Relationship Type and Use of the Vaginal Ring for HIV-1 Prevention in the MTN 020/ASPIRE Trial

AIDS Behav. 2020 Mar;24(3):866-880. doi: 10.1007/s10461-019-02521-9.

Abstract

Gender roles and imbalances in sexual power contribute to the heightened HIV-1 risk faced by women in Sub-Saharan Africa. This has led prevention research to focus on the development of female controlled methods. Despite the design of products such as vaginal rings to be used autonomously by women, male partners and women's perceptions of relationships influence HIV prevention choices. To understand the influences that male partners and dyadic dynamics had on the use of the Dapivirine Vaginal Ring in the ASPIRE trial, this analysis of qualitative data explored the types of intimate partner relationships that women engaged in. This paper describes how partners facilitated or challenged women's ring use and how women dealt with these challenges within six different types of relationships characterized by power dynamics and commitment levels. We offer insights into how future use of female-initiated HIV prevention products can be promoted through recognition of different relationship types.

Keywords: Adherence; Clinical trial; Couples; Female controlled HIV prevention; Gender; Gender relations; HIV; Microbicide; Qualitative research; Sexual relationship; Sub-Saharan Africa; Vaginal ring; Women.

MeSH terms

  • Administration, Intravaginal
  • Adolescent
  • Adult
  • Anti-HIV Agents / administration & dosage*
  • Anti-HIV Agents / therapeutic use
  • Clinical Trials as Topic
  • Contraceptive Devices, Female / statistics & numerical data*
  • Female
  • HIV Infections / prevention & control*
  • HIV-1
  • Humans
  • Interpersonal Relations*
  • Malawi
  • Male
  • Middle Aged
  • Pre-Exposure Prophylaxis / methods*
  • Pyrimidines / administration & dosage*
  • Qualitative Research
  • Sexual Behavior
  • Sexual Partners / psychology*
  • South Africa
  • Uganda
  • Vaginal Creams, Foams, and Jellies
  • Zimbabwe

Substances

  • Anti-HIV Agents
  • Pyrimidines
  • Vaginal Creams, Foams, and Jellies
  • Dapivirine