AIDS and Behavior

, Volume 22, Issue 2, pp 437–446 | Cite as

Impact of the Dapivirine Vaginal Ring on Sexual Experiences and Intimate Partnerships of Women in an HIV Prevention Clinical Trial: Managing Ring Detection and Hot Sex

  • Nicole D. Laborde
  • Elizabeth Pleasants
  • Krishnaveni Reddy
  • Millicent Atujuna
  • Teopista Nakyanzi
  • Miria Chitukuta
  • Sarita Naidoo
  • Thesla Palanee-Phillips
  • Jared M. Baeten
  • Elizabeth T. Montgomery
  • On behalf of the MTN-020/ASPIRE Study Team
Original Paper


Vaginally-inserted HIV prevention methods have been reported to impact the sexual experience for women and their partners, and hence impacts acceptability of and adherence to the method. We analyzed in-depth interviews and focus group discussions about participants’ sexual experiences while wearing the ring, collected during the MTN-020/ASPIRE phase 3 safety and effectiveness trial of a dapivirine vaginal ring for HIV prevention in Malawi, South Africa, Uganda, and Zimbabwe. Most women reported that partners did not feel the ring during sex, however, women felt they had to manage their partners’ interaction with or reaction to the ring. In maintaining positive relationships, women were concerned about partners’ discovering ring use and about ensuring that partners had a good sexual experience with them. Finally women were concerned about how they themselves experienced sex with the ring. Some found that the ring made the vaginal environment more desirable for their partners and themselves.


