Adolescent issues associated with knowledge of and access to topical microbicides

Research on adolescents and microbicides: a review

Adolescents are an important target for microbicide research, as they are disproportionately affected by sexually transmitted infections and currently are underrepresented in the microbicide research literature. Furthermore, adolescents are psychosocially and biologically different from adults, and findings from adult research cannot be assumed to apply universally to adolescents. Adolescents, to date have rarely been included in clinical trials and acceptability research for microbicides, in part because their participation requires attention to unique developmental issues, including parental consent and confidentiality. Despite these challenges, adolescents should be included in microbicide clinical research. If adolescents are ultimately expected to use microbicides, it is essential that we understand the developmental, contextual, and relationship variables that may influence use and acceptability. Accordingly, the goal of this paper was to examine the issues affecting the inclusion of adolescents in microbicide clinical research as well as review the existing adolescent-specific microbicide research, which highlights the various factors that may influence use and acceptability. It is hoped that this review can provide guidance for future work with this important, specialized population.

Young women's use of a vaginal microbicide surrogate: the role of individual and contextual factors in acceptability and sexual pleasure

Currently in clinical trials, microbicides have historically been promoted as a woman-controlled (although more recently woman initiated) method of sexually transmitted infection (STI) prevention. The contradicition that exists in this rationale is that women's bodies, specifically the genitals, have been constructed as a negotiated space within sexual interactions. This study qualitatively explored the factors influencing 40 young women's use of a vaginal moisturizer (VM), utilized as a microbicide surrogate. The results indicated that use of the VM was dependent upon product characteristics (i.e., the lubricating qualities affect on sexual pleasure, timing of insertion), individual factors (i.e., reproductive health goals, experiences with side effects of existing contraceptive methods), and contextual factors (i.e., social norms). An understanding of these bodily and social issues may be beneficial in designing targeted educational campaigns and effective instructional materials as well as in facilitating positive dialogue around women's bodies and their sexuality.

Vaginal microbicide preferences among midwestern urban adolescent women

PURPOSE

The purpose of this study was to assess adolescent women's preferences for specific microbicide characteristics including pregnancy prevention, timing of application, potential for side effects, and whether it targeted human immunodeficiency virus (HIV) or other sexually transmitted infections (STI). Potential differences in microbicide preferences by adolescent age group and behavioral patterns including engaging in sexual intercourse and use of hormonal contraception were examined, as it was hypothesized that as adolescents progress into adulthood and gain sexual experience their preferences in microbicide characteristics may shift.

METHOD

Adolescent and young women (N = 405, 56.0% African American; 24.0% Euro-American) between the ages of 14 and 20 (mean = 17.0, SD = 1.8) were recruited from urban community-based clinics. Video-Audio Computer-Assisted Self-Interviews were conducted with the young women, during which they were asked about their preferences regarding the characteristics of hypothetical vaginal microbicides. Conjoint analysis was utilized to determine adolescent women's relative preferences for each microbicide characteristic and intent-to-purchase microbicides based upon a combination of the selected properties.

RESULTS

Overall, the results suggest adolescent and young women had an ordered preference for a microbicide with (1) no side effects, (2) pregnancy prevention, (3) postcoital application, and (4) protection against HIV. Age and behavioral group conjoint analyses resulted in the same pattern of preferences as those reported for the entire group. However, women having sex and not using hormonal contraception had a stronger preference for postcoital application.

CONCLUSION

The findings suggest that young women's ratings of microbicides were sensitive to characteristics such as side effects, pregnancy prevention, and timing of application and should be considered in microbicide development. The conjoint analysis approach is useful in understanding microbicide preferences, and should be utilized with other populations to assess preferences for specific microbicide characteristics.

Predictors of using a microbicide-like product among adolescent girls

PURPOSE

This study examined demographic, sexual history and weekly contextual variables, and perceptions about microbicides as predictors of microbicide-like product use.

METHODS

Adolescent girls (N = 208; 14-21 years) participated in a 6-month study in which they completed three face-to-face interviews and 24-weekly phone call interviews. Participants were given microbicide-like products (vaginal lubricants) and encouraged to use them with condoms when they had intercourse.

