title: A qualitative study of obstacles to diaphragm and condom use in an HIV prevention trial in sub-Saharan Africa.
abstract: Consistent condom use and the substitution of condoms with potential HIV prevention methods of lower or unknown effectiveness are important concerns in the development of new prevention technologies. This qualitative study explored obstacles to consistent condom use with the diaphragm in MIRA, an HIV prevention trial in South Africa and Zimbabwe. We conducted 26 focus group discussions (FGDs) with 206 women and 7 FGDs and 10 in-depth interviews with 41 male partners of intervention-arm women. The belief that the diaphragm/gel prevented HIV, women's difficulties negotiating condom use, and men's unawareness that using the products together was recommended were obstacles to consistent condom use with the diaphragm/gel. Concerns about protection from HIV and pregnancy, recognition that the diaphragm was not yet proven to prevent HIV or sexually transmitted infections, and the trial context were facilitators. Understanding selective study product use in HIV prevention trials may inform improved adherence counseling and male involvement strategies.
authors.affiliation: Department of Biostatistics, Harvard School of Public Health, Boston, MA 02115, USA. dkacanek@gmail.com
authors.forename: Deborah
authors.initials: D
authors.lastname: Kacanek
authors.forename: Amanda
authors.initials: A
authors.lastname: Dennis
authors.forename: Nuriye Nalan
authors.initials: NN
authors.lastname: Sahin-Hodoglugil
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Montgomery
authors.forename: Neetha
authors.initials: N
authors.lastname: Morar
authors.forename: Sibongile
authors.initials: S
authors.lastname: Mtetwa
authors.forename: Busi
authors.initials: B
authors.lastname: Nkala
authors.forename: Jessica
authors.initials: J
authors.lastname: Phillip
authors.forename: Connie
authors.initials: C
authors.lastname: Watadzaushe
authors.forename: Ariane
authors.initials: A
authors.lastname: van der Straten
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D017280:Condoms / Q000706:statistics & numerical data*; D003274:Contraceptive Devices, Female / Q000706:statistics & numerical data*; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D036301:Qualitative Research; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data; D012747:Sexual Partners / Q000523:psychology; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology