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Title: Determinants of women's uptake of new barrier methods for HIV prevention in urban South Africa
Author: Terris-Prestholt, Fern
ISNI:       0000 0004 2702 0722
Awarding Body: London School of Hygiene & Tropical Medicine
Current Institution: London School of Hygiene and Tropical Medicine (University of London)
Date of Award: 2010
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Although there have been recent advances in HIV treatment, women still do not have a means to protect themselves from sexual transmission of HIV discreetly. Microbicides are products that would be applied vaginally to prevent HIV acquisition. Several microbicide products are being tested for their effectiveness in preventing HIV, and further studies of cervical barriers, such as the diaphragm, are planned. If found effective introduction and distribution systems need to be developed quickly to ensure women can access products and introduce them into their relationships. This study looks at determinants of women's demand for different barrier methods for HIV prevention to learn lessons for the introduction of new technologies such as microbicides and the diaphragm. A discrete choice experiment (DCE) was undertaken to identify critical factors to women's uptake of products. An iterative approach to the development of the DCE tool was taken. Qualitative group and individual interviews with women generated a wide range of potential factors influential to demand. An attribute identification workshop was introduced as a systematic method to reduce these attributes to the most important factors and identify the best way to represent them in the survey; this included the presentation of product effectiveness by the risk of HIV acquisition and becoming pregnant. During this workshop, women were given individual worksheets on which to rank the importance of the different attributes and levels in their decision to introduce, use and collect products. This provided individual responses in a group interview setting, which generated quantitative ranks on importance of attributes and their levels. Subsequently, a representative community survey was conducted among 1017 women in three Johannesburg townships. Women were asked questions about their socio-demographic backgrounds, their reproductive health histories and their preferences for different barrier methods and their distribution and promotion were elicited by a DCE. This study showed the usefulness of the attribute identification workshop in providing a structured framework for using women's attribute and level rankings to identify the importance of attributes generated in qualitative interviews and reduce these into a feasible and comprehensible DCE instrument. The analysis of women's preferences showed that there was a strong interest in the new barrier methods, microbicides in particular. The level of HIV effectiveness was very important in women's choices and will have an important impact on product uptake. Additionally, women who were successful in using condoms were predicted to have lower uptake of new products. Preferences for different distribution channels and ways of collecting product or advertising messages did not vary between products. However there was diversity in women's preferences for advertising messages, in particular in their valuation of promoting products for enhanced sexual pleasure, where employed women rated it positively. This study shows that women are very capable of using hierarchical messages about HIV effectiveness to make informed choices about how to best protect themselves from HIV in their situations. The different barrier methods can be distributed through similar distribution systems, but having a range of advertising strategies is likely to increase uptake of products by widening their appeal across different groups of women.
Supervisor: Hanson, K. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral