Men's attitudes toward vaginal microbicides and microbicide trials in Zimbabwee
Context: Vaginal microbicides, if shown to be safe and effective, might be useful for the many Zimbabwean women at risk for HIV and sexually transmitted diseases (STDs) who fail to negotiate condom use with their sexual partners. Because Zimbabwean men have authority around sexual issues, their attitudes toward microbicides may determine whether such a method will be adopted and used. Methods: Five focus-group discussions were held with urban and rural Zimbabwean men to determine their attitudes toward communication about sex, HIV risk-reduction strategies, traditional vaginal practices, vaginal microbicides and their wives' participation in microbicide trials. Results: Several men indicated that they might prefer microbicides to condoms, if they are shown to be safe and effective. Some men expressed a concern about microbicides being spermicidal, and, because there is a cultural preference in Zimbabwe for "dry sex," some men expressed concern that microbicides may cause excessive lubrication of the vagina. Both urban and rural men were willing to use condoms or microbicides with girlfriends and prostitutes, but not with wives. A few men conceded that the secret use of microbicides by their wives might be possible, but that they would be angry if they learned of it. Most men said that they would be supportive of their wives' participation in microbicide trials, if they are asked for permission first and if proper medical care and insurance coverage are provided. Conclusions: If they prove to be safe and effective, microbicides might become widely used in Zimbabwe, particularly if they do not substantially lubricate the vagina or act as contraceptives. Social acceptance will be more likely if researchers directly inform men about these products and seek male permission for their female partners to enroll in microbicide trials.