Contraceptive vaginal ring experiences among women and men in Kisumu, Kenya: A qualitative study

Abstract

Background Future HIV prevention options for women will likely include Antiretroviral (ARV)-based intravaginal rings. Valuable insights may be gained by examining user experiences with a similar licensed technology, a contraceptive ring, especially in settings where this technology may not be currently available. Methods In-depth interviews with 24 females enrolled in a trial assessing acceptability and use of a contraceptive ring, and 20 male sexual partners were conducted September 2014–April 2015. Elements of ethnography and phenomenological anthropology were used to collect, analyze, interpret, and describe ring users’ experiences. Thematic analysis was completed in MaxQDA-10. Results Experiences with the contraceptive ring reflected a broader Family Planning (FP) paradigm that centered around three themes: latitudes and drawbacks of FP (being free); an FP method needs to be compatible with a woman’s body (feeling normal); and dealing with fertility control uncertainties (how well does it really work). FP intentions and disclosure practices were influenced by partner support, socioeconomic factors, religion, cultural beliefs, and societal norms, including female sexuality. A user-friendly FP design was emphasized. Non-suppression of menstruation was favored by most. Unease with vaginal insertion as well as ring placement issues (slippage, expulsion) created initial challenges requiring clinician assistance and practice for some participants. While minor side-effects were described, concerns centered on ring efficacy, negative effect on a woman’s sexual desire, and future fertility issues. Conclusions Awareness of the multiple contexts in ring users’ experience may inform the development, education, and promotion approaches for future ARV rings.

<p>Engaging study participants in interpreting results: lessons from the TRIO study in Kenya and South Africa</p>

“…Such incremental improvement in acceptability and uptake of innovations have been demonstrated in other studies. McLellan-Lemal and colleagues12 argue that when acceptability is based only on information about and examination of a product, it is less reliable than when it is based on actual experience with a new product. Similarly, a study on acceptability of vaginal ring for HIV prevention observed improved adherence with practice and experience 22…”

“…We argue that providing many options could, in certain circumstances such as when there is no adverse health effect, make users switch products at will. A Kenyan study exploring acceptability of contraceptive vaginal ring reported that women admitted to switching from one method to another because of availability of a wide range of modern family planning approaches 12. While there was no overall effect of product choice on switching at stage 2,21 compared to participants who chose injection those who chose the ring had a higher odds of switching, suggesting that participants were attracted to or were looking for a product that combines what is familiar with what is less burdensome.…”

“…One way to address this adherence challenge with biomedical HIV prevention interventions is to co-formulate products that combine HIV prevention with something less stigmatizing but in high demand, such as contraceptives or prevention of sexually transmitted infections (STIs) 3,12. Capturing the views of potential end-users early in the product development process is a growing interest among researchers to gain insights that will yield products most likely to have high acceptability and use 13.…”

The ins and outs of drug-releasing vaginal rings: a literature review of expulsions and removals

“…User practices that involve physical straining or exertion while the ring is in placesuch as defaecation, urination, squatting, strenuous activity, lifting heavy objects, intercourse, and practices around menstruationcan result in involuntary ring expulsions [114][115][116][117][118][119]. For example, in certain countries and cultures, a squatting posture is adopted either when resting/sedentary or when using a toilet or pit latrine [120].…”

“…Rings tend to rest horizontally on the pelvic floor muscles and most instances of ring expulsion are attributed to opening or avulsion of the levator ani muscle [11,122]. However, some studies have reported partial or full expulsion while sleeping [117], perhaps pointing to poor fit or placement rather than muscle exertion as the cause. Specific articles reporting the contribution of user practices to ring expulsions are highlighted in the subsequent literature reviews.…”