Emic perspectives on microbicides and sexual health: a new approach to acceptability.
Background: Vaginal microbicides have predominantly been conceptualised within a disease prevention framework. Another approach, presented here, looks at the way in which, within clinical trials, microbicides contribute more broadly to women's sexual health, encompassing: physical, emotional, mental and social wellbeing; absence of disease and dysfunction; positive sexual relationships; and safe and pleasurable sexual experiences. Methodology: In-depth interviews were conducted with a random sub-sample of women participating in the MDP301 Phase III microbicide trial. Data from 464 women at six sites in South Africa, Zambia, Tanzania and Uganda were analysed using grounded theory to generate an emic understanding of gel acceptability. Results: Women's experience of the gel was overwhelmingly positive. Four main, interrelated categories emerged as the locus of this response: sex, relationships, health, and wellbeing. Gel was reported by many women to remove the pain from sex and to make it more enjoyable, both for them and their partners. This was a source of satisfaction that appears to create stability in relationships, with several instances of cohabitation or access to partners' resources. Some women felt desired by their partners for the first time, or experienced a renewed sense of desire, and were thereby enabled to play a more active role in their sexual relationship. Emotional and mental wellbeing were fostered and further developed through the hope that gel might protect them from infection. Women also perceived their health to have improved, having less discharge and improved vaginal hygiene. Conclusion: This grounded theoretical analysis of data from actual experiences of gel suggests that an emic model of gel acceptability coincides with the WHO definition of sexual health. It indicates that it is time to move beyond limited notions of acceptability and start to think about how microbicides can fit into a bigger and more holistic picture of women's sexual health.
Montgomery, C.M. Emic perspectives on microbicides and sexual health: a new approach to acceptability. Presented at Microbicides 2008, New Delhi, India, 24-27 February 2008. (2008)