AIDS and Behavior

, Volume 20, Issue 11, pp 2588–2601 | Cite as

Acceptability and Preferences for Hypothetical Rectal Microbicides among a Community Sample of Young Men Who Have Sex with Men and Transgender Women in Thailand: A Discrete Choice Experiment

  • Peter A. NewmanEmail author
  • Michael P. Cameron
  • Surachet Roungprakhon
  • Suchon Tepjan
  • Riccardo Scarpa
Original Paper


Rectal microbicides (RMs) may offer substantial benefits in expanding HIV prevention options for key populations. From April to August 2013, we conducted Tablet-Assisted Survey Interviewing, including a discrete choice experiment, with participants recruited from gay entertainment venues and community-based organizations in Chiang Mai and Pattaya, Thailand. Among 408 participants, 74.5 % were young men who have sex with men, 25.5 % transgender women, with mean age = 24.3 years. One-third (35.5 %) had ≤9th grade education; 63.4 % engaged in sex work. Overall, 83.4 % reported they would definitely use a RM, with more than 2-fold higher odds of choice of a RM with 99 versus 50 % efficacy, and significantly higher odds of choosing gel versus suppository, intermittent versus daily dosing, and prescription versus over-the-counter. Sex workers were significantly more likely to use a RM immediately upon availability, with greater tolerance for moderate efficacy and daily dosing. Engaging key populations in assessing RM preferences may support biomedical research and evidence-informed interventions to optimize the effectiveness of RMs in HIV prevention.


Rectal microbicides Young men who have sex with men (YMSM) Transgender women Male sex workers HIV Discrete choice experiment Thailand 



This research was supported in part by grants from the Canadian Institutes of Health Research (OGE-111397; HIB-120230) and the Canada Research Chairs Program. The authors thank our community collaborators, Mplus+, Chiang Mai; and Sisters, and Take Care!!, Pattaya, with special appreciation to Thitiyanun Nakpor, Pongpeera Patpeerapong, Jit Srichandon, Pramit Chaina, Jetsarit Intawong, Thanapat Thephawan, and Len Unterberg for assistance with recruitment, and Suthisak Sanwicha for help with data collection. We are grateful to all participants in the study.


  1. 1.
    Van Griensven F, Holtz TH, Thienkrua W, et al. Temporal trends in HIV-1 incidence and risk behaviours in men who have sex with men in Bangkok, Thailand, 2006-13: an observational study. Lancet HIV. 2015;2(2):e64–70.PubMedCrossRefGoogle Scholar
  2. 2.
    Chariyalertsak S, Kosachaunhanan N, Saokhieo P, et al. HIV incidence, risk factors, and motivation for biomedical intervention among gay, bisexual men and transgender persons in northern Thailand. PLoS One. 2011;6:e24295.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Baral SD, Poteat T, Stromdahl S, Wirtz AZ, Guadamuz TE, Beyrer C. Worldwide burden of HIV in trangender women: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13:214–22.PubMedCrossRefGoogle Scholar
  4. 4.
    Guadamuz TE, Wimonsate W, Varangrat A, et al. HIV prevalence, risk behavior, hormone use and surgical history among transgender persons in Thailand. AIDS Behav. 2011;15(3):650–8.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Baral SD, Friedman MR, Geibel S, et al. Male sex workers: practices, contexts, and vulnerabilities for HIV acquisition and transmission. Lancet. 2015;385:260–73.PubMedCrossRefGoogle Scholar
  6. 6.
    Operario D, Soma T, Underhill K. Sex work and HIV status among transgender women: systematic review and meta-analysis. J Acquir Immune Defic Syndr. 2008;48:97–103.PubMedCrossRefGoogle Scholar
  7. 7.
    Poteat T, Wirtz AL, Radix A, et al. HIV risk and preventive intervention in transgender women sex workers. Lancet. 2015;385:274–86.PubMedCrossRefGoogle Scholar
  8. 8.
