AIDS and Behavior

, Volume 7, Issue 4, pp 339–351

Perspectives Related to the Potential Use of Vaginal Microbicides Among Drug-Involved Women: Focus Groups in Three Cities in the United States and Puerto Rico

  • Theresa H. Mason
  • Susan E. Foster
  • H. Ann Finlinson
  • Kathleen M. Morrow
  • Rochelle Rosen
  • Sandra Vining
  • Carol L. Joanis
  • Theodore M. Hammett
  • George R. SeageIII


HIV transmission through heterosexual contact remains the greatest risk factor for women globally. Topical microbicides applied intravaginally may offer a female-initiated HIV prevention option for many who are unable or unwilling to use male condoms or who would want additional protection. This article presents results of focus groups in Bridgeport, Connecticut, Providence, Rhode Island, and San Juan, Puerto Rico, with women who use crack or heroin or have male partners who inject illegal drugs. Participants revealed motivation for and openness to using microbicides effective against HIV should they become available. Additional lubrication during intercourse was one of several expected positive features of microbicides; women saw lubrication as a means of enhancing pleasure and reducing condom irritation and breakage while also protecting them from infection. Conversely, some women feared that their male partners would interpret excessive lubrication as an indication of infection, improper hygiene, or evidence of sex with another man. Focus groups also provided insight into how aspects of different women's sexual lives, including partner type, might influence the issues that would concern them if and when they tried out new microbicidal products in the future.

