Male Partners of Young Women: Assessing their Attitudes towards Topical Microbicides

Abstract

Male partners’ attitudes toward microbicide use are important to understand; however, there are challenges in conducting research with adolescent couples. We describe the experience of recruiting male partners of adolescent females enrolled in a microbicide acceptability study. Creative solutions to enrolling partners of young women in studies need to be explored.

Introduction

Topical microbicides are products in development, which would be placed inside of the vagina to prevent the spread of HIV/AIDS and sexually transmitted infections (STIs). Initially, microbicides were viewed as offering an important advantage to other methods because they would be female-controlled and could possibility be used without partner knowledge. However, it has become clear that although women may be able to use these products without partner consent, male attitudes are paramount because most women say they would inform a partner, partners may be able to detect the presence of a microbicide, and men prefer to be told about use of a microbicide [1-4]. Further, research suggests that adolescents who communicate with their partners are more likely to implement STI preventive behaviors [5]. Young women are a target population for microbicide use; thus, it is important to understand their partners’ attitudes toward microbicide use [6]. However, there are challenges in conducting research with adolescents on sensitive topics. We describe the obstacles experienced in enrolling male partners of young women participating in a microbicide acceptability study as well as qualitative data of male partners’ attitudes towards microbicides.

Methods

Enrollment and Participants

One hundred and sixty-five females, ages 14 to 21, attended the final visit of a microbicide acceptability study [7-8]. The Institutional Review Board (IRB) stipulated that we could not offer male partner enrollment for any young women under the age of 18, because of concerns about identifying males engaging in statutory rape. An offer to educate the females about statutory rape laws prior to referral of partners was not considered sufficient. In addition, because of concerns that the young woman could purposefully or inadvertently place a male at psychological risk by identifying him as a sexual partner, the IRB required that the young women ask the partner to contact the research team. Thus, the young woman had to remember to give her partner the flyer with the contact information, and the partner had to be willing to call the research team. In addition, the young woman had to be comfortable talking to her partner about the study and the study personnel's interest in him. Further, the male partner's data was not allowed to be linked to his partner's data. There were 100 age eligible young women, and of those 100 young women, 58 took a flyer. Eleven male partners attended the visit.

These 11 male partners completed a face-to-face interview which included demographics and questions regarding their attitudes toward microbicides. The male partners were shown two microbicide-like products (gel and a suppository), which the young women had been given to use [7-8]. These products were vaginal moisturizers which are not known to have any STI or contraceptive properties. The young women were informed that the product would not provide any protection.

Results

The male partners had a mean age of 23 years (range = 18 to 36 years). Six of the participants were African-American, 3 were Hispanic, and 2 were non-Hispanic Caucasian. The 58 females were mostly non-Hispanic Caucasian (n = 25, 43%), followed by Hispanics (n = 18, 31%) and African-American (n = 15, 26%). In response to a list of relationship types, 3 participants reported being “engaged,” 7 described being in a “steady boyfriend/girlfriend” relationship, and 1 was in a “seeing other people/casual” relationship. It is unknown who were the female partners of these participants; thus, demographic characteristics of the relevant young women can not be reported.

Eight of the 11 male partners reported that they had used a product like the gel, and 3 of those 8 males also had used a product like the suppository. Only those males who had never used a similar product believed that the young woman could successfully use it without their knowledge. The males saw messiness, penile irritation, and concerns about fidelity as discouraging use. For some males, a product that required waiting after insertion was a barrier to use. However, most were able to solve the problem of waiting through planning and/or foreplay. The males reported that doctors, significant others and the media could help foster use by educating them about the effectiveness of microbicides. Many of the males who were skeptical that these products would be effective in preventing STI/HIV were concerned about the lack of a physical barrier and the small amount of product volume. A few of the males viewed microbicides as having advantages over condoms since condoms were perceived as decreasing sensation.

Discussion

Topical microbicides will be used with a partner and are now more typically described as female-initiated rather than female controlled. In order to promote their use once they are on the market, it will be important to be knowledgeable about males’ attitudes since it can be assumed that conversations about use are likely to occur between partners [1-4]. Thus, the attitudes of the partners of young women should be investigated in order to facilitate use once microbicides are on the market. The methods allowed for recruitment in this study and the inability to link the data were limitations in this study. It seems unlikely that this data represents the full range of attitudes of partners of young women since the participants were all 18 years or older and most were in steady relationships. In addition, since we could not link the data to the females’ experience and actual use, we were not able to tell the degree to which the male's attitudes were related to experience or to their female partners’ attitudes. Despite these limitations, these males reported attitudes similar to young women, suggesting that general attitudes towards microbicides were positive, and that anticipatory guidance about the likelihood of side effects, and integration of the product into one's sexual life may be important.

Topical microbicide studies need to be designed in order to protect the emotional, physical, and legal safety of both male and female participants. This presents challenges, both for the adolescent participants and for IRBs. Adolescents may be in relationships which are not legal (although state laws differ in reporting requirements) and may be living with parents who do not know of their sexual or romantic relationships. In addition, our IRB was concerned about the psychological risk to a male of a female identifying him to the research team. The young women were instructed as to the statutory rape laws in Texas before referring a partner so as to protect them from identifying a younger male partner; however, clearly that was a risk for which the IRB was less concerned. It is unknown whether they were less concerned because they did not think it likely that the young woman would have a male partner or because they did not think such identification would pose a risk to the identified male or the young woman in the study making the referral. More research is needed as to what those psychological risks might be and how they can be managed. Others have managed the legal risks by limiting the demographic data collected on the male participants [9]. Partner notification practices for STI infections can allow partners to be recruited directly, but that is not applicable in most behavioral studies. Creative ways to reach partners should be evaluated for their psychological safety, practicality, and recruitment success. The Society of Adolescent Medicine could take a lead in compiling existing data, identifying knowledge gaps, and developing recommendations or guidelines for such research. It is imperative to find new ways to design microbicide studies that can elucidate the full range of male attitudes regarding microbicides, including adolescent males.