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Male Partner Influence on Women’s HIV Prevention Trial Participation and Use of Pre-exposure Prophylaxis: the Importance of “Understanding”

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Abstract

There is widespread evidence that male partners influence women’s ability and willingness to join HIV prevention trials and to use female-controlled prevention strategies such as microbicide gels. VOICE-C was an ancillary study to the Microbicide Trials Network’s VOICE trial at the Johannesburg site that explored social and structural factors influencing women’s use of study tablets and vaginal gel. Qualitative data were analyzed from 102 randomly-selected VOICE participants interviewed through in-depth interviews (IDI, n = 41); ethnographic interviews (n = 21) or focus group discussions (FGD, n = 40) and 22 male partners interviewed in 14 IDI and 2 FGD. Male partners’ “understanding” pervaded as a central explanation for how male partners directly and indirectly influenced their female partners’ trial participation and product use, irrespective of assignment to the gel or tablet study groups. The meaning behind “understanding” in this context was described by both men and women in two important and complementary ways: (1) “comprehension” of the study purpose including biological properties or effects of the products, and (2) “support/agreeability” for female partners being study participants or using products. During analysis a third dimension of “understanding” emerged as men’s acceptance of larger shifts in gender roles and relationship power, and the potential implications of women’s increased access to biomedical knowledge, services and prevention methods. Despite displays of some female agency to negotiate and use HIV prevention methods, male partners still have a critical influence on women’s ability and willingness to do so. Efforts to increase their understanding of research goals, study design and products’ mechanisms of action could ameliorate distrust, empower men to serve as product advocates, adherence buddies, and foster greater adherence support for women in situations where it is needed. Strategies to address gender norms and the broader implications these have for female-initiated HIV prevention should likewise be integrated into future research and program activities.

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References

  1. Montgomery CM, Lees S, Stadler J, et al. The role of partnership dynamics in determining the acceptability of condoms and microbicides. AIDS Care. 2008;20(6):733–40.

    Article  CAS  PubMed  Google Scholar 

  2. Montgomery E, van der Straten A, Torjesen K. “Male Involvement” in women and children’s HIV prevention: challenges in definition and interpretation. JAIDS—J Acquir Immune Defic Syndr. 2011;57(5):e114.

    Article  Google Scholar 

  3. 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.

  4. Stein ZA. HIV prevention: the need for methods women can use. Am J Public Health. 1990;80(4):460–2.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. Dunkle KL, Jewkes RK, Brown HC, Gray GE, McIntryre JA, Harlow SD. Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet. 2004;363(9419):1415–21.

    Article  PubMed  Google Scholar 

  6. Baeten JM, Haberer JE, Liu AY, Sista N. Preexposure prophylaxis for HIV prevention: where have we been and where are we going? JAIDS J Acquir Immune Defic Syndr. 2013;63:S122–9.

    Article  Google Scholar 

  7. Celum C, Baeten JM. Tenofovir-based pre-exposure prophylaxis for HIV prevention: evolving evidence. Curr Opin Infect Dis. 2012;25(1):51.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Ware NC, Wyatt MA, Haberer JE, et al. What’s Love Got to Do With It? Explaining Adherence to Oral Antiretroviral Pre-Exposure Prophylaxis for HIV-Serodiscordant Couples. JAIDS J Acquir Immune Defic Syndr. 2012;59(5):463–8. doi:10.1097/QAI.0b013e31824a060b.

    Article  CAS  Google Scholar 

  9. 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.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Thigpen MC, Kebaabetswe PM, Paxton LA, et al. Antiretroviral Preexposure Prophylaxis for Heterosexual HIV Transmission in Botswana. New Engl J Med. 2012;367(5):423–34. doi:10.1056/NEJMoa1110711.

  11. Marrazzo J, Ramjee G, Nair G, et al. Pre-exposure prophylaxis for HIV in women: daily oral tenofovir, oral tenofoviremtricitabine, or vaginal tenofovir gel in the VOICE Study (MTN 003). CROI. Atlanta GA2013.

  12. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Latkin C, Forman V, Knowlton A, Norms SS. Social networks, and HIV-related risk behaviors among urban disadvantaged drug users. Soc Sci Med. 2003;56(3):465–76.

