe reviewed 103 peer-reviewed articles and reports. In Kenya, structural factors and gender inequality greatly influence HIV prevention for women. HIV risk perception and the ability to consistently use condoms and other prevention products often vary by partner type. Women in stable relationships find condom use challenging because they connote a lack of trust. However, women in other contexts are often able to negotiate condom use, though they may face challenges with consistent use. These women include FSWs who regularly use condoms with their casual clients, young women in the initial stages of a sexual relationship and discordant couples. Thus, we consider two approaches to framing messages aimed at increasing general awareness of microbicides – messages that focus strictly on HIV prevention and ones that focus on other benefits of microbicides such as increased pleasure, intimacy or sexual empowerment, in addition to HIV prevention.ConclusionsIf carefully tailored, microbicide communication materials may facilitate product use by women who do not currently use any HIV prevention method. Conversely, message tailoring for women with high-risk perception will help ensure that microbicides are used as additional protection, together with condoms.

Positioning Microbicides for HIV Prevention in Kenya

“…HIV risk perceptions, sexual practices, condom use, and microbicide communication consideration were explored for each audience, including young women, female sex workers (FSWs), serodiscordant couples, and women in stable relationships. The results of the Kenya literature review, which have been published elsewhere (Sidibe et al, 2014), confirmed that young women, women in stable relationships (including HIV discordant couples), and FSWs all have difficulty using condoms all or some of the time. These findings underscore the need for a product like microbicides.…”

“…In Kenya, the highest proportion of new HIV infections occur within stable relationships (National AIDS Control Council [NACC], 2009), which is not surprising given that an estimated 11% of married or cohabitating men have multiple sex partners (Kenya National Bureau of Statistics [KNBS] and ICF Macro, 2010). Within such relationships, women find it difficult to request condom use, because it implies infidelity and may result in violence (Sidibe et al, 2014). Young women, including adolescents, are at especially high risk of HIV, due in part to their low HIV risk perception and challenges negotiating condom use with older male partners.…”

Secrecy, empowerment and protection: positioning PrEP in KwaZulu-Natal, South Africa

“…The need for more woman-centred HIV prevention technologies still remains a key priority, due to the existing hegemonic masculinities that still exist in South Africa (Jewkes and Morrell 2012). Despite common features/characteristics between oral and vaginal ARV-based HIV prevention products, their introduction strategies may require different approaches as messages must be tailored for different users with varying perceptions of risk, outcome expectations and barriers to action (Sidibe et al 2014).…”

Women and ARV-based prevention: opportunities and challenges

“…A second paper, by Sidibe et al . [ 21 ], describes potential barriers and facilitators of microbicide use by four end-user audiences in Kenya based on a literature review and an in-country policy consultation: female sex workers, women in stable and discordant relationships, and sexually active young women. These groups varied in the extent to which the salience of HIV prevention versus partner intimacy or sexual pleasure as a motivation for using a vaginal microbicidal gel might encourage or discourage their use of such a product.…”