The role of partnership dynamics in determining the acceptability of condoms and microbicides

Abstract

Microbicides are a class of substances under development that could reduce the sexual transmission of HIV and other sexually transmitted diseases when applied locally to genital mucosal surfaces. Microbicide acceptability research has largely focused on product characteristics, rather than processes of negotiation within relationships about use. Gender relations, decision-making power and communication within sexual relationships are recognised as important determinants of condom and contraceptive use, and are likely to determine microbicide use also. As part of social science research linked to the Microbicides Development Programme (MDP) we combine relationship-based theories with anthropological work conducted with women and men using a placebo gel. We explore communication and decision-making in gel and condom use, including constructions of risk and trust. During the MDP301 Phase III pilot study, in-depth interviews were conducted at sites in South Africa, Tanzania, Uganda and Zambia. Following four weeks of placebo gel use, women and their partners were asked about gel use and acceptability, partner involvement, sexual practices and condom use. Data from 45 couples at five sites were analysed using a grounded theory approach in NVivo. Participation in the study did not require women to inform their partners, yet our data shows women seeking permission from their partners, negotiating disclosure, exchanging information and persuading or motivating for gel use. Although gel was supposedly ‘woman-controlled’, men exercised considerable influence in determining whether and how it was used. Despite this, negotiations around use were largely successful, since the gel increased sexual pleasure and provided opportunities for intimate communication and the building of trust. Decisions about condom and microbicide use are made in a dyadic context and involve a complex negotiation of risk and trust. Whilst preferences relating to product characteristics are largely individual, use itself is dependent on partnership dynamics and the broader social context in which sexual risk management occurs.

Keywords:

• sub-Saharan Africa
• microbicides
• condoms
• HIV prevention
• gender

Acknowledgements

The authors are grateful to the participants in the MDP301 pilot study. We also acknowledge the committed work of MDP staff who contributed to the data collected and analysed for this paper, in particular Angel Khathi, Patrick Sosibo, Thokozani Mbokazi, Johannes Dindi, Serah Kalumbilo, Miriam Musonda, Makasa Chilatu, Irene Mbabazi, Robert Lubega, Winifred Nalukenge, Henry Luwugge, Vinen Khubeka, Siyasanga Nkunwana, Ethel Qwana, Joyce Wayomi, Lemmy Medard, Gilbert Bugeke, Stanislaus Shitindi, Happy Ng'abi and Andrew Vallely. We would like to thank Julie Bakobaki and Lori Heise for commenting on earlier drafts of the manuscript. This study was funded by a grant from the UK Department for International Development (DFID), administered through the Medical Research Council's Clinical Trials Unit.

Notes

1. Data from the sixth site was not available at the time of analysis and is therefore omitted from further discussion in this paper.