    Article  PubMed  Google Scholar 

  14. Bronfenbrenner U. Toward an experimental ecology of human development. Am Psychol. 1977;32(7):513–31.

    Article  Google Scholar 

  15. Mooney A, Sarangi S. An ecological framing of HIV preventive intervention: a case study of non-government organizational work in the developing world. Health. 2005;9(3):275–96.

    PubMed  Google Scholar 

  16. Latkin CA, Forman V, Knowlton A, Norms SS. Social networks, and HIV-related risk behaviors among urban disadvantaged drug users. Soc Sci Med. 2003;56(3):465–76.

    Article  PubMed  Google Scholar 

  17. Montgomery C, Lees S, Stadler J, et al. The role of partnership dynamics in determining the acceptability of condoms and microbicides. AIDS Care. 2008;20(6):733–40.

    Article  CAS  PubMed  Google Scholar 

  18. Venables E, Stadler J. ‘The study has taught me to be supportive of her’: empowering women and involving men in microbicide research. Culture, Health and Sex. 2012;14(2):181–94.

    Article  Google Scholar 

  19. Sahin-Hodoglugil NN, van der Straten A, Cheng H, et al. Degrees of disclosure: a study of women’s covert use of the diaphragm in an HIV prevention trial in sub-Saharan Africa. Soc Sci Med. 2009;69(10):1547–55.

    Article  PubMed  Google Scholar 

  20. Montgomery E, Upkong M, White R, van der Straten A. Involving male partners in trials of female-initiated HIV prevention methods in Africa: a review of strategies and evidence. 5th IAS conference on HIV pathogenesis, treatment and prevention, Cape Town, South Africa (poster presentation). 2009.

  21. Remien R, Stirratt M, Dolezal C, et al. Couple-focused support to improve HIV medication adherence: a randomized controlled trial. AIDS. 2005;19:807–14.

    Article  PubMed  Google Scholar 

  22. Hunter M. Cultural politics and masculinities: multiple-partners in historical perspective in Kwa-Zulu Natal. Culture Health and Sex. 2005;7(4):389–403.

    Article  Google Scholar 

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Acknowledgments

We would like to pay tribute to the women and men who participated in this study, their dedication and commitment made this study possible. The contributions of the MTN Behavioral Research Working Group, the VOICE trial leadership, Katie Schwartz and Kat Richards of FHI360, Catie Magee and Helen Cheng at RTI International, Sello Seoka at WRHI and other Protocol study team members are acknowledged as critical in the development, implementation, and/or analysis of this study. The full MTN003-C study team can be viewed at http://www.mtnstopshiv.org/studies/1087. This study was supported through the Microbicide Trial Network (MTN) which is funded by NIAID (5UM1AI068633), NICHD and NIMH, and all of the U.S. National Institutes of Health.

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Authors and Affiliations

  1. Women’s Global Health Imperative, RTI International, 114 Sansome Street, Suite 500, San Francisco, CA, 94104, USA

    Elizabeth T. Montgomery, Ariane van der Straten, Miriam Hartmann & Nicole Laborde

  2. Department of Medicine, Center for AIDS Prevention Studies, UCSF, 50 Beale St., San Francisco, CA, 94105, USA

    Ariane van der Straten

  3. Faculty of Health Sciences, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, 22 Esselen St., Hillbrow, Johannesburg, 2001, South Africa

    Jonathan Stadler, Busisiwe Magazi & Florence Mathebula

  4. DAIDS, NIAID/NIH, 6700 B Rockledge Drive, Room 5138, Bethesda, MD, 20892-7628, USA

    Lydia Soto-Torres

Authors
  1. Elizabeth T. Montgomery
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  2. Ariane van der Straten
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  3. Jonathan Stadler
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  4. Miriam Hartmann
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  5. Busisiwe Magazi
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  6. Florence Mathebula
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  7. Nicole Laborde
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  8. Lydia Soto-Torres
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Correspondence to Elizabeth T. Montgomery.

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On behalf of the VOICE-C study team

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Montgomery, E.T., 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 19, 784–793 (2015). https://doi.org/10.1007/s10461-014-0950-5

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  • DOI: https://doi.org/10.1007/s10461-014-0950-5

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