Sahin-Hodoglugil Nuriye Nalan, Montgomery Elizabeth, Kacanek Deborah, Morar Neetha, Mtetwa Sibongile, Nkala Busisiwe, Philip Jessica, Ramjee Gita, Cheng Helen, van der Straten Ariane
School of Public Health, University of California, Berkeley, USA.
AIDS Care. 2011 Aug;23(8):1026-34. doi: 10.1080/09540121.2010.543879.
Methods for Improving Reproductive Health in Africa (MIRA), a phase III HIV prevention trial, was conducted among 5039 Zimbabwean and South African women to test the Ortho All-Flex diaphragm and Replens(®) lubricant gel. Among the 2418 intervention group participants, 105 women who had completed the trial and 41 male partners participated in focus group discussions and in-depth interviews about the acceptability of the diaphragm and gel and their experiences using the study products. Women who participated in the qualitative study had exited the trial in the prior nine months, were HIV negative, and used the diaphragm and gel for 12-24 months. The comprehensive and flexible conceptual framework was applied to investigate the salient attributes for acceptability of the products as potential HIV prevention methods, and emerging themes for acceptability were framed within three categories of attributes (product, relationship, and sexual intercourse attributes). Both diaphragm and gel were found to be highly acceptable in the study group, and the gel was popular due to its effect of enhancing sexual pleasure. Some of the important product attributes influencing acceptability as reported by users were convenience, ease of use, dual use potential for contraception and disease prevention, and being female-initiated. It was also noted that some elements (such as sexual pleasure, couple communication, and the necessity of diaphragm negotiation) could be more important than others in terms of influencing product acceptability and use. Acceptability attributes reflective of the broader contextual environment (beliefs generated in the trial community suggesting preventive efficacy - preventive method optimism - and gendered norms favoring male superiority in sexual decision making) also emerged as important themes. The high level of acceptability of the diaphragm and gel among MIRA trial participants and their male partners is an indicator of the continued need for an effective female-initiated product.
“非洲改善生殖健康方法”（MIRA）是一项三期HIV预防试验，在5039名津巴布韦和南非女性中开展，以测试奥豪全柔型子宫帽和Replens®润滑凝胶。在2418名干预组参与者中，105名完成试验的女性和41名男性伴侣参与了焦点小组讨论和深入访谈，内容涉及子宫帽和凝胶的可接受性以及他们使用研究产品的体验。参与定性研究的女性在之前九个月退出了试验，HIV检测呈阴性，且使用子宫帽和凝胶12至24个月。采用全面且灵活的概念框架来调查产品作为潜在HIV预防方法的可接受性的显著属性，可接受性的新出现主题被归入三类属性（产品、关系和性交属性）。研究组发现子宫帽和凝胶都具有很高的可接受性，凝胶因能增强性快感而受到欢迎。用户报告的一些影响可接受性的重要产品属性包括便利性、易用性、避孕和疾病预防的双重用途潜力以及由女性主动使用。还指出，在影响产品可接受性和使用方面，一些因素（如性快感、伴侣沟通以及协商使用子宫帽的必要性）可能比其他因素更重要。反映更广泛背景环境的可接受性属性（试验社区中产生的表明预防效果的信念——预防方法乐观主义——以及在性决策中有利于男性主导地位的性别规范）也成为重要主题。MIRA试验参与者及其男性伴侣对子宫帽和凝胶的高度可接受性表明，仍然需要一种有效的由女性主动使用的产品。