Gender HIV Clinical trial Vaginal ring Sexual relationship Sub-Saharan Africa 



This study was funded by the Microbicide Trials Network, which is funded by the National Institute of Allergy and Infectious Diseases (UM1AI068633, UM1AI068615, UM1AI106707), with co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Mental Health, all components of the U.S. National Institutes of Health.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Baeten JM, Palanee-Phillips T, Brown ER, et al. Use of a vaginal ring containing dapivirine for HIV-1 prevention in women. N Engl J Med. 2016;375:2121–32.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Montgomery ET, van der Straten A, Chitukuta M, et al. “It’s inside my body and it’s mine”: Acceptability and use of a dapivirine vaginal ring in a phase III trial. AIDS. 2017;31:1159–67.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Nel A, Bekker LG, Bukusi E, et al. Safety, acceptability and adherence of dapivirine vaginal ring in a microbicide clinical trial conducted in multiple countries in Sub-Saharan Africa. PLoS ONE. 2016;11(3):e0147743.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Kiser P, Johnson T, Clark J. State of the art in intravaginal ring technology for topical prophylaxis of HIV infection. AIDS Rev. 2012;14(1):62–77.PubMedGoogle Scholar
  5. 5.
    Malcolm RK, Edwards K-L, Kiser P, Romano J, Smith TJ. Advances in microbicide vaginal rings. Antiviral Res. 2010;88:S30–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Woodsong C, Holt JD. Acceptability and preferences for vaginal dosage forms intended for prevention of HIV or HIV and pregnancy. Adv Drug Deliv Rev. 2015;92:146–54.CrossRefPubMedGoogle Scholar
  7. 7.
    Montgomery CM, Gafos M, Lees S, et al. Re-framing microbicide acceptability: findings from the MDP301 trial. Cult Health Sex. 2010;12(6):649–62.CrossRefPubMedGoogle Scholar
  8. 8.
    Gafos M, Mzimela M, Sukazi S, Pool R, Montgomery C, Elford J. Intravaginal insertion in KwaZulu-Natal: sexual practices and preferences in the context of microbicide gel use. Cult Health Sex. 2010;12(8):929–42.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Mensch BS, van der Straten A, Katzen LL. Acceptability in microbicide and PrEP trials: current status and a reconceptualization. Curr Opin HIV AIDS. 2012;7(6):534–41.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Woodsong C, Montgomery E, Masenga G, et al. Safety and Acceptability of Vaginal Ring as Microbicide Delivery Method in African Women. Paper presented at: Microbicides 2010; May 23–26, 2010; Pittsburg, PA.Google Scholar
  11. 11.
    Severy LJ, Newcomer S. Critical issues in contraceptive and STI acceptability research. Journal of Social Issues. 2005;61(1):45–65.CrossRefGoogle Scholar
  12. 12.
    Hilber AM, Chersich MF, van de Wijgert JHHM, Rees H, Temmerman M. Vaginal practices, microbicides and HIV: what do we need to know? Sex Trans Inf. 2007;83(7):505–8.CrossRefGoogle Scholar
  13. 13.
    Jewkes R, Morrell R. Gender and sexuality: emerging perspectives from the heterosexual epidemic in South Africa and implications for HIV risk and prevention. J Int AIDS Soc. 2010;13(1):1–11.CrossRefGoogle Scholar
  14. 14.
    Gafos M, Pool R, Mzimela MA, Ndlovu HB, McCormack S, Elford J. Communication about microbicide use between couples in KwaZulu-Natal, South Africa. AIDS Behav. 2015;19(5):832–46.CrossRefPubMedGoogle Scholar
  15. 15.
    GUaJ. Estimates. Geneva: UNAIDS; 2016. p. 2016.Google Scholar
  16. 16.
    Jewkes R, Morrell R. Sexuality and the limits of agency among South African teenage women: theorising femininities and their connections to HIV risk practices. Soc Sci Med. 2012;74(11):1729–37.CrossRefPubMedGoogle Scholar
  17. 17.
    Morrell R, Jewkes R, Lindegger G. Hegemonic masculinity/masculinities in South Africa: culture, power, and gender politics. Men Masc. 2012;15:11–30.CrossRefGoogle Scholar
  18. 18.
    Pettifor A, MacPhail C, Anderson AD, Maman S. ‘If I buy the Kellogg’s then he should [buy] the milk’: young women’s perspectives on relationship dynamics, gender power and HIV risk in Johannesburg, South Africa. Cult Health Sex. 2012;14(5):477–90.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Montgomery CM. The role of partnership dynamics in determining the acceptability of condoms and microbicides. AIDS Care. 2008;20(6):733–40.CrossRefPubMedGoogle Scholar
  20. 20.
    Montgomery ET, Stadler J, Hartmann M, et al. Male partner roles and influence on women’s use of HIV pre-exposure prophylaxis in Johannesburg. Paper presented at: AIDS Impact; Sept 29–Oct 3, 2013, 2013; Barcelona, Spain.Google Scholar
  21. 21.
    Green G, Pool R, Harrison S, et al. Female control of sexuality: illusion or reality? Use of vaginal products in south west Uganda. Soc Sci Med. 2001;52(4):585–98.CrossRefPubMedGoogle Scholar
