Sexual Pleasure, Gender Power and Microbicide Acceptability in Zimbabwe and Malawi

Abstract

Topical vaginal microbicides are being developed to reduce HIV infection in women for whom correct and consistent condom use is impossible or undesirable. Although microbicides have been heralded as a "women-initiated" method that requires no action of the male partner, gender norms for sexual relationships and sexual practices could impede acceptability and use. To facilitate development of microbicides and look ahead to their eventual introduction, it is necessary to understand couples' sexual dynamics, including power and pleasure. This article presents data from a study of microbicide acceptability ancillary to a microbicide clinical trial in Malawi and Zimbabwe. Female trial participants, male partners, health care professionals and community stakeholders were interviewed about norms for sexual decision-making, sexual pleasure, and associated intravaginal practices that ensure this pleasure. Even though acceptability of microbicides was found to be high, sexual intercourse is accompanied by issues of power and gender norms that place women, particularly those in stable union, at a disadvantage for enactment of risk reduction strategies. Although woman-initiated use is an important goal in development of microbicides, the need for men's cooperation or agreement must be addressed in strategies for future product introduction.

Stakeholder engagement to informHIVclinical trials: a systematic review of the evidence

“…In contrast, fewer studies conducted stakeholder engagement in middle‐ (30 studies; 27.8%) 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100 and low‐income (nine studies; 8.3%) 101, 102, 103, 104, 105, 106, 107, 108, 109 countries. The location of stakeholder engagement could not be discerned in six studies (5.6%) 110, 111, 112, 113, 114, 115, and fifteen studies (13.9%) 16, 24, 116, 117, 118, 119, 120, 121, 122, 123, 124, 125, 126, 127, 128 conducted stakeholder engagement in multiple countries at different income levels.…”

Feasibility and potential acceptability of three cervical barriers among vulnerable young women in Zimbabwe

“…[43][44][45] Most participants favoured CB methods' attributes associated with female-control and non-interference with sex, which is consistent with results of other studies of female-controlled methods of HIV and pregnancy prevention. [46][47][48] Overall attitudes towards CB were positive, and few potential barriers to use were noted. Among those, a frequently reported misconception about losing the device in the vagina 41,46 was mentioned by a fifth of the sample.…”

The influence of social constructs of hegemonic masculinity and sexual behaviour on acceptability of vaginal microbicides in Zambia

“…M. Montgomery et al, 2008;Moon et al, 2002;Veldhuijzen et al, 2006;Venables & Stadler, 2012;C. Woodsong & Alleman, 2008).…”

“…Woodsong et al, 2013). One prominent issue from these studies is the role male partners play in the use of vaginal microbicide (Doggett et al, 2015;Jones, Weiss, Chitalu, Bwalya, & Villar, 2008;Koo, Woodsong, Dalberth, Viswanathan, & Simons-Rudolph, 2005;Lanham et al, 2014; C. M. Montgomery et al, 2010; C. M. Montgomery et al, 2008;Moon, Khumalo-Sakutukwa, Heiman, Mbizvo, & Padian, 2002;Venables & Stadler, 2012;C. Woodsong & Alleman, 2008;Cynthia Woodsong & Holt, 2015; C. Woodsong et al, 2013).…”