01 Ssali Adjusting Cultural Patterns In Hiv Prevention No V Version Final


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01 Ssali Adjusting Cultural Patterns In Hiv Prevention No V Version Final

  1. 1. 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
  2. 2. Background • Vaginal microbicides: – to reduce the risk of HIV infection in women – increase choices of HIV prevention • Cultural practices may promote or hinder adherence to microbicide. 2
  3. 3. UGANDA STUDY AREA Kampala Entebbe Lake Victoria 75 miles
  4. 4. Objective • To explore patterns of communication and practices related to sexual activity among HIV- discordant couples participating in a vaginal microbicide trial in Uganda. 4
  5. 5. Microbicides Development Programme (MDP) • 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+) 5
  6. 6. Methods – main study • Couples were identified through community surveys and VCT centres • Enrollment was done after couple VCT and the participants provided with study information • Study gel in pre-filled applicators were used before each sex act, in addition to condoms. 6
  7. 7. 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’ homes 7
  8. 8. Methods – sub-study • Interviews focused on communication and decision-making between couples • Data were analysed thematically with the support of Nvivo 2 soft-ware. 8
  9. 9. Results- Communication • Most women reported that sex issues were talked about regularly with their partner including condom use; • Reasons include: need for support to avoid HIV transmission, to avoid mistrust • Most women (90%) had informed their partners before inserting the gel. 9
  10. 10. “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 10
  11. 11. Decision making • 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. 11
  12. 12. “I decide for myself, he cannot force me, he sees it and l decide on gel use; he decides on condom use” 23 year old female 12
  13. 13. Challenges for men • Some women insisted on condom use when their male partner did not want to use them • Failure to enjoy sex because of the condom • Refusing to accept that their partner was really HIV-negative 13
  14. 14. Challenges for women • Living in constant fear of infection, so negotiation for safer-sex required all the time • Desire to have children while knowing the risk of HIV-infection • Inconvenient environment in which to use gel (where rooms were shared with grown- up children) 14
  15. 15. 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 sexual partner • Agreeing to adapt to gel and condom use. 15
  16. 16. Conclusion • 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. 16
  17. 17. Acknowledgements • MRC/UVRI Uganda Research Unit on AIDS • Study participants • MDP study team • Partners/collaborators • Sponsors (DFID UK, MRC UK) 17