We would like to thank the people of the Umkhanyakude District for their support. We especially thank all the women and men who participated in the Africa Centre Microbicides Development Programme feasibility study, pilot study and MDP301 clinical trial. We also thank all the Africa Centre microbicide study staff for their commitment and dedication. This paper is dedicated to five staff members who have died since the start of the Africa Centre Microbicide Study: Bonisiwe Mfekayi, Rachel Gina, Derrick Xulu, Thobile Ndaba and Manini Ngwenya. The MDP301 clinical trial was sponsored by the UK Medical Research Council (MRC) and funded by the Department for International Development (DFID) and MRC. The Africa Centre for Health and Population Studies of the University of KwaZulu-Natal, South Africa, is supported through grants from the Wellcome Trust (082384/Z/07/Z).
Firstly, as microbicide gels are applied intravaginally they are particularly comparable with intravaginal insertions. Secondly, the main challenge to the acceptability of microbicides is in relation to the impact that a vaginal lubricant gel may have on sexual pleasure, especially in relation to a desire for ‘dry’ sex. To better understand whether a lubricant-based vaginal microbicide gel would be acceptable in communities where intravaginal insertions are used, we investigated the desired effects of intravaginal insertion. We then investigated how women experienced the use of vaginal gels in a microbicide clinical trial in KwaZulu-Natal. We compared these findings to further understand sexual practices, preferences and expectations.
Many respondents referred to a state of sexual preparedness that a woman was expected to achieve and this was most regularly described as a woman being ‘alright’ in advance of sex. For example, Fundile said that women use intravaginal insertions:
They insert to become dry [yomile] because maybe a woman feels that she is wet or there is water [discharge] coming out, then she needs things to insert to make her dry. (Zinhle, 28-year-old trial participant)
In terms of gel use, women used simame to describe the gel being ‘successful’ in enhancing sexual pleasure thereby having a positive impact on the relationship overall.
I can say if you are having sex with someone there is a difference between if you had sex with her many days ago or if you had sex with her yesterday. There is a difference that feels like this person has been having sex with another person. The difference is [when using gel] you cannot differentiate whether she has been with another person. (Nkule, male partner of 37-year-old trial participant)
The main strength of this study is our ability to investigate in depth the concept of dry sex among a cohort of women using lubricant-based vaginal gels. When respondents discussed the use of insertions to dry the vagina, it might have been assumed that vaginal secretions were being removed to reduce lubrication and increase friction. However, the same respondents described the lubricating gel as drying the vagina. The comparison between traditional intravaginal insertions and the gel has allowed us to critically review the idea of vaginal ‘dryness’. These trial participants could have been using one of three vaginal gels: 0.5% PRO2000, 2% PRO2000 or placebo. Consequently it will be important to evaluate whether reports of the gel drying the vagina, or in fact making sex hot or tight, differ by gel group in future analyses.
|Female participant FGDs||Female community FGDs||Male community FGDs|
|Total number of FGDs||6||3||6|
|Number of respondents||47||26||53|