Men’s Sexual Experiences with the Dapivirine Vaginal Ring in Malawi, South Africa, Uganda and Zimbabwe

Montgomery, Elizabeth T.; Katz, Ariana; Duby, Zoe; Mansoor, Leila E.; Morar, Neetha; Naidoo, Kalendri; Tsidya, Mercy; Chitukuta, Miria; Guma, Victor; Tenza, Siyanda; Leslie, Jonah; Garcia, Morgan; Naidoo, Sarita

doi:10.1007/s10461-020-03119-2

Cited by 15 publications

(19 citation statements)

References 15 publications

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“…Other research notes the importance of understanding the socio-cultural context which may influence the uptake and use of products such as vaginal rings [ 50 ]. In this study, participants described that their male partners may be concerned about witchcraft if they were to see them using colored vaginal rings, similar to another study where male partners were initially concerned that the vaginal ring was a potion or magic snake [ 48 ]. Furthermore, participants in this study discussed the impact of vaginal ring use on virginity testing practices.…”

Section: Discussionmentioning

confidence: 87%

“…Women participating in vaginal ring HIV prevention studies have frequently mentioned a preference for using a device without partner knowledge [ 26 ], although in a study with male partners they felt that men should be engaged in ring use decisions in order to facilitate trust and open communication in relationships [ 48 ]. Some participants in our study also discussed covert use in relation to all three ring attributes, with particular concerns about which sizes may be more noticeable during sex than others.…”

Section: Discussionmentioning

confidence: 99%

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Color, Scent and Size: Exploring Women's Preferences Around Design Characteristics of Drug-Releasing Vaginal Rings

et al. 2022

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Steroid-releasing vaginal rings are available for contraception and estrogen replacement therapy, and a new antiretroviral-releasing ring was recently approved for HIV prevention. Marketed rings are white or transparent in appearance, non-scented, and supplied as one-size-fits-all devices with diameters ranging from 54 to 56 mm. In this study, drug-free silicone elastomer rings were manufactured in different sizes, colors and scents, and the opinions/preferences of 16 women (eThekwini District, South Africa; 20–34 years) assessed through focus group discussions and thematic analysis. Opinions varied on ring color and scent, with some women preferring specific colors or scent intensities, while for others these attributes were unimportant. Concerns about color and scent were linked to perceptions around vaginal health and safety related to chemical composition. There was greater agreement on preferred ring size; flexibility and width were considered important factors for insertion and comfort. Greater choice with ring products could facilitate acceptability and overall uptake.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Color, Scent and Size: Exploring Women's Preferences Around Design Characteristics of Drug-Releasing Vaginal Rings

et al. 2022

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“…These concerns about device use have been mirrored in a study about the SILCS Diaphragm in South Africa, in which it was also highlighted that education and information dissemination could address concerns about the physical properties of the device [ 24 , 25 ]. Studies on vaginal rings have also demonstrated the importance of comfort and partner acceptability with use, and especially the impact on sex [ 28 , 29 ]. Additionally, previous studies suggest that women have regularly been underestimated in their ability to care for and wear cervical barrier devices such as diaphragms appropriately [ 30 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

Toward an intravaginal device to detect risk of preterm labor: a user-centered design approach in Sub-Saharan Africa