    Toledo CA, Varangrat A, Wimonsate W, et al. Examining HIV infection among male sex workers in Bangkok, Thailand: a comparison of participants recruited at entertainment and street venues. AIDS Educ Prev. 2010;22(4):299–311.PubMedCrossRefGoogle Scholar
  9. 9.
    Wimonsate W, Naorat S, Varangrat A, et al. Risk behavior, hormone use, surgical history and HIV infection among transgendered persons (TG) in Thailand, 2005. In: The XVI International AIDS Conference, Toronto, Canada, 2006.Google Scholar
  10. 10.
    Ananworanich J, Sirivichayakul S, Pinyakorn S, et al. High prevalence of transmitted drug resistance in acute HIV-infected Thai men who have sex with men. J Acquir Immune Defic Syndr. 2015;68(4):481–5.PubMedCrossRefGoogle Scholar
  11. 11.
    The HIV Foundation. Efavirenz stock outs. Accessed 11 Dec 2015.
  12. 12.
    Barmania S. Thailand’s migrant sex workers struggle to access health care. Lancet. 2013;382(9891):493–4.PubMedCrossRefGoogle Scholar
  13. 13.
    Newman PA, Lee SJ, Roungprakhon S, Tepjan S. Demographic and behavioral correlates of HIV risk among men and transgender women recruited from gay entertainment venues and community-based organizations in Thailand: implications for HIV prevention. Prev Sci. 2012;13(5):483–92.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    McCormack S, Dunn D. Pragmatic open-Label randomised trial of preexposure prophylaxis: the PROUD Study. Conference on Retroviruses and Opportunistic Infections (CROI). Seattle, 2015 [abstract 22LB].Google Scholar
  16. 16.
    Molina J-M, Capitant C, Charreau I, et al. On demand PrEP with oral TDF-FTC in MSM: results of the ANRS Ipergay trial. Conference on Retroviruses and Opportunistic Infections (CROI). Seattle, 2015 [abstract 23LB].Google Scholar
  17. 17.
    Nunes R, Sarmento B, Neves JD. Formulation and delivery of anti-HIV rectal microbicides: advances and challenges. J Control Release. 2014;194:278–94.PubMedCrossRefGoogle Scholar
  18. 18.
    Rohan LC, Yang H, Wang L. Rectal pre-exposure prophylaxis (PrEP). Antiviral Res. 2013;100:S17–24.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Carballo-Dieguez A, Stein Z, Saez H, Dolezal C, Nieves-Rosa L, Diaz F. Frequent use of lubricants for anal sex among men who have sex with men: the HIV prevention potential of a microbicidal gel. Am J Public Health. 2000;90:1117–21.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Newman PA, Roungprakhon S, Tepjan S. A social ecology of rectal microbicide acceptability among young men who have sex with men and transgender women in Thailand. J Int AIDS Soc. 2013;16:18476.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Marrazzo JM, Ramjee G, Richardson BA, et al. Tenofovir-based preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2015;372(6):509–18.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    van der Straten A, Van Damme L, Haberer JE, Bangsberg DR. Unraveling the divergent results of pre-exposure prophylaxis trials for HIV prevention. AIDS. 2012;26(7):F13–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Woodsong C, MacQueen K, Amico KR, et al. Microbicide clinical trial adherence: insights for introduction. J Int AIDS Soc. 2013;16(1):18505.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Mantell JE, Myer L, Carballo-Dieguez A, et al. Microbicide acceptability research: current approaches and future directions. Soc Sci Med. 2005;60(20):319–30.PubMedCrossRefGoogle Scholar
  25. 25.
    Morrow KM, Ruiz MS. Assessing microbicide acceptability: a comprehensive and integrated approach. AIDS Behav. 2008;12:272–83.PubMedCrossRefGoogle Scholar
  26. 26.
