Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

622 Abstracts 33151-33154

12th World AIDS Conference

the products (74%, MAMG-78%, LI and RVM). Most women said they would be
willing to use a similar product (73%, MAMG-82%, RVM) with their main sexual
partner if it was shown to be as effective against HIV as a male condom; 94%
said they would be willing to pay for such a product.
Conclusions: Drug-involved women are willing to use vaginal microbicides if
such products are shown to be effective against HIV. The results of this study -
e.g. regarding ease of insertion, disposable applicators, and concern with "messiness" during sex - should be considered in the develop-ment and marketing
of microbicide products. Such products may represent important woman-controlled methods of HIV prevention for this highly at-risk population. (Supported by
National Institute on Drug Abuse Grant #1 R01 DA10871-01)
33151 Acceptability of a vaginal microbicide among sex
workers in Kwazulu Natal, South Africa
Gita Ramjee, S.S. Abdool Karim, N.S. Morar. Medical Research Council, PO.
Box 17120, Congella Durban 4000, South Africa
Objectives: To assess the user's opinions of the acceptability of a vaginal microbicide (COL-1492) and its compatibility with the preference for "dry sex" among sex
workers at truck stops in the KwaZulu-Natal Midlands. Further, to assess whether
COL-1492 is associated with changes in the vagina and cervix as determined by
colposcopy.
Design: A randomised double-blinded placebo controlled trial conducted in
March to June 1996 among sex workers at truckstops in KwaZulu Natal, South
Africa.
Method: Twenty sex workers were randomised after informed consent was
obtained, to receive their COL-1492 (which contains 52.5mg of nonoxynol 9) or
a placebo. The first month of use was followed by a one month washout period,
thereafter the women use the alternate product during the third month. Baseline
and fortnightly assessment included microbiology and serology for sexually transmitted diseases, questionnaires to assess acceptability of the COL-1492 and
a clinical examination with colposcopy for ulceration, abrasions, ecchymoses,
petechiae, oedema and erythema. Frequently of coitus, condom use and product
use was recorded on a self-administered coital log.
Results: While on COL-1492, 19 of the 20 women found the product entirely satisfactory, a similar proportion found the placebo unacceptable. There
were no complaints that COL-1492 made then "Wet" and thereby interfered with
"dry sex". On colposcopy, petechial haemorrhages, oedema and abrasions were
found in the women using dry COL-1492. The same lesions were found during
placebo use. The incidence of gonorrhoea, C.Trachomatous were reduced in the
COL-1492 group.
Conclusion: Col-1492 was found to be acceptable by sex workers. Comments
on COL-1492 included "helps prevent STD and HIV" AND "clients do not know gel
is inside". No serious adverse events were reported during the trial. COL-1492
was not associated with more colposcopic changes in the vagina and cervix
compared to placebo use. Conditions are conducive within this cohort of sex
workers for a COL-1492 efficacy trial.
33152 Real experience: The key to vaginal microbicide
acceptability
Margaret Chesney1, M.E. Bentley2, K.M. Morrow3, K. Mayer3. 1UCSF
Prevention Sciences Group 74 New Montgomery San Francisco, CA; 2Johns
Hopkins University Baltimore MD; 3Brown University Providence RI, USA
Objectives: To determine whether acceptability of a vaginal microbicide is influenced more by initial attitudes about microbicides or experience with actual
products.
Methods: As part of a Phase I Study of BufferGel, a novel vaginal microbicide,
27 low risk abstinent or monogamous women in Rhode Island responded to
self-report questionnaires assessing acceptability of vaginal microbicides. Mean
age of the women was 31 years; 63% were White, 15% Hispanic, 11% African
American, and 11% Other. Acceptability data were collected at enrollment and
after daily use of the product for four weeks. At the end of the study, women were
asked about their willingness to try BufferGel if approved for vaginal use. With no
differences between abstinent and monogamous women on key variables, the
data were combined for this analysis.
Results: At enrollment, women indicated that they would be more willing to
try microbicides that are gels rather than creams. While the majority (85%) were
moderately or very willing to try gels, 15% were only slightly willing. The women
had no preference for reusable or disposable applicators. After using the product,
100% of the women indicated liking BufferGel's color. Conversely, although 100%
of the women indicated a willingness to use reusable applicators prior to the
study, after experience with the reusable BufferGel applicator, 7 of these women
reported not liking the applicator, particularly the fact that it had to be washed
between uses. After daily use of BufferGel, 75% of the women said that they
would use the microbicide if it were approved for vaginal use. This willingness
was not related to any sociodemographic factors, or any attitudes or preferences
assessed prior to use. This willingness was supported by a positive change in

attitudes about clear gel after experience with the product. There was also a trend
indicating that not being willing to use BufferGel is associated with reports of not
liking reusable applicators, after having had experience with them.
Conclusions/Lessons Learned: Actual experience with vaginal microbicides
rather than attitudes prior to use are associated with willingness to these products
in the future. Strategies that encourage women to try these products are more

