Microbicides, sexuality and sexual health in KwaZulu-Natal, South Africa
There is an urgent need for additional HIV prevention options for women. Evidence supporting the benefit of microbicides in reducing the risk of vaginally acquired HIV acquisition has provided a major breakthrough. Despite the wealth of evidence supporting microbicide acceptability in Africa, there are still gaps in our understanding about how women will incorporate microbicides into their everyday lives. In this thesis I examine whether vaginal microbicides are compatible with socio-cultural norms regarding sexuality and sexual health in a predominantly rural area of KwaZulu-Natal, South Africa. Using qualitative and quantitative data collected as part of the MDP 301 clinical trial at the Africa Centre, I adopt a mixed methods approach to evaluate microbicide acceptability from a cultural perspective. I explore the compatibility of microbicides with socio-cultural norms that relate to intravaginal cleansing, intravaginal insertion, love medicines and sexual communication. I found that the desired effects of using intravaginal insertions to enhance sexual pleasure are compatible with the experiences of using microbicides; that contemporary socio-cultural norms relating to sexual communication in the context of the HIV epidemic are compatible with the introduction of microbicides; that women distanced microbicides from ‘love medicines’ in terms of separating microbicides from the supernatural; and, finally, that postcoital intravaginal cleansing practices could undermine a microbicides roll out programme if we fail to address these practices. Overall I found that microbicides are compatible with socio-cultural norms relating to intravaginal insertion and sexual communication, but they may be less compatible with norms relating to intravaginal cleansing and love medicines. While incompatibility with socio-cultural norms raises challenges for intravaginal cleansing, the fact that love medicines are incompatible with microbicides could be advantageous for their introduction. Ultimately these findings have implications for future research and service delivery, as well as offering insights into microbicides, sexuality and gender equality.
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