Ambiguity, sexual pleasure, and the acceptability of microbicidal products in southwest Uganda

Abstract

A study was carried out in south-west Uganda to assess the acceptability of the female condom and a variety of spermicidal products. Interviews were carried out with 50 men and 55 women and 25 focus group discussions (FGDs) were held with 138 women and 42 men in order to investigate attitudes to the male condom and to female controlled methods of protection. The female condom, foaming tablets, sponge, foam, gel and film were demonstrated to 146 women and 35 of their male partners, who then tried out two of the products. They were interviewed 7 times during the course of 5 months. At the end experiences were evaluated during a second series of 10 FGDs. People in this area are generally ambivalent about the male condom: they are aware of its protective value, but it is not popular because it decreases sexual enjoyment, is unacceptable in regular relationships because it implies distrust, and there are persistent rumours about dangerous side effects. Ambiguity also characterised study participants' attitudes to the spermicidal products. The women said they wanted methods that they could control and use secretly, but when they actually used the products most informed their partner. The men liked the idea of women being protected, but were worried about the autonomy this would give them. These ambiguities, like those relating to the male condom, resonate with deep-seated cultural attitudes. However, in spite of this, the products were not only acceptable but enthusiastically received by participants. This was due to the potential protection they might offer, and because of the generally perceived increase in sexual enjoyment, particularly relating to increased lubrication (in a cultural context in which 'wet sex' is important). Cultural acceptability is therefore important, but sexual enjoyment (which has been largely ignored in discussions about HIV prevention) is probably more important in the development of acceptable products.