Abstract
The first vaginal microbicide was recently proven effective in clinical trials. We assessed the willingness of clinicians to integrate microbicides into HIV prevention practices in Southern Africa, where women face elevated HIV risks. We conducted in-depth interviews (n = 60) and nationally representative surveys (n = 1,444) in South Africa and Zimbabwe with nurses and physicians. Over half of clinicians (58%) were aware of microbicides, with physicians far more likely than nurses to be familiar. Clinicians, including those in rural areas, were generally willing to discuss microbicides, a female-initiated method less effective than the condom, particularly when condom use was unlikely (70%). Fewer would include microbicides while counseling adolescents (51%). Most clinicians (85%) thought their patients would use microbicides; greater clinician familiarity with microbicides was significant for support. Training for both nurses and physicians prior to introduction is critical, so they have sufficient knowledge and skills to offer a microbicide upon availability.
Similar content being viewed by others
References
Central Statistical Office Zimbabwe, Macro International Inc. Zimbabwe demographic and health survey 2005–2006. Calverton: CSO and Macro International Inc.; 2007.
Department of Health, Medical Research Council, OrcMacro. South African demographic and health survey 2003. Praetoria: Department of Health; 2007.
UNAIDS. UNAIDS outlook 2010. Geneva: UNAIDS; 2010.
Callegari L, Harper C, van der Straten A, et al. Consistent condom use in married Zimbabwean women after a condom intervention. Sex Transm Dis. 2008;35:624–30.
Maharaj P, Cleland J. Condom use within marital and cohabiting partnerships in KwaZulu-Natal, South Africa. Stud Fam Plann. 2004;35:116–24.
Maharaj P, Cleland J. Risk perception and condom use among married or cohabiting couples in Kwa-Zulu-Natal, South Africa. Int Fam Plan Perspect. 2005;31:24–9.
Peters A, Jansen W, van Driel F. The female condom: the international denial of a strong potential. Reprod Health Matters. 2010;18(35):119–28.
Abdool Karim Q, Abdool Karim S, Frohlich J, et al. Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science. 2010;329(5996):1168.
Mantell J, Myer L, Carballo-Dieguez A, et al. Microbicide acceptability research: current approaches and future directions. Soc Sci Med. 2005;60(2):319–30.
Hoffman S, Cooper D, Ramjee G, et al. Microbicide acceptability: insights for future directions from providers and policy makers. AIDS Educ Prev. 2008;20(2):188–202.
Orner P, Harries J, Cooper D, et al. Challenges to microbicide introduction in South Africa. Soc Sci Med. 2006;63(4):968–78.
Ramjee G, Morar N, Mtimkulu J, et al. Perceptions of vaginal microbicides as an HIV prevention method among health care providers in KwaZulu-Natal, South Africa. AIDS Res Ther. 2007;4(1):7.
Foss A, Vickerman P, Heise L, Watts C. Shifts in condom use following microbicides introduction: should we be concerned? AIDS. 2003;17:1227–37.
Fontanet A, Saba J, Changdelying V, et al. Protection against sexually transmitted diseases by granting sex workers in Thailand the choice of using the male or female condom: results from a randomized controlled trial. AIDS. 1998;12:1851–9.
Gollub E, French P, Loundou A, et al. A randomized trail of hierarchical counseling in a short clinic-based intervention to reduce the risk of sexually transmitted diseases in women. AIDS. 2000;14:1249–55.
Latka M, Gollub E, French P, et al. Male condom and female condom use after counseling in a risk-reduction hierarchy for STD prevention. Sex Transm Dis. 2000;27:431–7.
Karim S, Coletti A, Richardson B, et al. Safety and effectiveness of vaginal microbicides BufferGel and 0.5% PRO 2000/5 gel for the prevention of HIV infection in women: results of the HPTN 035 trial. Lancet. 2009;371(9665):721–8.
Skoler-Karpoff S, Ramjee G, Ahmed K, et al. Efficacy of Carraguard for prevention of HIV infection in women in South Africa: a randomised, double-blind, placebo-controlled trial. Lancet. 2008;372(9654):1977–87.
Henderson J, Raine T, Schalet A, et al. I wouldn’t be this firm if I didn’t care: preventive clinical counseling for reproductive health. Patient Educ Couns. 2010;82(2):254–9.
Berwick D. Disseminating innovations in health care. JAMA. 2003;289:1969–75.
Rogers E. Diffusion of Innovations. New York: Free Press; 1995.
Gillespie D, Bradley H, Woldegiorgis M, et al. Integrating family planning into Ethiopian voluntary testing and counselling programmes. Bull World Health Organ. 2009;87(11):866–70.
Family Health International. Behavior change communication (BCC) for HIV/AIDS: a strategic framework. Arlington: FHI; 2002.
Montgomery E, Cheng H, van der Straten A, et al. Acceptability and use of the diaphragm and Replens lubricant gel for HIV prevention in Southern Africa. AIDS Behav. 2010;14:629–38.
Van de Widjgert J, Khumalo-Sakutukawa G, Coggins C, et al. Men’s attitudes toward vaginal microbicides and microbicide trials in Zimbabwe. Int Fam Plan Perspect. 1999;25:15–20.
Woodsong C, Alleman P. Sexual pleasure, gender power and microbicide acceptability in Zimbabwe and Malawi. AIDS Educ Prev. 2008;20:171–87.
Montandon M, Shahin-Hodoglugil N, et al. Sexuality, HIV risk and potential acceptability of involving adolescent girls in microbicide research in Kisumu, Kenya. Sex Health. 2008;5:339–46.
Shisana O, Rehle T, Simbayi L, et al. South African national HIV prevalence, incidence, behaviour and communication survey 2008: a turning tide among teenagers?. Cape Town: HSRC Press; 2009.
Dinkelman T, Lam D, Leibbrandt M. Household and community income, economic shocks and risky sexual behavior of young adults: evidence from the Cape Area Panel Study 2002 and 2005. AIDS. 2007;21(Suppl 7):S49–56.
Central Statistical Office, Macro International Inc. Zimbabwe demographic and health survey 2005–2006. Calverton: CSO and Macro International Inc.; 2007.
Hemmerling A, Harrison W, Schroeder A, et al. Phase 2a study assessing colonization efficiency, safety and acceptability of Lactobacillus crispatus CTV-05 (LACTIN-V) in women with bacterial vaginosis. Sex Transm Dis. 2010;37:745–50.
Hauptman P, Swindle J, Aussain Z, et al. Physician attitudes toward end-stage heart failure: a national survey. Am J Med. 2008;121:127–35.
Lawrence R, Curlin F. Physicians’ beliefs about conscience in medicine: a national survey. Acad Med. 2009;84:1276–82.
Acknowledgments
This project was funded by NIH/NICHD R01 HD046027. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. We would like to thank Dr. Mike Chirenje and Dr. Nancy Padian for their support. We would also like to thank the research teams, including Tarisai Chirenje, Violet Nyambo, Sibongile Mtetwa, Naomi Lince, Mthokozisi Radebe and Dr. Neetha Morar.
Conflict of interest
Authors have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Harper, C.C., Holt, K., Nhemachena, T. et al. Willingness of Clinicians to Integrate Microbicides into HIV Prevention Practices in Southern Africa. AIDS Behav 16, 1821–1829 (2012). https://doi.org/10.1007/s10461-011-0109-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10461-011-0109-6