  22. 22.
    Woodsong C. Covert use of topical microbicides: implications for acceptability and use. Int Fam Plan Perspect. 2004;30(2):94–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Hilber AM, Kenter E, Redmond S, et al. Vaginal practices as women’s agency in Sub-Saharan Africa: A synthesis of meaning and motivation through meta-ethnography. Soc Sci Med. 2012;74(9):1311–23.CrossRefGoogle Scholar
  24. 24.
    Scorgie F, Smit JA, Kunene B, Martin-Hilber A, Beksinska M, Chersich MF. Predictors of vaginal practices for sex and hygiene in KwaZulu-Natal, South Africa: findings of a household survey and qualitative inquiry. Cult Health Sex. 2011;13(04):381–98.CrossRefPubMedGoogle Scholar
  25. 25.
    Duby Z, Mensch B, Hartmann M, et al. Achieving the optimal vaginal state: the use of vaginal products and study gels in Uganda, Zimbabwe and South Africa. Int Persp Sex Reprod Health. 2017;29:247–57.CrossRefGoogle Scholar
  26. 26.
    Brache V, Faundes A. Contraceptive vaginal rings: a review. Contraception. 2010;82(5):418–27.CrossRefPubMedGoogle Scholar
  27. 27.
    Lete I, Cuesta MC, Marín JM, Guerra S. Vaginal health in contraceptive vaginal ring users—A review. Eur J Contracept Reprod Health Care. 2013;18(4):234–41.CrossRefPubMedGoogle Scholar
  28. 28.
    Brown E, Palanee-Philips Marzinke, Hendrix C, Dezutti C. Residual dapivirine ring levels indicate higher adherence to vaginal ring is associated with HIV-1 protection. Durban: International AIDS Society; 2016.Google Scholar
  29. 29.
    Montgomery ET, van der Straten A, Stadler J, et al. Male partner influence on women’s HIV prevention trial participation and use of pre-exposure prophylaxis: the importance of “Understanding”. AIDS Behav. 2014;19(5):784–93.CrossRefGoogle Scholar
  30. 30.
    Montgomery ET, van der Straten A, Chidanyika A, Chipato T, Jaffar S, Padian N. The importance of male partner involvement for women’s acceptability and adherence to female-initiated HIV prevention methods in Zimbabwe. AIDS Behav. 2010(15):959–69.Google Scholar
  31. 31.
    Lanham M, Wilcher R, Montgomery ET, et al. Engaging male partners in women’s microbicide use: evidence from clinical trials and implications for future research and microbicide introduction. J Int AIDS Soc. 2014;17(3 Suppl 2):19159.PubMedPubMedCentralGoogle Scholar
  32. 32.
    MacQueen KM, Dlamini S, Perry B, et al. Social context of adherence in an open-label 1% Tenofovir Gel Trial: gender dynamics and disclosure in KwaZulu-Natal, South Africa. AIDS Behav. 2016;20(11):2682–91.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Connell RW, Messerschmidt JW. Hegemonic masculinity rethinking the concept. Gender Soc. 2005;19(6):829–59.CrossRefGoogle Scholar
  34. 34.
    Hunter M. The changing political economy of sex in South Africa: the significance of unemployment and inequalities to the scale of the AIDS pandemic. Soc Sci Med. 2007;64:689–700.CrossRefPubMedGoogle Scholar
  35. 35.
    Hunter M. Love in the time of AIDS: inequality, gender, and rights in South Africa. Bloomington: Indiana University Press; 2010.Google Scholar
  36. 36.
    van der Straten A, Panther L, Laborde N, et al. Adherence and acceptability of a multidrug vaginal ring for HIV prevention in a phase I study in the United States. AIDS Behav. 2016;20:2644–53.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Creinin MD, Meyn LA, Borgatta L, et al. Multicenter comparison of the contraceptive ring and patch: a randomized controlled trial. Obstetr Gynecol. 2008;111:267–77.CrossRefGoogle Scholar
  38. 38.
    Roumen FJ. Review of the combined contraceptive vaginal ring, NuvaRing®. Ther Clin Risk Manag. 2008;4(2):441.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    van der Straten A, Stadler J, Montgomery E, et al. Women’s experiences with oral and vaginal pre-exposure prophylaxis: The VOICE-C qualitative study in Johannesburg, South Africa. PLoS ONE. 2014;9(2):e89118.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Nicole D. Laborde
    • 1
  • Elizabeth Pleasants
    • 1
  • Krishnaveni Reddy
    • 2
  • Millicent Atujuna
    • 3
  • Teopista Nakyanzi
    • 4
  • Miria Chitukuta
    • 5
  • Sarita Naidoo
    • 6
  • Thesla Palanee-Phillips
    • 2
  • Jared M. Baeten
    • 7
  • Elizabeth T. Montgomery
    • 1
  • On behalf of the MTN-020/ASPIRE Study Team
  1. 1.Women’s Global Health Imperative, RTI InternationalSan FranciscoUSA
  2. 2.Wits Reproductive Health, HIV Institute (WRHI)JohannesburgSouth Africa
  3. 3.Desmond Tutu HIV Research FoundationCape TownSouth Africa
  4. 4.Makerere University-Johns Hopkins University Research UnitKampalaUganda
  5. 5.UZ-UCSF Collaborative Research ProgrammeHarareZimbabwe
  6. 6.HIV Prevention Research UnitSouth Africa Medical Research CouncilDurbanSouth Africa
  7. 7.University of WashingtonSeattleUSA

Personalised recommendations