Microbicides in the bedroom

Bedroom politics were in the spotlight this week at the fourth international conference on microbicides in New Delhi, India, as researchers explored the power dynamics in sexual relationships, and their implications for microbicides.

The idea behind microbicides has always been to finally give women the power to protect themselves from HIV infection. But how would this work in the real world, where the power still largely rests with men?

According to Ravi Varma, a researcher exploring male sexuality in India, sexuality is a tool of control and power, and men would find it hard to accept something that could change this.

Varma presented findings of a survey that sought to gauge the reaction of Indian men to condom and microbicide use. The study found that more than half the men interviewed would be "outraged" if their wife suggested they use condoms; an even larger percentage viewed women who carried condoms as "loose".

He said men held wives to different standards from other partners, who would be permitted to use a microbicide, while their wives would not be allowed to use this potential prevention method.

Although HIV is transmitted mainly through heterosexual sex in much of Africa and Asia, there is no widely available female-controlled HIV prevention method. The female condom, the only female-controlled HIV prevention method, is still beyond the reach of many women who need it.

An effective microbicide would be important for women whose partners refused to use condoms because, in theory at least, it could be used secretly, without the male partner's knowledge.

But studies of women participating in microbicide trials have revealed that covert and autonomous use of the gel may not be feasible. Most sex is spontaneous, so inserting the gel secretly would be difficult; the desire for intimacy and sharing in established relationships could also make it problematic to keep the gel hidden.

Oliver Mweemba, a social scientist researcher at the University of Zambia, said trial participants reported that they had informed their partners they were using the gel, as they were scared their partner might feel the difference during sex because the vagina was "too wet".

While microbicides are designed to be woman-initiated, the dynamics within sexual relationships can't be ignored...

He noted that some men responded positively, even going so far as to help their partners insert the gel, and reminding them to use it, while others discouraged the women from using it.

In Zimbabwe, women expressed fears that they would be accused of promiscuity if they used the gel, and also that their partners would see this as an incentive to become unfaithful. "The man might think there is something that she is doing somewhere else; where would she get that idea [to use the gel]?" one participant was quoted as saying.

"While microbicides are designed to be woman-initiated, the dynamics within sexual relationships can't be ignored ... they may impact gel acceptability and use," warned Jessica Phillips, of South Africa's Medical Research Council (MRC).

She said an MRC study found that women who told their partners they were using the gel while participating in trials were able to use the gel most of the time they had sex. Women with supportive partners were more likely to use the gel consistently and follow trial procedures correctly.

Manju Chatani, coordinator of the African Microbicides Advocacy Group, agreed that use of the gel would ideally involve a discussion between the woman and her partner, but said this might not always be possible.

"There are women who are in situations where they cannot talk about those issues; there are situations where women don't have permission to talk about [how] to protect themselves, and we always have to keep in mind that even those women should be in a position to have options," she told IRIN/PlusNews.
"Of course we will be encouraging discussion, but when it cannot be discussed, we will still be encouraging use."

While microbicides could offer women more control over how they choose to protect themselves against HIV, inherent gender imbalances in the bedroom, and beyond, will persist.

"What we really need is a structural response, where we look at gender equality issues; where women are empowered, where women can protect themselves, where men are using more male condoms, and women can use female condoms," Chatani added. "Microbicides could be part of that package."

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