Engaging with men about microbicides

Engaging male partners in women's microbicide use: evidence from clinical trials and implications for future research and microbicide introduction.

Lanham M, Wilcher R, Montgomery ET, Pool R, Schuler S, Lenzi R, Friedland B. J Int AIDS Soc. 2014 Sep 8;17(3 Suppl 2):19159. doi: 10.7448/IAS.17.3.19159. eCollection 2014.

Introduction: Constructively engaging male partners in women-centred health programs such as family planning and prevention of mother-to-child HIV transmission has resulted in both improved health outcomes and stronger relationships. Concerted efforts to engage men in microbicide use could make it easier for women to access and use microbicides in the future. This paper synthesizes findings from studies that investigated men's role in their partners' microbicide use during clinical trials to inform recommendations for male engagement in women's microbicide use.

Methods: We conducted primary and secondary analyses of data from six qualitative studies implemented in conjunction with microbicide clinical trials in South Africa, Kenya, and Tanzania. The analyses included data from 535 interviews and 107 focus groups with trial participants, male partners, and community members to answer research questions on partner communication about microbicides, men's role in women's microbicide use, and potential strategies for engaging men in future microbicide introduction. We synthesized the findings across the studies and developed recommendations.

Results: The majority of women in steady partnerships wanted agreement from their partners to use microbicides. Women used various strategies to obtain their agreement, including using the product for a while before telling their partners, giving men information gradually, and continuing to bring up microbicides until resistant partners acquiesced. Among men who were aware their partners were participating in a trial and using microbicides, involvement ranged from opposition to agreement/non-interference to active support. Both men and women expressed a desire for men to have access to information about microbicides and to be able to talk with a healthcare provider about microbicides.

Conclusions: We recommend counselling women on whether and how to involve their partners including strategies for gaining partner approval; providing couples' counselling on microbicides so men have the opportunity to talk with providers; and targeting men with community education and mass media to increase their awareness and acceptance of microbicides. These strategies should be tested in microbicide trials, open-label studies, and demonstration projects to identify effective male engagement approaches to include in eventual microbicide introduction. Efforts to engage men must take care not to diminish women's agency to decide whether to use the product and inform their partners.

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Editor’s notes: Microbicides were initially conceived as being products that would enable women to protect themselves from HIV without prior negotiation with their partners. However, the experience from microbicide trials shows that in general, male partners play an important role in women’s microbicide use. This paper synthesizes the findings from qualitative research conducted as part of trials in east and southern Africa. The findings highlight that men’s responses to products vary widely, and that women use a range of strategies to obtain men’s agreement. The findings show that no one strategy will fit all women’s needs; and that the priority should be to support women’s agency to decide whether to use microbicides, how to introduce the subject with their partners, and ultimately gain their support. Currently different strategies of male engagement are being used within trials. But the positive and negative effects of different approaches – including their effect on partner communication, relationship quality and intimate partner violence - are not being routinely measured. The paper shows the need for further research in microbicide trials, open-label studies, and demonstration projects, not only on how to support women’s ability to access and use products, but to also to help ensure consistent product use, which is crucial to the overall effectiveness of products.

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