The relationship between vaginal ring use and intimate partner violence and social harms: formative research outcomes from the CHARISMA study in Johannesburg, South Africa

Hartmann, Miriam; Palanee‐Phillips, Thesla; O’Rourke, Shannon; Adewumi, Konyin; Tenza, Siyanda; Mathebula, Florence; Wagner, Danielle; Ayub, Asha; Montgomery, Elizabeth T.

doi:10.1080/09540121.2018.1533227

Cited by 12 publications

(2 citation statements)

References 34 publications

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“…Previous studies revealed that even if the DVR was designed for autonomous use, some women sought partner approval to use it and lack of male support may be a barrier for its use (Hartmann et al, 2019;Roberts et al, 2019). Although much has been made of the benefits of HIV prevention products that women can use 'covertly,' most of the evidence from microbicide gel studies suggest that women want to discuss gel use with their partners before they use it, especially married women (Woodsong, 2004).…”

Section: Discussionmentioning

confidence: 99%

The dapivirine vaginal ring from the perspective of married men in Uganda

Kabarambi

Kusemererwa

Krogstad

et al. 2021

African Journal of AIDS Research

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Men play a key role in influencing uptake of women's health products such as female condoms and vaginal microbicides, used for family planning and HIV prevention. We explored men's perceptions towards the dapivirine vaginal ring (DVR), a vaginal microbicide, in Kalungu District, rural Southwestern Uganda. Between June and July 2018, we conducted in-depth interviews with ten partners of women participating in the DREAM Study, a Phase IIIb open label extension trial of the DVR. Data were analyzed thematically, drawing on the socio-ecological model theoretical framework. Influencing factors like individual and interpersonal characteristics, perception of HIV risk, lack of knowledge about the DVR, misconceptions, and product characteristics acting at different levels (individual, societal and organizational) affected men's knowledge,attitudes and perceptions towards the DVR which in turn impacted on their willingness to allow their partners to use it. Above all, men wanted to be involved in the decisionmaking process about the use of the DVR. All the men were happy that there was a new HIV prevention option in the pipeline, and were not concerned about the degree of effectiveness saying it was better than nothing. The use of the DVR in an environment where men expect to make decisions about sex on behalf of women may affect its usage and success. Given this context, women may not always be able to independently choose to use it. If the DVR is approved and rolled out, increased sensitization of men about it will be critical to ensure its uptake.

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Section: Discussionmentioning

confidence: 99%

The dapivirine vaginal ring from the perspective of married men in Uganda

Kabarambi

Kusemererwa

Krogstad

et al. 2021

African Journal of AIDS Research

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“…The power imbalance in many households in sub‐Saharan Africa means that men's greater power in the relationship gives them leeway to seek outside partners, while simultaneously making it difficult for women to bring up issues related to sex and HIV prevention, including negotiating condom use and less risky sexual behaviours (Langen, 2005). Strategies for improved partner communication are needed to ensure that women who choose to use these types of HIV prevention methods feel comfortable disclosing their use and do not face increased risk of intimate partner violence (Cabral et al, 2018; Hartmann et al, 2019; Montgomery et al, 2019; Palanee‐Phillips et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

After their wives have delivered, a lot of men like going out: Perceptions of HIV transmission risk and support for HIV prevention methods during breastfeeding in sub‐Saharan Africa

Flax

Hawley

Ryan

et al. 2020

Maternal & Child Nutrition

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Female-initiated HIV prevention methods, such as oral pre-exposure prophylaxis (PrEP) and the vaginal ring, may be important risk reduction strategies for breastfeeding women. Given their novelty, information about the sociocultural context and how it influences perceptions of and support for their use during breastfeeding is lacking. To address this gap, we conducted 23 focus group discussions separately with pregnant and breastfeeding women, male partners and grandmothers (N = 196) and 36 in-depth interviews with key informants in Malawi, South Africa, Uganda and Zimbabwe. We analysed the data using a framework analysis method. Overall, breastfeeding was the norm, and participants described the transference of health (e.g., nutrition) and disease (e.g., HIV) to children through breast milk. Participants considered the early breastfeeding period as one of high HIV transmission risk for women. They explained that male partners tend to seek outside sexual partners during this period because women need time to recover from delivery, women focus their attention on the child, and some men are disgusted by breast milk. Participants highlighted concerns about the drugs in oral PrEP transferring to the child through breast milk, but fewer worried about the effects of the vaginal ring because the drug is localized. Women, grandmothers and key informants were supportive of women using these HIV prevention methods during breastfeeding, while male partners had mixed opinions. These findings can be used to tailor messages for promoting the use of PrEP or the vaginal ring during breastfeeding in sub-Saharan Africa.

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Influences on willingness to use vaginal or oral HIV PrEP during pregnancy and breastfeeding in Africa: the multisite MAMMA study

et al. 2020

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IntroductionWomen in sub‐Saharan Africa spend a substantial portion of their reproductive lives pregnant and/or breastfeeding (P/BF), yet they have limited options to prevent HIV during these maternal stages. In preparation for phase 3b prevention trials in P/BF women, we explored attitudes about using a vaginal ring or oral pills for pre‐exposure prophylaxis (PrEP), perceptions of HIV risk during P/BF and key influences on future PrEP use.MethodsIn 2018, we conducted 16 single‐sex focus group discussions (FGDs) with community‐ and clinic‐recruited HIV‐uninfected women, currently or recently P/BF, aged 18 to 40, and men with (currently or recently) P/BF partners, aged 18+. Participants completed a behavioural questionnaire, viewed an educational video and handled prototype placebo products. FGDs were conducted in local languages and transcribed, coded and analysed, using a socio‐ecological framework, for key influences on willingness to use products, HIV risk perceptions and opinions on product attributes.ResultsOf the 128 participants (65 women, 63 men) 75% lived with their partner and 84% had a child. Women reported the most important influencers when P/BF were partners, and all stated that health decisions when P/BF are typically made jointly (e.g. medication use; ante/postnatal and baby care). There was consensus that P/BF women are at high risk for HIV, primarily because of their partner’s infidelities, and new prevention options were welcomed. Participants valued multiple options and stated that woman’s personal preference would be key to product choice. Anticipated concerns about products included risk of miscarriage, impact on infant development, complications during delivery and adequate production or taste of breastmilk. Specific perceived disadvantages emerged for the ring (e.g. vaginal discomfort, difficulty inserting/removing) and for pills (e.g. nausea/vomiting) that may be exacerbated during pregnancy. Health care providers’ (HCPs) knowledge and approval of product use during P/BF was needed to mitigate anticipated fears.ConclusionsParticipants perceived pregnancy and breastfeeding as high HIV risk periods and valued new prevention options. HIV protection of the mother‐child dyad, safety of the baby, and ultimately, health of the family were paramount. Endorsement by HCPs and support from partners were key to future product acceptance. Participants recommended involving partners and HCPs in sensitization efforts for future trials.

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The relationship between vaginal ring use and intimate partner violence and social harms: formative research outcomes from the CHARISMA study in Johannesburg, South Africa

Cited by 12 publications

References 34 publications

The dapivirine vaginal ring from the perspective of married men in Uganda

The dapivirine vaginal ring from the perspective of married men in Uganda

After their wives have delivered, a lot of men like going out: Perceptions of HIV transmission risk and support for HIV prevention methods during breastfeeding in sub‐Saharan Africa

Influences on willingness to use vaginal or oral HIV PrEP during pregnancy and breastfeeding in Africa: the multisite MAMMA study

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