Muslim women's reflections on the acceptability of vaginal microbicidal products to prevent HIV infection

Abstract

This paper examines South African Muslim women's opinions of the acceptability of microbicidal products to prevent HIV infection if these were to become available in the future. In the context of the HIV pandemic, prophylactic methods such as male circumcision, vaccines and microbicidal preparations are increasingly thought of as ways to reduce the incidence of infection. We examine the extent to which participants' religious beliefs and the implications of religious norms and ideals might influence decision-making concerning hypothetical acceptability to use a microbicide. We conducted qualitative interviews with 29 Muslim women residing in South Africa, a country with one of the highest HIV prevalence rates in the world. Four themes emerged from the data, namely, (1) participants' questioning of the need for microbicides; (2) reasons they gave in favour of microbicide use; (3) the juxtaposition of microbicide use and religious ethics; and (4) the role of religious authorities in decision-making regarding microbicide use. The juxtaposition of microbicide use and religious ethics was further informed by three sub-themes, namely, the life-promoting nature of both Islam and microbicide use, the possibility that microbicide use could encourage sexual risk-taking among male partners, and that the use of these products contradicted womens' notions of ethical agency and ideals about marriage. These themes and sub-themes are analysed in the context of gender relations among South African Muslims. The study findings are significant in light of recent data showing the effectiveness of a microbicidal preparation in reducing the risk of HIV infection in South Africa. We also show that the acceptability of microbicidal products is to a certain extent linked to a variety of religious persuasions and ideals. When microbicides become available in the future, proponents of their use will need to consider religious reasoning of potential users, including that of Muslim women.

An assessment of the likely acceptability of vaginal microbicides for HIV prevention among women in rural Ghana

“…Our finding of a possible association between religious persuasion and microbicide acceptability coincides with the findings of Hoel N et al 2011 , who conducted a qualitative study to assess the reflections of Muslim women on the acceptability of vaginal microbicidal products in South Africa [30]. Although we failed to explore this further in the FGDs, we believe that it should prompt attention to the possibility that religious sensitivities could impact on the acceptability of microbicide among some sections of the society.…”

“…In many settings in sub-Saharan Africa, women are vulnerable to the possibility of partner violence, relationship termination, with attendant loss of financial support and social status [30]. As the findings of our study suggest covert use is likely to fester mistrust particularly when the male partner gets to find out.…”

Optimizing HIV prevention for women: a review of evidence from microbicide studies and considerations for gender‐sensitive microbicide introduction

“…As discussed below, this difficulty stems in part from issues of trust and intimacy within primary or married relationships. In other studies, married women were not perceived to be at risk for HIV and therefore microbicides were viewed as unnecessary within marriage [ 15 , 24 , 25 ]. In these studies, respondents felt that sex workers, women with casual sex partners or women in HIV serodiscordant relationships were the most appropriate user groups for microbicides [ 15 – 17 , 26 – 28 ].…”

“…Relationship type also affects whether and how women communicate with their partners about microbicide use. Women and men in steady relationships preferred joint decision-making on microbicide use [ 15 , 20 , 25 , 26 , 28 , 36 , 44 , 47 , 60 , 66 , 70 – 72 ]. In steady relationships, using microbicides without partner communication may imply infidelity or mistrust [ 15 , 35 , 61 , 66 ] or be perceived as challenging male authority and decision-making [ 16 , 72 ].…”

“…Women noted that a change in the amount of lubrication from the gel may be more noticeable to a steady partner than to a casual partner [ 12 , 15 , 20 , 36 , 38 , 47 ]. Nonetheless, many women and men in trials and hypothetical studies in sub-Saharan Africa, and in particular South Africa, acknowledged the reality that some women in steady partnerships, including married women, were likely to use the product without telling their partners [ 13 , 17 , 25 , 44 ].…”