et al. 2022

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Background Prematurity and its complications are the leading cause of death and disability in children under five in Africa and North America, affecting as many as one in ten pregnancies. Screening tests to predict preterm birth (PTB) are insensitive, costly, and often unavailable in low resource settings. In parallel with early-stage U.S.-based testing of a novel self-placed intravaginal device to predict PTB risk, we elicited key stakeholder input from two sub-Saharan African countries to ensure local contextual factors inform future development of the device and its acceptability. Methods A qualitative study was conducted in Kiambu County, Kenya and KwaZulu-Natal Province, South Africa. We conducted 26 focus group discussions with pregnant women (n = 132) and males from the community (n = 54); in-depth interviews with women who had a history of PTB (n = 10), healthcare providers (n = 16), and health system experts (n = 10). Interviews were transcribed and thematic analysis was performed using an iterative coding technique. In addition, we facilitated user-centered design sessions to generate prototype preferences. Results Women with a personal history of PTB were almost unanimous in support of the proposed device, whereas those with no experience of PTB expressed the greatest degree of reservation. Healthcare providers anticipated that women with a history of PTB would accept the device. However, various potential challenges were identified, including potential discomfort with device insertion, hygiene, and sexual activity, as well as need for provider training, and attention to country-specific regulatory processes. Both community participants and providers expressed a preference for a provider inserted device. Design recommendations included preference for a small, soft, pliable device, with a shape that could facilitate easy removal. Conclusions Use of an intravaginal device to detect risk of PTB was generally acceptable, however stakeholders expressed a notable preference for insertion by providers. This reflects the significance of end-user consultation in device design and use. Recommended device modifications as well as educational messaging and provider technical assistance may facilitate utilization.

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“…The AHA study methods have been reported previously. 11,16 Male partners were recruited based on permission to contact from HOPE participants, and they provided written informed consent before data collection. FGD data collected by trained male interviewers in the local language (isiZulu) were transcribed and translated in English.…”

Section: Methodsmentioning

confidence: 99%

“…Intercoder reliability was verified in 10% of the transcripts. 16 For this analysis, excerpts corresponding to the codes were summarized into the following themes: a) study participation and ring use disclosure (sexual impact and relationship dynamics/support of female partner's use of ring) and b) male opinions of the vaginal ring and opinions about the research.…”

Section: Methodsmentioning

confidence: 99%

Male Partner Opinions of the Dapivirine Vaginal Ring Used During an Open-Label Extension HIV Prevention Trial in KwaZulu-Natal, South Africa

Morar

Mansoor

Naidoo

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background:The dapivirine vaginal ring (“the ring”) reduced HIV acquisition by about 35% in phase III trials, with modeling from open-label extension trials estimating 50% HIV protection with consistent use. The ring may be used without male partner knowledge. The Assessment of ASPIRE and HOPE Adherence (AHA) substudy aimed to understand the impact of sociocontextual issues on ring adherence. This subanalysis provides insight into disclosure and male partner influence on ring acceptability.Methods:Data were collected using 4 focus group discussions with 18 male partners of phase III trial participants at 2 sites in KwaZulu-Natal, South Africa. Qualitative data were coded, summarized by urban vs. rural location, and analyzed thematically.Results:Male partners aged 23–49 years wanted to be informed about the ring use to maintain the trust in their relationships. Their initial response to the ring was characterized by fear due to perceived impact of the ring on their female partner's reproductive system, their penile safety, and that the ring would encourage women to engage in unprotected sex and infidelity. Over time and with information and experience with having a partner who had used the vaginal ring, this fear transformed to support for women to have their own HIV prevention option.Conclusion:Male partners supported the ring as an HIV prevention method for women but wanted to be informed about its use. Engaging male partners on female-initiated HIV prevention methods and increased education among rural men may contribute to improved partner support and facilitate women's consistent use.

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Men’s Sexual Experiences with the Dapivirine Vaginal Ring in Malawi, South Africa, Uganda and Zimbabwe

Cited by 15 publications

References 15 publications

Color, Scent and Size: Exploring Women's Preferences Around Design Characteristics of Drug-Releasing Vaginal Rings

Color, Scent and Size: Exploring Women's Preferences Around Design Characteristics of Drug-Releasing Vaginal Rings

Toward an intravaginal device to detect risk of preterm labor: a user-centered design approach in Sub-Saharan Africa

Male Partner Opinions of the Dapivirine Vaginal Ring Used During an Open-Label Extension HIV Prevention Trial in KwaZulu-Natal, South Africa

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