Microbicide Acceptability Research Articles

Knowledge, perception and acceptability of microbicides among non-health care workers in Lagos, Nigeria

Knowledge, perception and acceptability of microbicides among non-health care workers in Lagos, Nigeria

Willingness to use microbicides varies by race/ethnicity, experience with prevention products, and partner type.

To investigate women's willingness to use vaginal microbicides to reduce/prevent HIV infection, using measures grounded in the individual, behavioral, and social contexts of sex. A cross-sectional study that enrolled a sample (N = 531) of 18-55 year old Latina, African-American, and White women in the U.S. between October, 2004, and July, 2005. Willingness to use microbicides and individual- and context-related variables (e.g., demographics, relationship status). Exploratory and confirmatory factor analyses supported a one-dimensional, 8-item scale, with high internal consistency (alpha = .91). Subgroup analyses within the Latina (n = 166), African- American (n = 193), and White sub-samples (n = 172) also supported a unidimensional scale with strong internal validity and high reliability. Race/ethnicity as a contextual factor, a woman's history of using prevention products, and the nature of the sexual partnership were predictive of willingness to use microbicides (R = .41). That is, women with greater frequencies of condom use, a history of spermicide use, and non-main sexual partners had higher predicted Willingness to Use Microbicides scale scores, while White women had lower predicted scores. The Willingness to Use Microbicides scale serves as the first psychometrically validated measure of factors related to microbicide acceptability. Developing and implementing psychometrically validated and contextualized microbicide acceptability measures, in an effort to understand microbicide users and circumstances of use, is crucial to both clinical trials and future intervention studies.

P2-161 The evaluation of causes of unwanted pregnancy in pregnant's women

We describe adolescent girls' perceptions of sexual assertiveness and examine the relationship of these perceptions with developmental and interpersonal variables.Cross-sectional analysis.Participants were recruited from a school-based health clinic and local colleges, and through snowballing to participate in a 6-month study examining microbicide acceptability.106 sexually experienced girls (ages 14 through 21 years).Girls described their demographics, sexual history, and romantic relationships and completed the Sexual Assertiveness Scale for Women (SAS-W), which assesses perceptions of sexual assertiveness: Initiation of Sex, Refusal of Unwanted Sex, and Pregnancy-STD Prevention.Girls perceived themselves as asserting themselves between 50% and 75% of the time with their current or most recent partner. The Initiation subscale was not related to the other two subscales. In final models, girls with a prior pregnancy perceived themselves as initiating sex more than girls without a prior pregnancy. Having a greater number of lifetime partners was related to perceptions of less refusal, whereas greater number of partners, being sexually experienced longer, and engaging in more unprotected sex were related to perceptions of less implementation of preventive methods. None of the relationship variables were related to scores on any subscale.Most of these girls perceived themselves as sexually assertive. Given that sexual experience, not relationship factors, were related to perceptions of sexual assertiveness, the design of counseling messages should incorporate sexual experience. These messages should find effective ways to help girls both to communicate their sexual desires and to enhance their ability to protect themselves.

Assessing microbicide acceptability: a comprehensive and integrated approach.

A safe, effective, and acceptable microbicide is needed in order to decisively impact the global AIDS pandemic. As such, microbicide acceptability research is of paramount importance. In order to best utilize limited financial resources and save precious development time, acceptability studies should be fully integrated into preclinical and clinical trial contexts where candidate products are being developed and tested. An integrated approach for examining theoretically valid and relevant variables is needed so that data across studies and products can more effectively advance the field. We propose an approach for measuring factors related to microbicide acceptability in each phase of product development, and dependent on what product-specific knowledge is already established in the field. We discuss the roles that behavioral and social science methodologies should play in all phases of microbicide development, as well as the challenges faced when conducting acceptability research in the context of preclinical and clinical trial settings.

Measurement of Microbicide Acceptability Among U.S. Adolescent Girls

Topical microbicides will only be effective if they are acceptable to potential users. The purpose of this study is to develop a scale to evaluate characteristics and aspects of topical microbicides that are important to adolescent girls. Girls (n = 207) completed a questionnaire on perceptions of microbicide-like products. A principal components factor analysis with a varimax rotation produced a 6-factor solution. The mean factor scores suggested that girls saw the products positively. Age was positively correlated with "comparison to condoms" and "comfort while using" factor scores and inversely correlated with "negative impact on interpersonal relationships" factor score. Sexually transmitted infection (STI) history was related to higher scores on the "health benefits" and "pleasure" factors. Age, race/ethnicity, and STI history were not related to the other factor scores. The current scale shows promise in assessment of microbicide acceptability, and in general, girls expressed positive views about microbicides.

