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Relationship Type and Use of the Vaginal Ring for HIV-1 Prevention in the MTN 020/ASPIRE Trial

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Abstract

Gender roles and imbalances in sexual power contribute to the heightened HIV-1 risk faced by women in Sub-Saharan Africa. This has led prevention research to focus on the development of female controlled methods. Despite the design of products such as vaginal rings to be used autonomously by women, male partners and women’s perceptions of relationships influence HIV prevention choices. To understand the influences that male partners and dyadic dynamics had on the use of the Dapivirine Vaginal Ring in the ASPIRE trial, this analysis of qualitative data explored the types of intimate partner relationships that women engaged in. This paper describes how partners facilitated or challenged women’s ring use and how women dealt with these challenges within six different types of relationships characterized by power dynamics and commitment levels. We offer insights into how future use of female-initiated HIV prevention products can be promoted through recognition of different relationship types.

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Acknowledgements

The study was designed and implemented by the Microbicide Trials Network (MTN) and 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 (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The vaginal rings used in this study were developed and supplied by the International Partnership for Microbicides (IPM).

Study Team Leadership: Jared Baeten, University of Washington (Protocol Chair); Thesla Palanee-Phillips, Wits Reproductive Health and HIV Institute (Protocol Co-chair); Elizabeth Brown, Fred Hutchinson Cancer Research Center (Protocol Statistician); Lydia Soto-Torres, US National Institute of Allergy and Infectious Diseases (Medical Officer); Katie Schwartz, FHI 360 (Clinical Research Manager). Study sites and site Investigators of Record: Malawi, Blantyre site (Johns Hopkins University, Queen Elizabeth Hospital): Bonus Makanani. Malawi, Lilongwe site (University of North Carolina, Chapel Hill): Francis Martinson. South Africa, Cape Town site (University of Cape Town): Linda-Gail Bekker. South Africa, Durban – Botha’s Hill, Chatsworth, Isipingo, Tongaat, Umkomaas, Verulam sites (South African Medical Research Council): Vaneshree Govender, Samantha Siva, Zakir Gaffoor, Logashvari Naidoo, Arendevi Pather, and Nitesha Jeenarain. South Africa, Durban, eThekwini site (Center for the AIDS Programme for Research in South Africa): Gonasagrie Nair. South Africa, Johannesburg site (Wits RHI): Thesla Palanee-Phillips. Uganda, Kampala site (John Hopkins University, Makerere University): Flavia Matovu. Zimbabwe, Chitungwiza, Seke South and Zengeza sites (University of Zimbabwe College of Health Sciences Clinical Trials Unit): Nyaradzo Mgodi. Zimbabwe, Harare, Spilhaus site (University of Zimbabwe College of Health Sciences Clinical Trials Unit): Felix Mhlanga. Data management was provided by The Statistical Center for HIV/AIDS Research & Prevention (Fred Hutchinson Cancer Research Center, Seattle, WA) and site laboratory oversight was provided by the Microbicide Trials Network Laboratory Center (Pittsburgh, PA). For qualitative data, management was provided by the Women’s Global Health Imperative Program (RTI International, San Francisco, CA).

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Authors and Affiliations

  1. RTI International, Women’s Global Health Imperative, UC Berkeley SPH, 628 Beacon Street, Oakland, CA, 94610, USA

    E. Pleasants, E. T. Montgomery, Jared Baeten, Thesla Palanee-Phillips, Elizabeth Brown, Lydia Soto-Torres, Bonus Makanani, Francis Martinson, Linda-Gail Bekker, Vaneshree Govender, Samantha Siva, Zakir Gaffoor, Logashvari Naidoo, Arendevi Pather, Nitesha Jeenarain, Gonasagrie Nair, Flavia Matovu, Nyaradzo Mgodi & Felix Mhlanga

  2. University of Zimbabwe-University of California San Francisco Collaborative Research Program (UZ-UCSF), San Francisco, CA, USA

    T. Tauya

  3. University of the Witwatersrand, Wits Reproductive Health and HIV Institute (Wits RHI), Johannesburg, South Africa

    K. Reddy & T. Palanee-Phillips

  4. Makerere University - Johns Hopkins University Research Collaboration (MU-JHU), Kampala, Uganda

    B. G. Mirembe

  5. South African Medical Research Council (SAMRC), HIV Prevention Research Unit, Cape Town, South Africa

    K. Woeber

  6. UNC Project, Tidziwe Centre, Lilongwe, Malawi

    C. Zimba

  7. Kamuzu Central Hospital, Lilongwe, Malawi

    C. Zimba

  8. The Desmond Tutu HIV Foundation, Desmond Tutu HIV Centre (DTHC) at the University of Cape Town, Cape Town, South Africa

    M. Atujuna

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  1. E. Pleasants
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  2. T. Tauya
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  9. E. T. Montgomery
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Consortia

the MTN-020/ASPIRE Study Team

  • Jared Baeten
  • , Thesla Palanee-Phillips
  • , Elizabeth Brown
  • , Lydia Soto-Torres
  • , Bonus Makanani
  • , Francis Martinson
  • , Linda-Gail Bekker
  • , Vaneshree Govender
  • , Samantha Siva
  • , Zakir Gaffoor
  • , Logashvari Naidoo
  • , Arendevi Pather
  • , Nitesha Jeenarain
  • , Gonasagrie Nair
  • , Flavia Matovu
  • , Nyaradzo Mgodi
  •  & Felix Mhlanga

Corresponding author

Correspondence to E. Pleasants.

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The members of the MTN-020/ASPIRE Study Team are listed in the Acknowledgement section.

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Pleasants, E., Tauya, T., Reddy, K. et al. Relationship Type and Use of the Vaginal Ring for HIV-1 Prevention in the MTN 020/ASPIRE Trial. AIDS Behav 24, 866–880 (2020). https://doi.org/10.1007/s10461-019-02521-9

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  • DOI: https://doi.org/10.1007/s10461-019-02521-9

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