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Re-framing microbicide acceptability: findings from the MDP301 trial
Catherine M Montgomery1, Mitzy Gafos, Shelley Lees
1Centre for International Health Research (CRESIB), University of Barcelona, Spain. Catherine.montgomery@lshtm.ac.uk
Abstract:
Microbicides are most usually conceptualised within a disease prevention framework and studies usually define acceptability in terms of product characteristics, willingness to use and risk reduction. This starting point has led to assumptions about microbicides which, rather than being challenged by empirical studies, have tended to foreclose the data and subsequent conceptual models. Few studies take an emic ('insider') perspective or attempt to understand how microbicides fit into the broader context of women's and men's everyday lives. As part of the integrated social science component of the MDP301 Phase III microbicide trial, in-depth interviews were conducted with female trial participants in South Africa, Zambia, Tanzania and Uganda. Women's experiences of the gel challenge several assumptions that have commonly been reiterated about microbicides. Our analysis suggests that current definitions and conceptual frameworks do not adequately account for the range of meanings that women attribute to gel. Even within the context of a clinical trial, it is possible to obtain a richer, ethnographic and cross-cultural concept of acceptability based on women's practice and emic interpretations. We now need to move beyond limited notions of acceptability and consider how microbicides fit into a more holistic picture of women's and men's sexuality and sexual health.
Insights
Microbicide acceptability requires understanding women's lived experiences beyond product features. Research should incorporate emic perspectives to grasp how microbicides integrate into daily sexual health practices.
Area of Science:
- Social and Behavioral Sciences
- Public Health
- HIV/AIDS Prevention Research
Background:
- Microbicide acceptability is typically defined by product characteristics and willingness to use within disease prevention frameworks.
- Existing conceptual models often overlook the emic ('insider') perspective and the integration of microbicides into daily life.
- Previous studies have made assumptions about microbicide use that empirical data has not adequately challenged.
Purpose of the Study:
- To explore women's lived experiences with microbicide gel within a large-scale clinical trial.
- To challenge common assumptions about microbicide acceptability by incorporating an emic perspective.
- To develop a richer, ethnographic understanding of microbicide acceptability.
Main Methods:
- Conducted in-depth interviews with female participants in the MDP301 Phase III microbicide trial.
- Included participants from South Africa, Zambia, Tanzania, and Uganda.
- Integrated social science methods within a clinical trial setting.
Main Results:
- Women's experiences with microbicide gel revealed meanings not captured by current definitions of acceptability.
- Current conceptual frameworks inadequately account for the diverse interpretations and uses of microbicides.
- An ethnographic and cross-cultural understanding of acceptability is achievable even within a clinical trial context.
Conclusions:
- Existing definitions of microbicide acceptability are insufficient.
- A holistic approach is needed to understand microbicide acceptability within the broader context of sexual health.
- Future research should prioritize emic interpretations and integrate microbicides into the complex realities of users' lives.
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