Perspectives Related to the Potential Use of Vaginal Microbicides Among Drug-Involved Women: Focus Groups in Three Cities in the United States and Puerto Rico

Abstract

HIV transmission through heterosexual contact remains the greatest risk factor for women globally. Topical microbicides applied intravaginally may offer a female-initiated HIV prevention option for many who are unable or unwilling to use male condoms or who would want additional protection. This article presents results of focus groups in Bridgeport, Connecticut, Providence, Rhode Island, and San Juan, Puerto Rico, with women who use crack or heroin or have male partners who inject illegal drugs. Participants revealed motivation for and openness to using microbicides effective against HIV should they become available. Additional lubrication during intercourse was one of several expected positive features of microbicides; women saw lubrication as a means of enhancing pleasure and reducing condom irritation and breakage while also protecting them from infection. Conversely, some women feared that their male partners would interpret excessive lubrication as an indication of infection, improper hygiene, or evidence of sex with another man. Focus groups also provided insight into how aspects of different women's sexual lives, including partner type, might influence the issues that would concern them if and when they tried out new microbicidal products in the future.

Assessing Microbicide Acceptability: A Comprehensive and Integrated Approach

“…Both qualitative and quantitative data, collected during clinic visits, or in focus groups or interviews, provide specific answers to well-constructed research questions during clinical trials and avoid problems associated with pre-use and hypothetical studies (Elias & Coggins, 2001;Mason et al, 2003;Murphy, Miller, Moore, & Clark, 2000). However, many clinical trials have not been designed to incorporate comprehensive acceptability measures, and the utilization of these measures-particularly those requiring qualitative data collection methods -can increase trial cost and burden.…”

“…Even as they face increased risk, many women have little control over HIV/STD prevention decisions. Currently, women must rely on HIV prevention methods that require the knowledge and consent of sex partners (i.e., male condom, female condom, and abstinence) (Bentley et al, 2000;Mason et al, 2003;Wulf, Frost, & Darroch, 1999).…”

“…Even as they face increased risk, many women have little control over HIV/STD prevention decisions. Currently, women must rely on HIV prevention methods that require the knowledge and consent of sex partners (i.e., male condom, female condom, and abstinence) (Bentley et al, 2000;Mason et al, 2003;Wulf, Frost, & Darroch, 1999).Microbicides could change this reality. While the focus has primarily been on developing topical vaginal microbicides, rectal microbicides will likely also have a significant impact on HIV infection rates among both women and men.…”

“…However, since the utility of quantitative findings often has been limited by the small sample sizes of early stage clinical trials (Bentley et al, 2000;Morrow et al, 2003b; ElSadr et al, 2006), it is often the qualitative methods that yield a greater depth of understanding of the many factors associated with acceptability, thereby complementing and enhancing the quantitative data (Morrow, Costello, & Rosen, 2003a). Data from focus groups and in-depth interviews conducted in conjunction with standard quantitative assessments, as opposed to purely in-depth qualitative designs, have confirmed the validity of clinical data (Denzin, 1978;Denzin & Lincoln, 1998), explained unexpected findings in quantitative analysis (Morrow, 2006;Morrow et al, 2003b), and helped microbicide developers understand the product-related factors that contribute to or detract from its acceptability and use (Bentley et al, 2000;Mantell et al, 2005;Morrow et al, 2003b; Rosen et al, 2006; Severy & Newcomer, 2005).Both qualitative and quantitative data, collected during clinic visits, or in focus groups or interviews, provide specific answers to well-constructed research questions during clinical trials and avoid problems associated with pre-use and hypothetical studies (Elias & Coggins, 2001;Mason et al, 2003;Murphy, Miller, Moore, & Clark, 2000). However, many clinical trials have not been designed to incorporate comprehensive acceptability measures, and the utilization of these measures-particularly those requiring qualitative data collection methods -can increase trial cost and burden.…”

The Utility of Non-proportional Quota Sampling for Recruiting At-risk Women for Microbicide Research

“…Studies investigating microbicide development and use typically utilize convenience samples recruited via word of mouth, flyers, and outreach, often at a variety of community-based organizations (Coggins et al, 1998;Hammett, et al, 2000a, b;Holt et al, 2006;Mason et al, 2003). Weeks et al (2004) used targeted sampling with outreach and referrals to recruit a sample of women at high risk for HIV infection.…”