In the Journals

Men often control use of women’s HIV prophylactic gel in Zambia

In Zambia, men often control the use of a microbicide gel that is meant to give women autonomy in preventing HIV infection, according to researchers.

Use of the vaginal gel, which is now in phase 3 trials, is limited by social norms that entrench male dominance, they wrote in Global Public Health.

“This study has demonstrated that the complex social constructs associated with hegemonic masculinity and the associated sexual behaviors shape women’s, couples’, and communities’ acceptance of vaginal microbicides,” researcher Oliver Mweemba, PhD, of the University of Zambia School of Medicine, Ridgeway Campus, and colleagues wrote. “The same constructs of masculinity seemed to produce both positive and negative influences on decisions to use the gel, decisions to use it autonomously and the ability to use it consistently.”

To gain perspective on those constructs, the researchers spoke to dozens of women who had participated in the trial and their partners, recruited from the southern Zambian town of Mazabuka.

Mweemba and colleagues conducted two types of discussions with participants — focus group discussions (FGDs) and in-depth interviews (IDIs) — from March to August of 2009.

They held eight FGDs with 38 men and 38 women. Four of the FGDs were with men, two were with women gel users and two with women not using the gel.

The researchers conducted 18 IDIs, which included six women who used the gel and six men whose partners used it. The IDIs also included six key informants — three community leaders and three MDP community workers.

Participants’ comments in both the FGDs and IDIs showed that men were largely considered the heads of their households and had the final say on matters, including gel use.

“According to our custom, anything that you want to do as a woman, you are supposed to ask your husband first,” a 40-year-old woman was quoted as saying in an IDI. “We are supposed to ask for permission from the partner to use the gel ... You are supposed to ask for permission from the man. He needs to authorize because he is the head.”

Several men became violent when they found out their partners had been using the gel without telling them, the researchers said.

“One woman was beaten,” they were told by a key informant. “She was on the trial and after getting the gel, she was using the gel secretly and the husband discovered. She was beaten ... He accused her of using the gel with another man.”

Some men and women said they opposed gel use out of fear that it would inhibit conception. Some approved of it, however, because they felt it allowed conception by, in their view, eliminating the need for a condom, the researchers said. Community members and spouses often fault women for the failure to conceive, they added.

“When you stop bearing children, they would say that ‘she has become a prostitute,’” a married woman in her early 30s was quoted as saying in an FGD. “You can be beaten or divorced.”

In addition, women in both the IDIs and FGDs expected their male partners to have other sex partners. For at least some women, that stirred fears of HIV infection from their partners and convinced them to use the gel.

Several men reportedly became more faithful when the gel was used, often because they felt sex was more pleasurable with it. Some women feared that, if they stopped using it, their partners would become unfaithful again.

“As they were clocking their week 52 [final study visit], they would be sad that they would no longer be able to use the gel,” a key informant told the researchers. “They would ask if they could be allowed to continue to use the gel because, they said, ‘my marriage relationship is now good. This enhanced our bond. The sexual enjoyment had really improved ... and now if it goes, they will go back to other women.’” – by Joe Green

Disclosure: The researchers report no relevant financial disclosures.

In Zambia, men often control the use of a microbicide gel that is meant to give women autonomy in preventing HIV infection, according to researchers.

Use of the vaginal gel, which is now in phase 3 trials, is limited by social norms that entrench male dominance, they wrote in Global Public Health.

“This study has demonstrated that the complex social constructs associated with hegemonic masculinity and the associated sexual behaviors shape women’s, couples’, and communities’ acceptance of vaginal microbicides,” researcher Oliver Mweemba, PhD, of the University of Zambia School of Medicine, Ridgeway Campus, and colleagues wrote. “The same constructs of masculinity seemed to produce both positive and negative influences on decisions to use the gel, decisions to use it autonomously and the ability to use it consistently.”

To gain perspective on those constructs, the researchers spoke to dozens of women who had participated in the trial and their partners, recruited from the southern Zambian town of Mazabuka.

Mweemba and colleagues conducted two types of discussions with participants — focus group discussions (FGDs) and in-depth interviews (IDIs) — from March to August of 2009.

They held eight FGDs with 38 men and 38 women. Four of the FGDs were with men, two were with women gel users and two with women not using the gel.

The researchers conducted 18 IDIs, which included six women who used the gel and six men whose partners used it. The IDIs also included six key informants — three community leaders and three MDP community workers.

Participants’ comments in both the FGDs and IDIs showed that men were largely considered the heads of their households and had the final say on matters, including gel use.

“According to our custom, anything that you want to do as a woman, you are supposed to ask your husband first,” a 40-year-old woman was quoted as saying in an IDI. “We are supposed to ask for permission from the partner to use the gel ... You are supposed to ask for permission from the man. He needs to authorize because he is the head.”

Several men became violent when they found out their partners had been using the gel without telling them, the researchers said.

“One woman was beaten,” they were told by a key informant. “She was on the trial and after getting the gel, she was using the gel secretly and the husband discovered. She was beaten ... He accused her of using the gel with another man.”

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Some men and women said they opposed gel use out of fear that it would inhibit conception. Some approved of it, however, because they felt it allowed conception by, in their view, eliminating the need for a condom, the researchers said. Community members and spouses often fault women for the failure to conceive, they added.

“When you stop bearing children, they would say that ‘she has become a prostitute,’” a married woman in her early 30s was quoted as saying in an FGD. “You can be beaten or divorced.”

In addition, women in both the IDIs and FGDs expected their male partners to have other sex partners. For at least some women, that stirred fears of HIV infection from their partners and convinced them to use the gel.

Several men reportedly became more faithful when the gel was used, often because they felt sex was more pleasurable with it. Some women feared that, if they stopped using it, their partners would become unfaithful again.

“As they were clocking their week 52 [final study visit], they would be sad that they would no longer be able to use the gel,” a key informant told the researchers. “They would ask if they could be allowed to continue to use the gel because, they said, ‘my marriage relationship is now good. This enhanced our bond. The sexual enjoyment had really improved ... and now if it goes, they will go back to other women.’” – by Joe Green

Disclosure: The researchers report no relevant financial disclosures.