    McGowan I. The development of rectal microbicides for HIV prevention. Expert Opin Drug Deliv. 2014;11(1):69–82.PubMedCrossRefGoogle Scholar
  27. 27.
    McGowan I. Rectal microbicide development. Curr Opin HIV AIDS. 2012;7(6):526–33.PubMedCrossRefGoogle Scholar
  28. 28.
    Newman PA, Duan N, Rudy ET, Anton PA. Challenges for HIV vaccine dissemination and clinical trial recruitment: if we build it, will they come? AIDS Patient Care STDs. 2004;18(12):691–701.PubMedCrossRefGoogle Scholar
  29. 29.
    Woolf SH. The meaning of translational research and why it matters. J Am Med Assoc. 2008;999:211–3.Google Scholar
  30. 30.
    Newman PA, Duan N, Kakinami L, Roberts K. What can HIV vaccine trials teach us about dissemination? Vaccine. 2008;26(20):2528–36.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Gross M, Celum CL, Tabet SR, Kelly CW, Coletti AS, Chesney MA. Acceptability of a bioadhesive nonoxynol-9 gel delivered by an applicator as a rectal microbicide. Sex Transm Dis. 1999;26(10):572–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Tabet SR, Surawicz C, Horton S, et al. Safety and toxicity of nonoxynol-9 gel as a rectal microbicide. Sex Transm Dis. 1999;26(10):564–71.PubMedCrossRefGoogle Scholar
  33. 33.
    Dezzutti CS, Rohan LC, Wang L, et al. Reformulated tenofovir gel for use as a dual compartment microbicide. J Antimicrob Chemother. 2012;67:2139–42.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    McGowan I, Hoesley C, Cranston RD, et al. A phase 1 randomized, double blind, placebo controlled rectal safety and acceptability study of tenofovir 1% gel (MTN-007). PLoS One. 2013;8(4):e60147.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Anton PA, Cranston RD, Kashuba A, et al. RMP-02/MTN-006: a phase 1 rectal safety, acceptability, pharmacokinetic, and pharmacodynamics study of tenofovir 1% gel compared with oral tenofovir disoproxil fumarate. AIDS Res Hum Retro. 2012;28(11):1412–21.CrossRefGoogle Scholar
  36. 36.
    Carballo-Dieguez A, Giguere R, Dolezal C, et al. Adherence to rectal gel use among mainly ethnic minority young men who have sex with men during a 3-month placebo gel trial: implications for microbicide research. AIDS Behav. 2014;18:1726–33.PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Pines HA, Gorbach PM, Weiss RE, et al. Acceptability of potential microbicide delivery systems for HIV prevention: a randomized crossover trial. AIDS Behav. 2013;17:1002–15.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Pines HA, Gorbach PM, Reback CJ, Landovitz RJ, Mutchler MG, Mitsuyasu R. Commercial lubricant use among HIV-negative men who have sex with men in Los Angeles: implications for the development of rectal microbicides for HIV prevention. AIDS Care. 2014;26(12):1609–18.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Newman PA, Woodford MR, Logie C. HIV vaccine acceptability and culturally appropriate dissemination among sexually diverse Aboriginal peoples in Canada. Glob Public Health. 2012;7(1):87–100.PubMedCrossRefGoogle Scholar
  40. 40.
    Pettifor A, Nguyen NL, Celum C, Cowan FM, Go V, Hightow-Weidman L. Tailored combination prevention package and PrEP for young key populations. J Int AIDS Soc. 2015;18(2Suppl1):19434.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Carballo-Dieguez A, Dolezal C, Bauermeister JA, O’Brien W, Ventuneac A, Mayer K. Preference for gel over suppository as delivery vehicle for a rectal microbicide: results of a randomized, crossover acceptability trial among men who have sex with men. Sex Transm Infect. 2008;84(6):483–7.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Newman PA, Roungprakhon S, Tepjan S, Yim S. Preventive HIV vaccine acceptability and behavioral risk compensation among high-risk men who have sex with men and transgenders in Thailand. Vaccine. 2010;28:958–64.PubMedCrossRefGoogle Scholar
  43. 43.