Vaginal microbicides HIV prevention sexually transmitted diseases women-controlled methods acceptability research 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Abdool Karim, K., and Zuma, N. D. (1993). Prevention of HIV infection for women by women in Natal, South Africa, Durban. Preliminary findings, ICRW: Women and AIDS Program. Durban, South Africa: Research Institute for Diseases in a Tropical Environment.Google Scholar
  2. Astemborski, J., Vlahov, D., Warren, D., Solomon, L., and Nelson, K. E. (1994). The trading of sex for drugs or money and HIV seropositivity among female intravenous drug users. American Journal of Public Health, 84, 382–387.Google Scholar
  3. Baleta, A. (1998). Concern voiced over “dry sex” practices in South Africa. Lancet, 352, 1292.Google Scholar
  4. Bentley, M. E., Morrow, K., Fullem, A., Chesney, M., Horton, S., Rosenberg, Z., and Mayer, K. H. (2000). Acceptability of a novel vaginal microbicide during Phase 1 safety trial among low-risk women. Family Planning Perspectives, 32, 184–188.Google Scholar
  5. Blanchard, K., Coggins, C., Friedland, B., and van Wijgert, J. (1998). Men's attitudes toward vaginal products: A three-country study. New York: Population Council.Google Scholar
  6. Brown, J. E., Ayowa, O. B., and Brown, R. (1993). Dry and tight: Sexual practices and potential AIDS risk in Zaire. Social Science and Medicine, 37, 989–994.Google Scholar
  7. Centers for Disease Control and Prevention (1996). Contraceptive method and condom use among women at risk for HIV infection and other sexually transmitted diseases–Selected U.S. sites, 1993–1994. Morbidity and Mortality Weekly Report, 45, 820.Google Scholar
  8. Centers for Disease Control and Prevention (2000). HIV/AIDS Surveillance Report, 12, 14.Google Scholar
  9. Centers for Disease Control and Prevention (2001). HIV/AIDS Surveillance Report, 13, 14.Google Scholar
  10. Chesney, M., Bentley, M. E., Morrow, K. M., and Mayer, K. (1998, June). Real experience: The key to microbicide acceptability. Poster session presented at the 12th World AIDS Conference, Geneva.Google Scholar
  11. Civic, D., and Wilson, D. (1996). Dry sex in Zimbabwe and implications for condom use. Social Science and Medicine, 42, 91–98.Google Scholar
  12. References regarding the formulation of over-the-counter vaginal spermicides. Critical issues in reproductive health. New York: Population Council.Google Scholar
  13. Darroch, J. E., and Frost, J. J. (1999). Women's interest in vaginal microbicides. Family Planning Perspectives, 31, 16–23.Google Scholar
  14. de Zoysa, I., Elias, C. J., and Bentley, M. (1998). Ethical challenges in efficacy trials of vaginal microbicides for HIV prevention. American Journal of Public Health, 88, 571–575.Google Scholar
  15. Elias, C., and Coggins, C. (1996). Female-controlled methods to prevent sexual transmission of HIV. AIDS, 10 (Suppl. 3), S43–S51.Google Scholar
  16. Elias, C., and Coggins, C. (2001). Acceptability research on female-controlled barrier methods to prevent heterosexual transmission of HIV: Where have we been? Where are we going? Journal of Women's Health and Gender-Based Medicine, 10, 163–173.Google Scholar
  17. Elias, C. J., and Heise, L. (1994). Challenges for the development of female-controlled vaginal microbicides. AIDS, 8, 1–9.Google Scholar
  18. Exner, T. M., Seal, D. W., and Ehrhardt, A. A. (1997). A review of HIV interventions for at-risk women. AIDS and Behavior, 1, 93–124.Google Scholar
  19. Gollub, E. L. (1995). Women-centered prevention techniques and technologies. In A. O'Leary and L. S. Jemmott (Eds.), Women at risk: Issues in the primary prevention of AIDS (pp. 43-82). New York: Plenum Press.Google Scholar
  20. Gollub, E. L. (1999). Human rights is a US problem, too: The case of women and HIV. American Journal of Public Health, 89, 1479–1482.Google Scholar
  21. Gollub, E. (2000). The female condom: Tool for women's empowerment. American Journal of Public Health, 90, 1377.Google Scholar
  22. Gollub, E. L., Stein, Z., and El-Sadr, W. (1995). Short-term acceptability of the female condom among staff and patients at a New York City hospital. Family Planning Perspectives, 27, 155–158.Google Scholar
  23. Gross, M., Buchbinder, S., Celum, C., Hagerty, P., and Seage, G. (1998). Rectal microbicides for gay men. Are clinical trials needed? Are they feasible? Sexually Transmitted Diseases, 25, 296–302.Google Scholar
  24. Hammett, T., Mason, T., Joanis, C., Foster, S., Harmon, P., Robles, R., Finlanson, A., Feudo, R., Vining-Bethea, S., Jeter, G., Mayer, K., Dougherty-Iddings, P., and Seage, G. (2000a). Acceptability of formulations and application methods for vaginal microbicides among drug-involved women: Results of product trials in three cities. Sexually Transmitted Diseases, 27, 119–126.Google Scholar
  25. Hammett, T., Norton, G., Mason, T., Langenbahn, S., Mayer, K., Robles, R., Feudo, R., and Seage, G. (2000b). Drug-involved women as potential users of vaginal microbiocides for HIV and SID prevention: A three-city survey. Journal of Women's Health and Gender-Based Medicine, 9, 1071–1080.Google Scholar
  26. Harrison, P. F. (2002). Products in the pipeline: Overview, change, lessons and implications. Paper presented at Microbicides 2002, Antwerp, Belgium.Google Scholar
  27. Heise, L. (1997). Beyond acceptability: Reorienting research on contraceptive choice. In T. K. Sundari Ravindran, M. Berer, and J. Cottingham (Eds.). Beyond acceptability: Users' perspectives on contraception. London: Reproductive Health Matters, for the World Health Organization.Google Scholar
  28. Heise, L., and Elias, C. (1994). Transforming AIDS prevention to meet women's needs: A focus on developing countries. Social Science and Medicine, 40, 931–943.Google Scholar