Perceptions of Sexual Assertiveness among Adolescent Girls: Initiation, Refusal, and Use of Protective Behaviors

Study Objective We describe adolescent girls' perceptions of sexual assertiveness and examine the relationship of these perceptions with developmental and interpersonal variables. Design Cross-sectional analysis. Setting Participants were recruited from a school-based health clinic and local colleges, and through snowballing to participate in a 6-month study examining microbicide acceptability. Participants 106 sexually experienced girls (ages 14 through 21 years). Methods Girls described their demographics, sexual history, and romantic relationships and completed the Sexual Assertiveness Scale for Women (SAS-W), which assesses perceptions of sexual assertiveness: Initiation of Sex, Refusal of Unwanted Sex, and Pregnancy-STD Prevention. Results Girls perceived themselves as asserting themselves between 50% and 75% of the time with their current or most recent partner. The Initiation subscale was not related to the other two subscales. In final models, girls with a prior pregnancy perceived themselves as initiating sex more than girls without a prior pregnancy. Having a greater number of lifetime partners was related to perceptions of less refusal, whereas greater number of partners, being sexually experienced longer, and engaging in more unprotected sex were related to perceptions of less implementation of preventive methods. None of the relationship variables were related to scores on any subscale. Conclusions Most of these girls perceived themselves as sexually assertive. Given that sexual experience, not relationship factors, were related to perceptions of sexual assertiveness, the design of counseling messages should incorporate sexual experience. These messages should find effective ways to help girls both to communicate their sexual desires and to enhance their ability to protect themselves.

Willingness to Use Microbicides Is Affected by the Importance of Product Characteristics, Use Parameters, and Protective Properties

Along with efficacy, a microbicide's acceptability will be integral to its impact on the pandemic. Understanding Product Characteristics that users find most acceptable and determining who will use which type of product are key to optimizing use effectiveness. To evaluate psychometrically the Important Microbicide Characteristics (IMC) instrument and examine its relationship to willingness to use microbicides. Exploratory and confirmatory factor analyses revealed 2 IMC subscales (Cronbach's coefficient alpha: Product Characteristics subscale (alpha = 0.84) and Protective Properties subscale (alpha = 0.89)). Significant differences on Product Characteristics subscale scores were found for history of douching (P = 0.002) and employment status (P = 0.001). Whether a woman used a method to prevent pregnancy or sexually transmitted disease (STD) in the last 3 months (P < 0.001) and whether she used a condom during the last vaginal sex episode (P < 0.001) were significantly related to her rating of the importance of microbicides being contraceptive. Product Characteristics (r = 0.21) and Protective Properties (r = 0.27) subscale scores and whether a microbicide had contraceptive properties (r = 0.24) were all significantly associated (P < 0.001) with willingness to use microbicides. Formulation and use characteristics and product function(s) affect willingness to use microbicides and should continue to be addressed in product development. The IMC instrument serves as a template for future studies of candidate microbicides.

Opportunities for Woman-Initiated HIV Prevention Methods among Female Sex Workers in Southern China

Rapid changes in China over the past two decades have led to significant problems associated with population migration and changing social attitudes, including a growing sex industry and concurrent increases in STIs and HIV. This article reports results of an exploratory study of microbicide acceptability and readiness and current HIV prevention efforts among female sex workers in two rural and one urban town in Hainan and Guangxi Provinces in southern China. The study focused on these women's knowledge and cultural understandings of options for protecting themselves from exposure to STIs and HIV, and the potential viability and acceptability of woman-initiated prevention methods. We report on ethnographic elicitation interviews conducted with women working within informal sex-work establishments (hotels, massage and beauty parlors, roadside restaurants, boarding houses). We discuss implications of these findings for further promotion of woman-initiated prevention methods such as microbicides and female condoms among female sex workers in China.

Rectal Microbicide Acceptability: Results of a Volume Escalation Trial

The objectives of this study were to determine what volume of a microbicide placebo gel is acceptable when applied intrarectally before receptive anal intercourse (RAI); and to evaluate responses to properties of the gel, its application, and its use. HIV-uninfected men who reported unprotected RAI with serodiscordant or unknown-status partners were enrolled in a volume escalation trial. Up to 35 mL of gel with the physical properties of Femglide (transparent and odorless) was acceptable to the majority of participants. Choice of different levels of viscosity may be needed. For some men, volumes judged acceptable when tried without intercourse were not acceptable when used during sex. Overall, participants reported high intentions to use microbicides when available. Condom use was inconsistent despite advice to use condoms. Microbicides that would require up to 35 mL of volume to be effective would be acceptable to men who engage in high-risk RAI.

