Abstract
BackgroundThe acceptability of female-controlled biomedical prevention technologies has not been established in Papua New Guinea, the only country in the Pacific region experiencing a generalised, moderate-prevalence HIV epidemic. Socio-cultural factors likely to impact on future product uptake and effectiveness, such as women’s ability to negotiate safer sexual choices, and intravaginal hygiene and menstrual practices (IVP), remain unclear in this setting.MethodsA mixed-method qualitative study was conducted among women and men attending a sexual health clinic in Port Moresby. During in-depth interviews, participants used copies of a hand-drawn template to indicate how they wash/clean the vulva and/or vagina. Interviewers pre-filled commercially available vaginal applicators with 2-3mL KY Jelly® to create a surrogate vaginal microbicide product, which was demonstrated to study participants.ResultsA total of 28 IDIs were conducted (women=16; men=12). A diverse range of IVP were reported. The majority of women described washing the vulva only with soap and water as part of their daily routine; in preparation for sex; and following sexual intercourse. Several women described cleaning inside the vagina using fingers and soap at these same times. Others reported cleaning inside the vagina using a hose connected to a tap; using vaginal inserts, such as crushed garlic; customary menstrual ‘steaming’ practices; and the use of material fragments, cloth and newspaper to absorb menstrual blood. Unprotected sex during menstruation was common. The majority of both women and men said that they would use a vaginal microbicide gel for HIV/STI protection, should a safe and effective product become available. Microbicide use was considered most appropriate in ‘high-risk’ situations, such as sex with non-regular, transactional or commercial partners. Most women felt confident that they would be able to negotiate vaginal microbicide use with male sexual partners but if necessary would be prepared to use product covertly.ConclusionsNotional acceptability of a vaginal microbicide gel for HIV/STI prevention was high among both women and men. IVP were diverse in nature, socio-cultural dimensions and motivators. These factors are likely to impact on the future acceptability and uptake of vaginal microbicides and other biomedical HIV prevention technologies in this setting.
Highlights
The acceptability of female-controlled biomedical prevention technologies has not been established in Papua New Guinea, the only country in the Pacific region experiencing a generalised, moderate-prevalence HIV epidemic
Some preparations have been designed for application immediately before and/or after each vaginal sex act, whilst others such as intravaginal rings are intended to be placed in the vagina and to release microbicide over several weeks, providing protection independent of the timing of sexual activity
In this paper we report findings from the first study conducted in a moderate-prevalence setting in the Pacific region to investigate intravaginal practices and vaginal microbicide acceptability, and discuss the implications of our findings on future HIV prevention policy and research priorities
Summary
The acceptability of female-controlled biomedical prevention technologies has not been established in Papua New Guinea, the only country in the Pacific region experiencing a generalised, moderate-prevalence HIV epidemic. Effective, affordable HIV prevention methods that are initiated and controlled by women have been seen as a high priority for HIV prevention. A major breakthrough occurred in 2010 when the CAPRISA 004 trial in South Africa found that vaginally-administered tenofovir gel reduced HIV acquisition in women by 39% overall (and by 54% in those with high adherence), and was safe, acceptable and well tolerated [6]. The gel provided a similar level of protection to women against acquisition of Herpes simplex type-2 (HSV-2). Should these results be confirmed in a second trial [7], a new era in HIV prevention can truly begin
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