    Wheelock A, Eisingerich AB, Ananworanich J, et al. Are Thai MSM willing to take PrEP for HIV prevention? An analysis of attitudes, preferences and acceptance. PLoS One. 2013;8(1):e54288.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Gaebelein CJ, Gleason BL. Contemporary drug information: an evidence-based approach. Philadelphia: Lippincott Williams & Wilkins; 2008.Google Scholar
  45. 45.
    Clark MD, Determann D, Petrou S, et al. Discrete choice experiments in health economics: a review of the literature. Pharmacoeconomics. 2014;32(9):883–902.PubMedCrossRefGoogle Scholar
  46. 46.
    Ferrini S, Scarpa R. Designs with a priori information for nonmarket valuation with choice-experiments: a Monte Carlo study. J Environ Econ Manage. 2007;53(3):342–63.CrossRefGoogle Scholar
  47. 47.
    Sándor Z, Wedel M. Designing conjoint choice experiments using managers’ prior beliefs. J Market Res. 2001;38:430–44.CrossRefGoogle Scholar
  48. 48.
    Bliemer MCJ, Rose JM, Hess S. Approximation of Bayesian efficiency in experimental choice designs. J Choice Modeling. 2008;1(1):98–126.CrossRefGoogle Scholar
  49. 49.
    Vermuelen B, Goos P, Scarpa R, Vandebroek M. Bayesian conjoint choice designs for measuring willingness to pay. Environ Resour Econ. 2011;48(1):129–49.CrossRefGoogle Scholar
  50. 50.
    Scarpa R, Rose JM. Design efficiency for non-market valuation with choice modeling: how to measure it, what to report and why. Aust J Agric Resour Econ. 2008;52:253–82.CrossRefGoogle Scholar
  51. 51.
    Green PE, Srinivasan V. Conjoint analysis in consumer research: issues and outlook. J Consum Res. 1978;5(2):103–23.CrossRefGoogle Scholar
  52. 52.
    Newman PA, Lee SJ, Rudy E, et al. Preventive HIV vaccine acceptability and behavioral risk compensation among a random sample of high-risk adults in Los Angeles (L.A. VOICES). Health Serv Res. 2009;44(6):2167–79.PubMedPubMedCentralCrossRefGoogle Scholar
  53. 53.
    Ryan M, Kolstad J, Rockers P, Dolea C. How to conduct a discrete choice experiment for health workforce recruitment and retention in remote and rural areas: a user guide with case studies. Report No. 74489. Geneva: World Health Organization; 2012.Google Scholar
  54. 54.
    Youngkong S, Baltussen R, Tantivess S, Koolman X, Teerawattananon Y. Criteria for priority setting of HIV/AIDS interventions in Thailand: a discrete choice experiment. Health Serv Res. 2010;10:197.CrossRefGoogle Scholar
  55. 55.
    McFadden D. Conditional logit analysis of qualitative choice behavior. In: Zarembka P, editor. Frontiers in econometrics. New York: Academic Press; 1973.Google Scholar
  56. 56.
    Hausman J, Ruud P. Specifying and testing econometric models for rank-ordered data. J Econom. 1987;34:83–103.CrossRefGoogle Scholar
  57. 57.
    Cameron MP, Newman PA, Roungprakhon S, Scarpa R. Using discrete choice modelling to estimate the marginal willingness-to-pay for features of a hypothetical HIV vaccine. Vaccine. 2013;31:3712–7.PubMedCrossRefGoogle Scholar
  58. 58.
    Thai Ministry of Labor. Minimum wage. Accessed 11 Dec 2015.
  59. 59.
    Sineath RC, Finneran C, Sullivan P, et al. Knowledge of and interest in using preexposure prophylaxis for HIV prevention among men who have sex with men in Thailand. J Int Assoc Provid AIDS Care. 2013;12(4):227–31.PubMedCrossRefGoogle Scholar
  60. 60.
