HIV This Week

Cohen JA, Steele MS, Urena FI, Beksinska ME. Microbicide Applicators: Understanding Design Preferences Among Women in the Dominican Republic and South Africa. Sex Transm Dis 2006 May 9; [Epub ahead of print].

Cohen et al aimed to identify acceptable microbicide applicator designs in 2 low-resource settings. They surveyed 895 women, randomly sampled from clinics in the Dominican Republic (n = 449) and South Africa (n = 446), with questions on sociodemographics, applicator attribute preferences, and price/design tradeoffs. They found that single-use design was the most valued attribute, and reusable design and low price were the least valued attributes in both populations. Preference for single-use design was associated with concern about reusable applicators spreading germs, secondary or higher education, older age, having children, and perception of moderate to high HIV risk. They conclude that acceptability factors related to microbicide delivery mechanisms should continue to be evaluated among potential microbicide users to directly inform product development and introduction of microbicides.

El-Sadr WM, Mayer KH, Maslankowski L, et al. Safety and acceptability of cellulose sulfate as a vaginal microbicide in HIV-infected women. AIDS 2006;20:1109-116.

El-Sadr et al conducted a randomized placebo-controlled trial to evaluate the safety and acceptability of 6% cellulose sulfate (CS) gel as a vaginal microbicide in sexually abstinent and active HIV-infected women. Sexually abstinent women applied the gel once or twice daily and sexually active women used gel once daily for 14 days. The authors found the CS gel to be safe with no reported severe or life-threatening adverse events (AE). 39 of 59 (66%) participants experienced urogenital AE probably or possibly related to gel, with no significant difference noted between the CS and placebo arms in the prevalence. There was no increase in AE by frequency of gel use or sexual activity with the exception of abdominal/pelvic pain which was noted more frequently with twice daily use among sexually abstinent women. Women and men found the gel highly acceptable. The authors conclude that they have demonstrated the vaginal gel was safe, well tolerated and acceptable by HIV-infected women and their male partners, and recommend further development of the gel as a potential method to prevent HIV transmission and acquisition.

Holt BY, Morwitz VG, Ngo L, et al. Microbicide preference among young women in California. J Womens Health 2006;15:281-94.

Holt et al integrated conjoint analysis with more traditional epidemiological and behavioural research to examine potential users' preferences for different microbicide formulations. Focus group discussions (n = 67) were held with a diverse population of young men and women (aged 18-32 years) from Northern California. Then young women participated in structured surveys (n = 321) that included a conjoint study, a methodology not yet used in microbicide acceptability. Participants' responses suggested that the ideal microbicide would (1) offer protection from pregnancy, HIV, STIs, and vaginal infections, (2) offer as much protection as condoms, (3) allow insertion up to 8 hours prior to sexual activity, (4) be available over the counter, (5) be inserted with an applicator, and (6) have only slight leakage not requiring a panty liner. The average predicted purchase probability for this ideal microbicide was 69%. The authors conclude that their findings help illustrate microbicide product preferences and demand among young women in California, and that the methodological approach should lend itself to other populations as well as during clinical trials when understanding product use and non-use is critical.