Table 3.

Illustrative quotes about product use adherence.

Theme	Illustrative quote
(A) Team effort	Ah we just felt happy because what we expected-, to be told that ‘as a group’ we were doing well like a soccer ‘team’. Just to be told that all of us were doing well was pleasant than to be given the ‘result’ that some were using while others were not. Ah this pulls back progress [she meant if participants were not using the ring the study will not progress in terms of achieving its study objectives] Ok so can we say those ‘feedbacks' influenced participants' use of the ring in any way here at (clinic site)? Yes because there was going to be a few who would not use the ring but if they heard that all of you are doing well in [ring use] then they would also use. (SIDI3, Harare)
(B) Pride; effect of use on future generations	It is also something to be proud of when you will tell your relatives even after 50 years that, ‘Ah do you know that this ring being used we once-, it is us who made it to be approved for use to prevent HIV.’ (SIDI3, Harare)
(C) Empowerment	No, I told him to take the ring as the condom. I said: ‘Because you do not want the condom, this is now our condom, just ignore it, it's inside my body and it's mine. Because you don't want the condom so pretend as if this is my condom because you don't want to wear a condom I am wearing mine.’ We never had problems about it and we never spoke about it again. (SIDI2, Durban)
(D) Involuntary expulsions	No it never got out, I always placed it well, it never got out not when I am having sex, not when I am partying, not when I am urinating, not when I am bathing, it stayed there (in the vagina). (Single IDI, Johannesburg)
(E) Removal for sex	When my husband is in the mood for sex, then it's time for sex, which isn't the case with the other man. The other man will spend time caressing me (foreplay), which isn't the case with my husband. That's why I would remove it, fearing that he might feel it. I thought he’d quarrel about the ring. (SIDI1, Kampala)
(F) Removals for menses	During my first months [of using the ring] I used to feel uncomfortable, like when I was on my periods because I used tampons so I would feel uncomfortable when I was pulling out a used tampon. So during my periods I used to remove it maybe for the first 2 months but then I came here to the clinic and I explained to the [study] doctors and they told me, ‘No its fine’. From there onwards it has been like that. (SIDI3, Johannesburg)
(G) Others (young women) not using ring	I think, what I really wanted you to say, ever since I came here at (clinic site), you can see when people are sitting here and we would be chatting … Yes, what I have noticed is that, most of the younger people, let me say those who are younger than me, they are not using the ring because they are saying it's just for the money; others that it's just a waste of time; they take it off when they get home and put it back again the next week. And you cannot just decide to advise someone, they might humiliate you in front of others, so you decide to rather keep your mouth shut. I wish that there could be something done about this, because most of them are young; I think those who do that are less than 30 years in age. Because when you are chatting with the matured ones, you can see that yes, they are using the ring, but the young ones are not using it. Once a person gets home, they take it off and put it back during the week they are coming to (clinic site). So that is something that they need to look at. (SIDI1, Cape Town)