The Utility of Non-proportional Quota Sampling for Recruiting At-risk Women for Microbicide Research

In the context of a measurement development study designed to contextualize microbicide acceptability, a sample that represented a range of at-risk women and maintained the statistical power needed for validity analyses was required. A non-proportional quota sampling strategy focused on race/ethnicity and number of sexual partners was utilized. This strategy resulted in enrollment of approximately equal proportions of Latina (31%), Black (36%), and White (32%) women, and an approximately 1:2 ratio of single-partnered (29%) and multi-partnered (71%) women. About 17% of women screened were ineligible based on eligibility criteria; an additional 16% were ineligible based on quota closures. Most participants were recruited through word of mouth (39%), community-based organizations (19%), or media sources (19%). Women recruited through word of mouth had the highest screen-to-interview completion percentage (67%). Non-proportional quota sampling is a feasible option for ensuring adequate representation of sample characteristics in microbicide research, but this goal should be weighed against cost and staff burden.

5: Surrogate vaginal microbicide use among adolescent women

To assess acceptability of topical microbicides through field trials of vaginal moisturizer. We examined moisturizer use as a function of timing-of-application. We also assessed how perceived ease of use, messiness, and partner reaction varied by timing condition.

Adolescent Girls' Communication with “Mothers” About Topical Microbicides

Study Objective Topical microbicides, a female-initiated method to protect against sexually transmitted infections (STI) and pregnancy, will only be effective if found acceptable. Mothers may have an influence on acceptability and use among adolescent girls. The current study examined the communication between girls and mothers to understand the potential predictors and nature of conversations regarding surrogate microbicide products. Design Sexually experienced girls, 14 to 21 years, were recruited for a 6-month study examining microbicide acceptability. During face-to-face interviews, qualitative data were collected regarding communication between girls and mothers. Two independent raters coded the responses, which were organized into themes. Themes were interpreted according to the conceptual understanding of mother-daughter communication. Results Fifty percent of the 171 girls with codable responses had a conversation with their mother. Higher levels of indirect parental monitoring were related to being more likely to have a conversation. Concrete events related to the study (i.e. receiving phone call from the researcher, having an appointment, or seeing the product) or inquiries by mothers appeared to promote conversation. Barriers to conversation included the private nature of the information and relationship issues between the mother and daughter. Conversations often addressed issues related to girls' participation in the study, although some conversations included global issues related to sexuality. Conclusions Girls may talk to their mothers about new products for STI prevention, and such conversations may provide opportunities to promote use.

Adolescents' Descriptions of the Physical Characteristics of Microbicide Surrogates and Experiences of Use

Our purpose was to describe adolescent girls' perceptions of microbicide surrogates and experiences of use, including impact on sexual pleasure. Sexually experienced girls, 14-21 years, were recruited for a study examining microbicide acceptability. The girls were given vaginal moisturizers (gel or suppository) to use as if they were microbicides. Girls (n = 175) discussed their perceptions and experiences of use of these products in response to semistructured interviews. Girls were asked at weekly phone interviews about the impact of product use on their and their partners' sexual pleasure. These answers were averaged, and girls were categorized into those for whom the product predominantely made sex feel worse, better less than half the time, or better half the time or more. The relationship of demographics and sexual history to the impact on pleasure was evaluated. Overall, participants were positive about their experience with the products. More girls preferred the gel. Specific concerns about the suppository included the wait period, texture, and messiness of self-insertion. Many liked the lubricating quality of both of the surrogates. Girls discussed messiness, leakage, clumping, and the difficulties in communicating with partners. Over half reported an increase in pleasure most of the time for themselves and their partners. None of the demographic and sexual history predictors were significantly related to impact on pleasure. Anticipatory guidance should help girls initiate and sustain use. Future research should examine the best way to accomplish counseling about microbicide use with adolescent girls.

