Vaginal Microbicide and Diaphragm Use for Sexually Transmitted Infection Prevention: A Randomized Acceptability and Feasibility Study Among High-Risk Women in Madagascar
Frieda BehetsA Norris TurnerKathleen Van DammeNy Lovaniaina RabenjaNoro Lantoniaina Rosa RavelomananaTheresa A. SwezeyApril J. BellDaniel R. NewmanD'Nyce WilliamsDenise J. Jamieson
5
Citation
0
Reference
10
Related Paper
Citation Trend
Abstract:
In the Discussion section of the article, “Vaginal microbicide and diaphragm use for sexually transmitted infection prevention: a randomized acceptability and feasibility study among high-risk women in Madagascar” (Sex Transm Dis 2008 Sep;35(9):818–26), we misstated key results of the MIRA study, which investigated the effect of a prevention package of the diaphragm, lubricant, and male condoms, compared to male condoms alone, for prevention of HIV and STI among Zimbabwean and South African women.1 We wrote: “Of note, self-reported condom use was similar for both arms at baseline, but during follow-up, significantly more women in the diaphragm arm than in the control arm reported condom use during the last sex act.” Actually, as is demonstrated by the figure in the Lancet publication that we cited, during the follow-up period participants’ reported condom use at last sex was lower in the intervention (diaphragm, lubricant and condom) arm compared to the control (condom only) arm.Keywords:
Female condom
Vaginal microbicide
Sub-Saharan Africa is the region worst affected by the HIV pandemic, hosting over 64% of global infections. Women are
disproportionately affected, with reports of almost 60% of infections among women between the ages of 15 and 49 years in
sub-Saharan Africa. In South Africa, 1 in 4 women are infected by the age of 25 years. Biological, socio-economic and cultural
factors contribute to the vulnerability of women to HIV. The only effective method of HIV prevention, the male condom, is not
in the control of women. It has therefore become increasingly clear that female-initiated methods or technologies need to be
developed to allow women to have control over their sexual health, and HIV prevention in particular. Microbicides are one of the female-initiated technologies for prevention of HIV among women. The products could be
formulated as gels, creams or suppositories. The concept is based on application of the product in the vagina prior to sexual
intercourse to prevent HIV infection. There are several products in the pipeline, their development ranging from early stages to
large-scale efficacy trials. The field of microbicides research is increasingly gaining momentum in South Africa and elsewhere. South Africa is host to five phase III clinical trials; four microbicide trials and one trial of vaginal diaphragms for HIV prevention. The majority of microbicides being tested are compounds called fusion inhibitors which act by preventing the binding of HIV to target cells in the vagina.
Vaginal microbicide
Pandemic
Female condom
Cite
Citations (0)
We present a simple mathematical model for assessing the effects of introducing a microbicide as an HIV infection protective method. As very little is known about the in vivo efficacy of microbicides, we ran sample scenarios for microbicides of various efficacies. We found that, in general, if existing condom usage in a community is low, introducing a microbicide will most likely have a positive impact on HIV incidence as abandonment of condom use in favor of microbicides will not play a significant role. If condom use in a community is high, though, attrition of condom users could play a role large enough to overwhelm any added risk reduction afforded new microbicide users. Our model illustrates the importance of knowing key behavioral parameters, such as the proportion of the population that uses condoms, before microbicides can be safely introduced. These parameters include the proportion of condom users likely to maintain condom use and the proportion of condom nonusers likely to adopt microbicides, as well as the efficacy of the candidate microbicide.
Vaginal microbicide
Female condom
Pre-exposure prophylaxis
Cite
Citations (25)
Abandoning condoms for microbicides is termed 'condom migration'. This study estimated the reduction in condom use that can be tolerated following the introduction of an HIV- and sexually transmitted disease (STD)-efficacious microbicide without increasing an individual's risk of HIV infection, and explored how microbicide use affects HIV-risk.Development of a static mathematical model to compare how different combinations of condom and microbicide use affect individual risk of HIV and STD infection at a particular point in time.The model is used to identify the 'break-even point' at which any increased risk associated with condom migration is counter-balanced by the protection afforded with microbicides. Data from Benin is used as a case-example.Considering a 50% HIV- and STD-efficacious microbicide, groups that use condoms with 25% consistency or less could cease using condoms without increasing their risk if they use microbicides in 50% or more of sex acts. However, migration may increase risk if the initial condom-consistency is high (> 70%) and microbicide-consistency is low (< 50% of non-condom-protected acts). For the Benin case-example, if condoms are initially used in 70% or less of sex acts, and if consistency of condom use is sustained following microbicide introduction, there will be a 20% or greater reduction in HIV-risk if the microbicide is used in 50% of non-condom-protected sex acts.There are likely to be many situations in which the benefits of microbicide use outweigh the negative impact of condom migration, and where microbicides could substantially reduce HIV-risk.
Vaginal microbicide
Female condom
Cite
Citations (132)
Female condom
Vaginal microbicide
Cite
Citations (0)
Men desire to be involved in their partner's decision-making about vaginal microbicide use. This coincides with women's desire to inform male partners about their microbicide use. Educating men about microbicides may enhance acceptability and generate critical support for the female participants of microbicide trials. In this multiphase mixed-methods study, we adapted an educational intervention on vaginal microbicides and tested it among men (n = 45) to determine its effect on men's knowledge regarding HIV/STI, vaginal microbicides and microbicide trials. We also conducted focus group discussions (FGDs) with the female partners (K = 3, n = 43) of the study participants and community representatives (K = 2, n = 24) to obtain their views on male partner microbicide education. We analysed FGD data for key themes using content analysis. HIV and vaginal microbicide knowledge scores increased significantly among men after the educational intervention. Both women and men highly supported male partner microbicide education, in the context of existing gender relations, to increase men's understanding about microbicides, promote adherence and help women gain their partners' trust. Complex gender dynamics should be considered when designing male partner educational interventions to improve acceptability and the use of microbicides and other female-initiated HIV prevention methods.
Vaginal microbicide
Cite
Citations (0)
The impact on HIV prevalence in men and women of the introduction of vaginal microbicides, and subsequent changes in condom usage, depends critically on the efficacy of microbicides in both blocking transmission to women and reducing the infectiousness of infected women. Neglecting to consider how differences in microbicide efficacy by direction of transmission can affect HIV prevalence over time will result in underestimation of the effect of condom replacement.
Vaginal microbicide
Female condom
Cite
Citations (16)
It is often true that women lack the autonomy to insist on condom use during intercourse, even when the men engage in behavior that facilitates the heterosexual transmission of HIV/AIDS and sexually transmitted diseases. Therefore, researchers are seeking new options for women in the form of female condoms and vaginal spermicides. In July 1996, the US Secretary of Health and Human Resources announced that the US government will devote $100 million to microbicide research over the next four years. The goal is to create inexpensive products that could be used without detection. An initial microbicide trial is nearing completion in Cameroon, where the ability of the contraceptive nonoxynol-9 to protect against HIV transmission is being studied in 1000 female prostitutes. Barriers to research into microbicides include a lack of resources, the unwillingness of major pharmaceutical companies to invest in the research, and ethical issues relating to testing products on humans.
Vaginal microbicide
Sexual transmission
Female condom
Cite
Citations (0)
Vaginal microbicide
Intravaginal administration
Female condom
Intrauterine device
Cite
Citations (23)