  29. Hira, S., Spruyt, A., Feldblum, P., Sankutu, M. R., Glover, L. H., and Steiner, M. J. (1995). Spermicide acceptability among patients at a sexually transmitted disease clinic in Zambia. American Journal of Public Health, 85, 1098–1103.Google Scholar
  30. Jones, D. L., Weiss, S. M., Malon, R., Ishii, M., Devieux, J., Stanley, H., Cassels, A., Tobon, J. N., Brondolo, E., LaPerriere, A., Efantis-Potter, J., O'Sullivan, M., and Schneiderman, N. (2001). A brief sexual barrier intervention for women living with AIDS: Acceptability, use, and ethnicity. Journal of Urban Health, Bulletin of the New York Academy of Medicine, 78, 593–604.Google Scholar
  31. Keller, A. (1979). Contraceptive acceptability research: Utility and limitations. Studies in Family Planning, 10, 230–237.Google Scholar
  32. Latka, M. (2001). Female-initiated barrier methods for the prevention of STI/HIV: Where are we now? Where should we go? Journal of Urban Health, Bulletin of the New York Academy of Medicine, 78, 571–580.Google Scholar
  33. Mantell, J. E., Hoffman, S., Weiss, E., Adeokun, L., Delano, G., Jagna, T., Exner, T. M., Stein, Z. A., Abdool Karim, Q., Scheepers, E., Atkins, K., and Weiss, E. (2001). The acceptability of the female condom: Perspectives of family planning providers in New York City, South Africa, and Nigeria. Journal of Urban Health, Bulletin of the New York Academy of Medicine, 78, 658–668.Google Scholar
  34. Moon, M. W., Khumalo-Sakutukwa, G. N., Heiman, J. E., Mbizvo, M. T., and Padian, N. S. (2002). Vaginal microbicides for HIV/STI prevention in Zimbabwe: What key informants say. Journal of Transcultural Nursing, 13, 19–23.Google Scholar
  35. Morrow, K., Rosen, R. K., Richter, L., Emans, A., Forbes, A., Day, J., Shagan, N., Maslankowski, L., Profy, A. T., Kelly, C., Abdool Karim, S. S., and Mayer, K. (2002). The acceptability of an investigational vaginal microbicide agent, Pro2000 gel. Poster presented at Microbicides 2002, Antwerp, Belgium.Google Scholar
  36. Morrow, K. M., Rosen, R. R., Richter, L., Emans, A., Forbes, A., Day, J., Morar, N., Maslankowski, L., Profy, A. T., Kelly, C., Abdool Karim, S. S., and Mayer, K. H. (2003). The acceptability of an investigational vaginal microbicide, PRO 2000 Gel, in the context of a Phase I clinical trial. Manuscript submitted for publication.Google Scholar
  37. Pool, R. (1999). Acceptability of the female condom and vaginal spermicidal products in Uganda. Sexual Health Exchange, 1, 5–7.Google Scholar
  38. Pool, R., Hart, G., Green, G., Harrison, S., Nyanzi, S., and Whitworth, J. (2000). Men's attitudes to condoms and female controlled means of protection against HIV and STDs in south-western Uganda. Culture, Health and Sexuality, 2, 197–211.Google Scholar
  39. Rosenthal, S. L., Cohen, S. S., and Stanberry, L. R. (1998). Topical microbicides: Current status and research considerations for adolescent girls. Sexually Transmitted Diseases, 25, 368–377.Google Scholar
  40. Sokal, D. C., and Hermonat, P. L. (1995). Priorities for vaginal microbicide research. American Journal of Public Health, 185, 737–738.Google Scholar
  41. Stein, Z. A. (1993). HIV prevention: An update on the status of methods women can use. Editorial. American Journal of Public Health, 83, 1379–1382.Google Scholar
  42. Stein, Z. A. (1994). What was new at Yokohama: Women's voices at the 1994 International AIDS conference. American Journal of Public Health, 84, 1887–1888.Google Scholar
  43. Steiner, M., Spruyt, A., Joanis, C., Glover, L., Cordero, M., Alvarado, G., and Onoka, C. (1995). Acceptability of spermicidal film and foaming tablets among women in three countries. International Family Planning Perspectives, 21, 104–107.Google Scholar
  44. Steiner, M., Glover, L., Bou-Saada, I., and Piedrahita, C. (1998). Increasing barrier method use among oral contraceptive users at risk of STDs: What approach is best? Sexually Transmitted Disease, 25, 139.Google Scholar
  45. Stevens, S. J., Estrada, A., and Estrada, B. D. (1998). HIV, sex and drug risk behavior and behavior change in a national sample of injection drug and crack cocaine using women. In S. J. Stevens, S. Tortu, and S. L. Coyle (Eds.), Women, drug use and HIV infection (pp. 25-47). New York: The Haworth Press, Inc.Google Scholar
  46. Stone, A. B., and Hitchcock, P. J. (1994). Vaginal microbicides for preventing the sexual transmission of HIV. AIDS, 8(Suppl. 1): S285-S293.Google Scholar
  47. Strauss, A., and Corbin, J. (1990). Basics of qualitative research: grounded theory procedures and techniques. Newbury Park, CA: Sage.Google Scholar
  48. Tortu, S., Beardsley, M., Deren, S., Williams, M., and McCoy, H. V., Stark, M., Estrada, A., and Goldstein, M. (2000). HIV Infection and patterns of risk among women drug injectors and crack users in low and high sero-prevalence sites. AIDS Care, 12, 65-76Google Scholar
  49. Wood, M. M., Tortu, S., Rhodes, F., and Deven, S. (1998). Differences in condom behaviors and beliefs among female drug users recruited in two cities. Women's Health, 27, 137.Google Scholar

Copyright information

© Plenum Publishing Corporation 2003

Authors and Affiliations

  • Theresa H. Mason
    • 1
  • Susan E. Foster
    • 1
  • H. Ann Finlinson
    • 2
  • Kathleen M. Morrow
    • 3
  • Rochelle Rosen
    • 4
    • 5
  • Sandra Vining
    • 6
  • Carol L. Joanis
    • 7
  • Theodore M. Hammett
    • 1
  • George R. SeageIII
    • 8
  1. 1.Abt Associates Inc.Cambridge
  2. 2.Universidad Central del Caribe School of MedicineBayamonPuerto Rico
  3. 3.Centers for Behavioral and Preventive MedicineBrown Medical School/Miriam HospitalProvidence
  4. 4.Department of AnthropologyBrown UniversityProvidence
  5. 5.Centers for Behavioral and Preventive MedicineMiriam HospitalProvidence
  6. 6.Greater Bridgeport Adolescent Pregnancy Program, Inc.Bridgeport
  7. 7.Family Health InternationalResearch Triangle Park
  8. 8.Harvard School of Public HealthBoston

Personalised recommendations