Preparing for microbicide trials in Rwanda: Focus group discussions with Rwandan women and men

The acceptability and feasibility of microbicide studies and future microbicide use are influenced by existing norms and values regarding sexual and contraceptive behaviour. In preparation for microbicide research in Rwanda, focus group discussions were conducted to assess sexual and contraceptive behaviour, preferences for vaginal lubrication, and hypothetical acceptability of microbicides among Rwandan women and men. Seven focus group discussions were conducted among sexually active married women, unmarried women, sex workers, female students, older women and men living in Kigali, Rwanda, and an additional group of women living in a rural area. The results indicate that condom use is low among Rwandan men and women and that condoms are mainly used by men during commercial sex. Women have limited power to negotiate condom or family planning use. Vaginal hygiene practices are very common and consist primarily of washing with water. Lubrication during sex is highly preferred by both men and women. Hypothetical microbicide acceptability after an explanation of what microbicides are and a demonstration with lubricant jelly was high. Résumé L'acceptabilité et la faisabilité des études sur les microbicides et de l'usage de ces derniers à l'avenir subissent l'influence de normes et de valeurs existantes, relatives aux comportements sexuels et reproductifs. Dans le cadre de la préparation de la recherche sur les microbicides au Rwanda, des discussions de groupes focus ont été menées pour évaluer les comportements sexuels et reproductifs, les préférences en matière de lubrification vaginale et l'acceptabilité hypothétique des microbicides chez les femmes et les hommes du Rwanda. Sept discussions de groupes focus ont été menées avec des femmes mariées, des femmes célibataires, des travailleuses du sexe, des étudiantes, des femmes plus âgées et des hommes sexuellement actif(ve)s, vivant à Kigali au Rwanda, ainsi qu'avec d'autres femmes vivant dans une zone rurale. Les résultats indiquent que le taux d'usage du préservatif est faible chez les hommes et les femmes rwandais(es), et que les préservatifs sont principalement utilisés par les hommes pour les rapports sexuels avec les travailleuses du sexe. Les femmes ont peu de pouvoir pour négocier le recours aux préservatifs ou au planning familial. Les pratiques d'hygiène vaginale sont très courantes et consistent principalement en lavages avec de l'eau. Aussi bien les hommes que les femmes ont manifesté une forte préférence pour la lubrification qui se produit au cours des rapports sexuels. L'acceptabilité hypothétique des microbicides (après explication de ce que sont les microbicides et une démonstration avec du gel lubrifiant) s'est révélée très importante. Resumen La aceptación o la viabilidad de los estudios sobre microbicidas y el futuro uso de estas sustancias están influenciados por normas y valores existentes con respecto a conductas sexuales y de contracepción. En preparación para un estudio sobre microbicidas en Ruanda, se llevaron a cabo grupos de discusión para evaluar la conducta sexual y de contracepción, las preferencias por lubricaciones vaginales y la hipotética aceptación de microbicidas entre mujeres y hombres de Ruanda. Se llevaron a cabo siete grupos de discusión entre mujeres casadas y activas sexualmente, mujeres solteras, trabajadoras sexuales, estudiantes femeninas, y mujeres y hombres mayores que viven en Kigali, Ruanda y un grupo adicional de mujeres que viven en zonas rurales. Los resultados indican que el uso del preservativo es bajo entre mujeres y hombres de Ruanda y que sólo los usan los hombres cuando intercambian sexo con prostitutas. Las mujeres tienen un poder limitado para negociar el uso del preservativo o la planificación familiar. Las prácticas de higiene vaginal son muy comunes y consisten principalmente en el lavado con agua. Ambos, hombres y mujeres, prefieren la lubricación en sus relaciones sexuales. Muchos aceptarían hipotéticamente el uso de microbicidas (después de explicar qué son los microbicidas y demostrarlo con un lubricante de vaselina).

Examining the context of microbicide acceptability among married women and men in India

Married women in India are increasingly at risk of HIV, often due to their husbands' extramarital sexual behaviour. Topical microbicides may provide protection to women who are unable to negotiate condom use. During the formative phase of a study to develop measures related to microbicide acceptability, we conducted in‐depth interviews with 14 ‘high‐risk’ and 16 ‘low‐risk’ married women and 15 husbands. Some participants had recently completed a 2‐week microbicide safety trial. A sequence of in‐depth interviews with each participant explored the context of microbicide acceptability, including perceptions of couple harmony, vulnerability to HIV, sexual power, and ability to control life events. Women's perceptions of control and sexual power influenced attitudes towards microbicide use. HIV risk was most commonly associated with partner infidelity and easily detected, according to both men and women, by a lack of marital harmony. Despite this, high‐risk women denied perceiving HIV risk until confronted with specific evidence of a husband's positive HIV or STI diagnosis. This study provides an in‐depth examination of HIV risk for Indian married women, identifying potential determinants of microbicide use, and providing guidance for the development of psychometric scales to measure couple harmony, HIV risk perception, and sexual power and control.