likely to increase vaginal microbicide use than educational campaigns designed
to change pre-existing attitudes.
33153 Reduced STD reinfection and more protected acts with a
choice of methods: The women's risk reduction hierarchy
Erica Gollub'2, P. French3, C. Rogers2, M. Latka4, Z.A. Stein5. 114 Rue Dieude
13006 Marseille, France; 2Dept. of Public Health, Philadelphia, PA; 3Smithkline
Beecham, Collegeville, PA; 4New York Academy Medicine/Columbia University,
New York, NY; SColumbia University/Ny Psychiatric Instit., New York, NY US
Background: Although women's risk of sexually-acquired HIV and other STD's
is superior to that of men, the most common counseling approach consists of
training on the male condom. The "women's risk reduction hierarchy" gives information and training on male and female condoms, diaphragms and cervical caps,
spermicides, and withdrawal to reduce risk of infection.
Methods: The Philadelphia Women's Health Sister Studies is a large study
of counseling approaches for women in the context of a busy inner-city STD
clinic. 292 women agreed to participate in a prospective cohort study of different
counseling approaches, including Male Condom only (MC), Female Condom only
(FC), and Hierarchy approach. We present here results on 88 of 118 women in
the hierarchy cohort (HC) who returned for 6-mo follow-up (FU).
Results: Male and female condoms were used by 85% of those sexually active
with a main partner (SAMP) in the HC, and spermicides and/or diaphragm/cap by
56%. For all SAMP in the HC, the proportion of protected acts (PPA) rose from
30% at intake to 76% at FU (p = 0.00). For those using condoms with spermicides,
the PPA was 82% at FU (p = 0.00). Among 11 SAMP reporting no condom use at
FU, 6 (55%) used spermicides. For these 11, the PPA was 6% at intake and 41%
at FU (p = 0.02). For the 6 women using spermicides but no condoms at FU, the
PPA rose from 10% at intake to 75% at FU (p = 0.01). Over 6 months, reinfection
rates (with gonorrhea, early syphilis, trichomonas, chlamydia) were 19% lower
for the HC than for the MC or FC.
Conclusions: Spermicide availability resulted in a substantial and significant
increase in PPA for women with main partners who reported no condom use.
Reinfection rates with the hierarchy were lower than those with a single-method
approach. Choice in methods, including spermicides, represents an important
advance in reducing the risk of HIV/STD infection in women.
33154 Factors affecting acceptability of vaginal microbicides
among drug-involved women: Results of focus groups in
three cities
Theresa H. Mason1, S.E. Foster1, H.A. Finlinson2, K.M. Morrow3,
S. Vining-Bethea4, G.R. Seage5. ABTAssociates Inc. 55 Wheeler Street,
Cambridge, MA 02138; 3Brown U. CNTR Alcohol & Addiction Stud. Providence
RI; 4GTR Bridgeport Adol Pregnancy Prog. Bridgeport CT; "Boston University
Boston MA, USA; 2 School of Medicine, UCC Bayamon, Puerto Rico
Background: New woman-controlled methods of prevention are urgently needed
for women at high risk for HIV. Information on facilitators of and barriers to
acceptance of vaginal microbicides for such women is needed.
Methods: 14 focus groups were conducted in 3 cities - Bridgeport, CT; Providence, RI; and San Juan, Puerto Rico: 9 groups totaling 64 women heroin users,
crack users, and sexual partners of male drug injectors; 3 groups totaling 24
adult male drug injectors; and 2 groups totaling 17 high sexual risk adolescents.
Participants discussed perceptions of risk, experiences with HIV risk reduction
and contraception, and vaginal spermicide and lubricant products.
Results: Facilitating factors include: 1) Interest in and motivation for using woman-controlled methods to prevent sexual transmission of HIV was high
among adult women due to a deeply personalized sense of risk and to frustrations
with existing options; 2) Males and females report diminished sexual pleasure
with condoms as a positive motivator for using alternative anti-HIV products;
3) Women expressed extreme conflict between fear of infection and difficulty
insisting on condom use with their steady drug injecting versus casual partners,
suggesting a need for woman-controlled products; 4) Lubrication during vaginal
intercourse generally held positive associations for males and females. Possible
barriers to acceptance include: 1) Females were concerned about what excessive
lubrication or discharge might signify to male partners (e.g. infection, infidelity,
improper hygiene); 2) Women with multiple sex partners prefer condoms to topical products to ensure removal of ejaculate from their vaginas immediately after
intercourse; 3) Sex workers and others who have multiple sex acts in succession
expressed concern that repeated applications of vaginal products would produce
excessive lubrication and "messiness". These results informed subsequent trials
of three products.
Conclusions: Females at high risk of HIV infection through their own and/or
their partners' drug use show strong interest in and motivation for using womancontrolled anti-HIV products. Preliminary evidence suggests differences in the
priority of acceptability factors for vaginal products used with steady partners
as compared with casual and commercial sex partners. Identified facilitators
and barriers to product acceptability should be incorporated into the design and

dissemination of vaginal microbicide products.
Supported by National Institute on Drug Abuse Grant #RO1DA 10871-01