title: Social Context of Adherence in an Open-Label 1 % Tenofovir Gel Trial: Gender Dynamics and Disclosure in KwaZulu-Natal, South Africa.
abstract: CAPRISA 008, an open-label extension study of tenofovir gel with coitally-related dosing, provided an opportunity to explore the relationship between product adherence and gender dynamics in a context where women knew they were receiving an active product with evidence of HIV prevention effectiveness. Interviews with 63 CAPRISA 008 participants and 13 male partners in KwaZulu-Natal, South Africa, highlighted that the process of negotiating gel use was determined in part by relationship dynamics including the duration of the relationship, the living situation, an evaluation of the relationship (e.g., partner intimacy and relationship expectations) and culturally-defined steps for formalizing the relationship. While disclosure facilitated adherence for many, others reported using the gel effectively with no disclosure, and in some situations disclosure was a barrier to adherence. Women should be supported in their choice about what to disclose and have opportunity to use this and similar products without their partners' knowledge or acquiescence.
authors.affiliation: Global Health Research, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA. kmacqueen@fhi360.org.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: MacQueen
authors.affiliation: CAPRISA, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Sarah
authors.initials: S
authors.lastname: Dlamini
authors.affiliation: Global Health Research, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Perry
authors.affiliation: Global Health Research, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA.
authors.forename: Eunice
authors.initials: E
authors.lastname: Okumu
authors.affiliation: Global Health Research, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA.
authors.forename: Steve
authors.initials: S
authors.lastname: Sortijas
authors.affiliation: CAPRISA, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Chitra
authors.initials: C
authors.lastname: Singh
authors.affiliation: CAPRISA, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Diantha
authors.initials: D
authors.lastname: Pillay
authors.affiliation: Global Health Research, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA.
authors.forename: Alesha
authors.initials: A
authors.lastname: Majors
authors.affiliation: Global Health Research, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA.
authors.forename: Sonja
authors.initials: S
authors.lastname: Jerome
authors.affiliation: Global Health Research, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Watson
authors.affiliation: CAPRISA, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Salim Abdool
authors.initials: SA
authors.lastname: Karim
authors.affiliation: CAPRISA, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Quarraisha Abdool
authors.initials: QA
authors.lastname: Karim
authors.affiliation: CAPRISA, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Leila E
authors.initials: LE
authors.lastname: Mansoor
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D005260:Female; D005782:Gels; D005783:Gender Identity; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology*; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D017008:Negotiating; D065129:Pre-Exposure Prophylaxis; D012650:Self Disclosure; D012737:Sex Factors; D013019:South Africa; D000068698:Tenofovir / Q000008:administration & dosage*
chemical_list: D019380:Anti-HIV Agents; D005782:Gels; D000068698:Tenofovir
keywords: Adherence; Disclosure; Gender dynamics; Microbicide; Tenofovir gel