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

ABSTRACT

Despite being designed for autonomous use, research suggests partner approval is often in women's microbicide use. Microbicide study participants have described many ways product use affects relationships, from improving sexual pleasure to increasing harm, including exacerbating intimate partner violence (IPV). As the dapivirine ring proceeds closer to licensure, supporting women's agency to use microbicides safely is a priority. We conducted 42 in-depth interviews with former participants of the Microbicide Trials Network (MTN)-020 trial of the dapivirine vaginal ring and their male partners in Johannesburg, South Africa, to explore how ring use and partnership dynamics interacted. We sampled women who reported harms or partner non-support and women with supportive partners. Male and female narratives revealed high background levels of IPV. Women described how study participation/ring use exacerbated violence, and for a few couples served as a rationale for additional abuse. In response, women described feeling powerless and fearful of conflict, resulting in product nonuse. For one participant violence was reduced, and for several others, empowerment was sparked. These findings suggest future providers have the opportunity to shift more women from a place of fear/violence to one of safety/empowerment through the integration of IPV screening and relationship counselling.

KEYWORDS:

• HIV prevention
• pre-exposure prophylaxis
• microbicides
• intimate partner violence
• South Africa

Acknowledgements

We would like to acknowledge the willing contributions of the women and men who participated in this study without whom this study would not have been possible. The contributions of the Wits RHI MTN025/HOPE and CHARISMA study teams and community stakeholders are acknowledged as critical in the implementation of this study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the authors’ employers or funders. This program is made possible by the generous assistance from the American people through the U.S. Agency for International Development (USAID) in partnership with PEPFAR. The contents do not necessarily reflect the views of USAID or the United States Government.

Disclosure Statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by United States Agency for International Development: [Grant Number AID-OAA-A-15-00032].