Transcript of "01 Ssali Adjusting Cultural Patterns In Hiv Prevention No V Version Final"
Patterns of Communication and
Practices Related to Sexual Activity
Among HIV- Discordant Couples
Participating in a Vaginal Microbicide
Trial in Uganda
Agnes Ssali1, S.Namukwaya1 ,H. Grosskurth1,2,
J.Seeley1,3, R.Pool4, A. Kamali1
1MRC/UVRI Uganda Research Unit on AIDS
2 London School of Hygiene and Tropical Medicine
3 University of East Anglia
4 Barcelona Centre for International Health Research
• Vaginal microbicides:
– to reduce the risk of HIV infection in
– increase choices of HIV prevention
• Cultural practices may promote or hinder
adherence to microbicide.
Lake Victoria 75 miles
• To explore patterns of communication and
practices related to sexual activity among
HIV- discordant couples participating in a
vaginal microbicide trial in Uganda.
• A phase III multi-centre trial evaluating the
efficacy and safety of a microbicide gel (PRO
2000) for the prevention of HIV infection
• In Uganda, 840 HIV discordant couples were
enrolled (F-/ M+)
Methods – main study
• Couples were identified through community
surveys and VCT centres
• Enrollment was done after couple VCT and
the participants provided with study
• Study gel in pre-filled applicators were used
before each sex act, in addition to condoms.
Methods -- sub-study
• A random sample of 150 couples were
selected for in-depth interviews
• Of these144 of the female and 106 of the
male partners consented to participate in
individual in-depth interviews
• Interviews conducted in participants’
Methods – sub-study
• Interviews focused on communication and
decision-making between couples
• Data were analysed thematically with the
support of Nvivo 2 soft-ware.
• Most women reported that sex issues were talked
about regularly with their partner including condom
• Reasons include: need for support to avoid HIV
transmission, to avoid mistrust
• Most women (90%) had informed their partners
before inserting the gel.
“I had to tell him because we are to use
gel together, so couldn't hide it because if
he came across it, it would bring problems
yet gel may protect one of us from the
problem that exists”
39 year old female
• In the majority of cases the decision to use
gel and condoms was made jointly
• However, in some cases some men and
women made the decision on their own
without consulting their partner.
“I decide for myself, he cannot
force me, he sees it and l decide
on gel use; he decides on
23 year old female
Challenges for men
• Some women insisted on condom use
when their male partner did not want to
• Failure to enjoy sex because of the
• Refusing to accept that their partner was
Challenges for women
• Living in constant fear of infection, so
negotiation for safer-sex required all the
• Desire to have children while knowing the
risk of HIV-infection
• Inconvenient environment in which to use
gel (where rooms were shared with grown-
How are couples trying to adjust
to safer-sex methods?
• Accepting joint decision-making (not just
the man to decide)
• Voluntary counseling and testing as a
couple and sharing HIV test results with
• Agreeing to adapt to gel and condom use.
• These data are from a trial and may not be
representative of the general population
• However the findings indicate:
– A shift in practices about sex related decisions
– The prevailing HIV/AIDS situation has led to
increased communication about sex, and safer-
sex in particular, among couples.
• MRC/UVRI Uganda Research Unit on
• Study participants
• MDP study team
• Sponsors (DFID UK, MRC UK)
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