Awareness and Attitudes Regarding Microbicides and Nonoxynol-9 use in a Probability Sample of Gay Men

A household probability sample of 879 adult gay and other men who have sex with men in San Francisco underwent phone interviews. Approximately, half reported recent unprotected anal intercourse (UAI). Yet, lubricant use was high, a behavior that may facilitate future adoption of topical microbicide delivered by a lubricant gel. Despite warnings against Nonoxynol-9 (N-9), 26% of respondents reported still using it. Microbicide awareness was higher among men reporting UAI than among consistent condom users. Scenarios presenting microbicides "as effective as condoms," "nearly as effective," or "less effective but better than nothing" produced wide variability in willingness to use them, which may have implications for microbicide acceptability. HIV-infected men and those who reported UAI showed greater microbicide acceptance.

Microbicide Preference among Young Women in California

Microbicides for HIV/sexually transmitted infection (STI) prevention are still in development. Microbicide acceptability studies have thus focused on soliciting input from individuals about hypothetical products using traditional epidemiological and behavioral research methodologies. Here, we integrate a well-established market research method, conjoint analysis, with more traditional epidemiological and behavioral research to examine potential users' preferences for different microbicide formulations. Focus group discussions (n = 67) were held with a diverse population of young men and women (aged 18-32 years) from Northern California. Then, young women participated in structured surveys (n = 321) that included a conjoint study, a methodology not yet used in microbicide acceptability. The main outcome measures were intentions for different microbicide formulations, inferred preferences for microbicide characteristics, and self-reported risk factors for HIV, other STIs, and pregnancy. Risk of STIs and unwanted pregnancies is a concern within this population. Participants' responses suggest that the ideal microbicide would (1) offer protection from pregnancy, HIV, STIs, and vaginal infections, (2) offer as much protection as condoms, (3) allow insertion up to 8 hours prior to sexual activity, (4) be available over the counter (OTC), (5) be inserted with an applicator, and (6) have only slight leakage not requiring a panty liner. The average predicted purchase probability for this ideal microbicide was 69%. Our findings help illustrate microbicide product preferences and demand among young women in California, and the methodological approach should lend itself to other populations as well as during clinical trials when understanding product use and nonuse is critical.

Knowledge, perception and acceptability of microbicides among healthcare workers in Lagos, Nigeria

Aim The study is aimed at assessing the knowledge, perception and acceptability of microbicides among non-health care workers in Lagos, Nigeria.

Preferences and Practices Related to Vaginal Lubrication: Implications for Microbicide Acceptability and Clinical Testing

Research on vaginal microbicides for HIV prevention is progressing rapidly; the first large-scale effectiveness trials were launched in 2004. The majority of candidate microbicides are formulated as gels, which will act as lubricants when used during sex. Preferences and practices regarding lubrication during sex, therefore, likely influence microbicide acceptability and use. Researchers seek to maximize consistent and correct use of candidate microbicides during clinical trials to enable valid estimates of product effectiveness, and if proven effective, microbicides will be widely used only if acceptable. We conducted a comprehensive literature review and interviewed 13 key informants from nine countries in Africa, Asia, Latin America, and North America. We found that norms and practices regarding lubrication during sex exist in many different countries. Despite significant variation, common themes emerged. In the majority of countries, women's genital hygiene is highly valued, and women are expected to achieve a moderate amount of vaginal lubrication during sex that is neither excessive nor inadequate. Women may try to achieve this by engaging in a wide variety of vaginal practices. Even though some informants expressed concerns about the acceptability of lubricating microbicides in some settings, they thought that microbicides should be developed, that women and men may be willing to accept a certain level of increased lubrication in exchange for protection from HIV, and that lubricating microbicides may be considered more acceptable when perceived as genital hygiene products. Recommendations are made on how to take vaginal practices into account during clinical testing of microbicides.

A Framework for Examining the Sustained Acceptability of Microbicides

The concept of acceptability involves a complex set of individual, couple and socio-cultural factors. Within a specific focus on microbicides, this article sets forth the relevant behavioral issues demanding attention as scientists and product developers strive to identify microbicides that will be used in a sustained, long-term fashion to prevent HIV/AIDS. The paper re-conceptualizes long-term acceptability within the ARRM framework, reviews the basic issues and research related to microbicide acceptability, discusses couple relationships (especially the nature of intimate relationships), and identifies related gender and power factors. The importance of the cultural context within various international settings pervades all of these issues. Finally, a set of challenges is discussed for those contemplating such research.