title: User experiences and acceptability attributes of the diaphragm and lubricant gel in an HIV prevention trial in southern Africa.
abstract: Methods for Improving Reproductive Health in Africa (MIRA), a phase III HIV prevention trial, was conducted among 5039 Zimbabwean and South African women to test the Ortho All-Flex diaphragm and Replens(®) lubricant gel. Among the 2418 intervention group participants, 105 women who had completed the trial and 41 male partners participated in focus group discussions and in-depth interviews about the acceptability of the diaphragm and gel and their experiences using the study products. Women who participated in the qualitative study had exited the trial in the prior nine months, were HIV negative, and used the diaphragm and gel for 12-24 months. The comprehensive and flexible conceptual framework was applied to investigate the salient attributes for acceptability of the products as potential HIV prevention methods, and emerging themes for acceptability were framed within three categories of attributes (product, relationship, and sexual intercourse attributes). Both diaphragm and gel were found to be highly acceptable in the study group, and the gel was popular due to its effect of enhancing sexual pleasure. Some of the important product attributes influencing acceptability as reported by users were convenience, ease of use, dual use potential for contraception and disease prevention, and being female-initiated. It was also noted that some elements (such as sexual pleasure, couple communication, and the necessity of diaphragm negotiation) could be more important than others in terms of influencing product acceptability and use. Acceptability attributes reflective of the broader contextual environment (beliefs generated in the trial community suggesting preventive efficacy - preventive method optimism - and gendered norms favoring male superiority in sexual decision making) also emerged as important themes. The high level of acceptability of the diaphragm and gel among MIRA trial participants and their male partners is an indicator of the continued need for an effective female-initiated product.
authors.affiliation: School of Public Health, University of California, Berkeley, USA. hodoglugiln@yahoo.com
authors.forename: Nuriye Nalan
authors.initials: NN
authors.lastname: Sahin-Hodoglugil
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Montgomery
authors.forename: Deborah
authors.initials: D
authors.lastname: Kacanek
authors.forename: Neetha
authors.initials: N
authors.lastname: Morar
authors.forename: Sibongile
authors.initials: S
authors.lastname: Mtetwa
authors.forename: Busisiwe
authors.initials: B
authors.lastname: Nkala
authors.forename: Jessica
authors.initials: J
authors.lastname: Philip
authors.forename: Gita
authors.initials: G
authors.lastname: Ramjee
authors.forename: Helen
authors.initials: H
authors.lastname: Cheng
authors.forename: Ariane
authors.initials: A
authors.lastname: van der Straten
authors.lastname: The Mira Team
mesh_terms: D000293:Adolescent; D000328:Adult; D000353:Africa, Southern; D003268:Contraception Behavior; D003274:Contraceptive Devices, Female / Q000706:statistics & numerical data*; D003964:Diaphragm; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D054327:Lubricants; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance / Q000706:statistics & numerical data*; D036301:Qualitative Research; D012725:Sexual Behavior; D013019:South Africa / Q000453:epidemiology; D014622:Vaginal Creams, Foams, and Jellies / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D054327:Lubricants; D014622:Vaginal Creams, Foams, and Jellies