    Yang D, Chariyalertsak C, Wongthanee A, et al. Acceptability of pre-exposure prophylaxis among men who have sex with men and transgender women in Northern Thailand. PLoS One. 2013;8(10):e76650.PubMedPubMedCentralCrossRefGoogle Scholar
  61. 61.
    Carballo-Dieguez A, Exner T, Dolezal C, Pickard R, Lin P, Mayer KH. Rectal microbicide acceptability: results of a volume escalation trial. Sex Transm Infect. 2007;34(4):224–9.CrossRefGoogle Scholar
  62. 62.
    Kinsler JJ, Cunningham WE, Nurena CR, et al. Using conjoint analysis to measure the acceptability of rectal microbicides among men who have sex with men in four south American cities. AIDS Behav. 2012;16:1436–47.PubMedCrossRefGoogle Scholar
  63. 63.
    Rogers EM. Diffusion of innovations. 4th ed. NY: The Free Press; 1995.Google Scholar
  64. 64.
    Ferlie E, Gabbay L, Fitzgerald L, Locock L, Dopson S. Organisational behaviour and organisational studies in health care: reflections on the future. In: Ashburner L, editor. Evidence-based medicine and organisational change: an overview of some recent qualitative research. Basingstoke: Palgrave; 2001.Google Scholar
  65. 65.
    Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82(4):581–629.PubMedPubMedCentralCrossRefGoogle Scholar
  66. 66.
    Godwin J. Legal environments, human rights and HIV responses among men who have sex with men and transgender people in Asia and the Pacific: an agenda for action. Bangkok: United Nations Development Programme; 2010.Google Scholar
  67. 67.
    Nemoto T, Iwamoto M, Perngparn U, Areesantichai C, Kamitani E, Sakata M. HIV-related risk behaviors among Kathoey (male-to-female transgender) sex workers in Bangkok, Thailand. AIDS Care. 2012;24:210–9.PubMedGoogle Scholar
  68. 68.
    Gile KJ, Johnston LG, Salganik MJ. Diagnostics for respondent-driven sampling. J R Stat Soc. 2015;178(1):241–69.CrossRefGoogle Scholar
  69. 69.
    White RG, Lansky A, Goel S, et al. Respondent driven sampling—where we are and where should we be going? Sex Transm Infect. 2012;88(6):397–9.PubMedPubMedCentralCrossRefGoogle Scholar
  70. 70.
    Lancar E, Louviere J. Conducting discrete choice experiments to inform healthcare decision making. Pharmacoeconomics. 2008;26(8):661–7.CrossRefGoogle Scholar
  71. 71.
    Johnson FR, Lancsar E, Marshall D, et al. Constructing experimental designs for discrete-choice experiments: report of the ISPOR conjoint analysis experimental design good research practices task force. Value Health. 2013;16(1):3–13.CrossRefGoogle Scholar
  72. 72.
    Mangham J, Hanson K, McPake B. How to do (or not to do)… Designing a discrete choice experiment for application in a low-income country. Health Policy Plan. 2009;24:151–8.PubMedCrossRefGoogle Scholar
  73. 73.
    Beyrer C, Cargo AL, Bekker LG, et al. An action agenda for HIV and sex workers. Lancet. 2015;385(9964):287–301.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Peter A. Newman
    • 1
    Email author
  • Michael P. Cameron
    • 2
  • Surachet Roungprakhon
    • 3
  • Suchon Tepjan
    • 1
  • Riccardo Scarpa
    • 2
  1. 1.Factor-Inwentash Faculty of Social WorkUniversity of TorontoTorontoCanada
  2. 2.Department of EconomicsUniversity of WaikatoHamiltonNew Zealand
  3. 3.Faculty of Science and TechnologyRajamangala University of Technology Phra NakhonBangkokThailand

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