RESULTS

Of the girls, 75% had had a sexual opportunity to use the product. Using multi-variable logistic regression, the following variables independently predicted ever using the product: length of sexual experience, number of lifetime vaginal partners, and the Comparison to Condoms subscale on the Perceptions of Microbicides Scale. Using a mixed model repeated measure linear regression, the following variables independently predicted frequency of use: week of the study, age, condom frequency prior to the study, and three subscales on the Perceptions of Microbicide Scale: namely, the Comparison to Condoms subscale, the Negative Effects subscale, and the Pleasure subscale.

CONCLUSION

Most girls used the product, including those who were not protecting themselves with condoms. Girls' initial perceptions regarding the product predicted initial use and frequency of use. Further research should evaluate the best methods for supporting the use of these products by young or sexually less experienced girls.

Measurement of microbicide acceptability among U.S. adolescent girls

BACKGROUND AND OBJECTIVE

Topical microbicides will only be effective if they are acceptable to potential users. The purpose of this study is to develop a scale to evaluate characteristics and aspects of topical microbicides that are important to adolescent girls.

STUDY DESIGN

Girls (n = 207) completed a questionnaire on perceptions of microbicide-like products.

RESULTS

A principal components factor analysis with a varimax rotation produced a 6-factor solution. The mean factor scores suggested that girls saw the products positively. Age was positively correlated with "comparison to condoms" and "comfort while using" factor scores and inversely correlated with "negative impact on interpersonal relationships" factor score. Sexually transmitted infection (STI) history was related to higher scores on the "health benefits" and "pleasure" factors. Age, race/ethnicity, and STI history were not related to the other factor scores.

CONCLUSION

The current scale shows promise in assessment of microbicide acceptability, and in general, girls expressed positive views about microbicides.

Adolescents' descriptions of the physical characteristics of microbicide surrogates and experiences of use

PURPOSE

Our purpose was to describe adolescent girls' perceptions of microbicide surrogates and experiences of use, including impact on sexual pleasure.

METHODS

Sexually experienced girls, 14-21 years, were recruited for a study examining microbicide acceptability. The girls were given vaginal moisturizers (gel or suppository) to use as if they were microbicides. Girls (n = 175) discussed their perceptions and experiences of use of these products in response to semistructured interviews. Girls were asked at weekly phone interviews about the impact of product use on their and their partners' sexual pleasure. These answers were averaged, and girls were categorized into those for whom the product predominantely made sex feel worse, better less than half the time, or better half the time or more. The relationship of demographics and sexual history to the impact on pleasure was evaluated.

RESULTS

Overall, participants were positive about their experience with the products. More girls preferred the gel. Specific concerns about the suppository included the wait period, texture, and messiness of self-insertion. Many liked the lubricating quality of both of the surrogates. Girls discussed messiness, leakage, clumping, and the difficulties in communicating with partners. Over half reported an increase in pleasure most of the time for themselves and their partners. None of the demographic and sexual history predictors were significantly related to impact on pleasure.

CONCLUSIONS

Anticipatory guidance should help girls initiate and sustain use. Future research should examine the best way to accomplish counseling about microbicide use with adolescent girls.

Adolescent girls' communication with "mothers" about topical microbicides

STUDY OBJECTIVE

Topical microbicides, a female-initiated method to protect against sexually transmitted infections (STI) and pregnancy, will only be effective if found acceptable. Mothers may have an influence on acceptability and use among adolescent girls. The current study examined the communication between girls and mothers to understand the potential predictors and nature of conversations regarding surrogate microbicide products.

DESIGN

Sexually experienced girls, 14 to 21 years, were recruited for a 6-month study examining microbicide acceptability. During face-to-face interviews, qualitative data were collected regarding communication between girls and mothers. Two independent raters coded the responses, which were organized into themes. Themes were interpreted according to the conceptual understanding of mother-daughter communication.

RESULTS

Fifty percent of the 171 girls with codable responses had a conversation with their mother. Higher levels of indirect parental monitoring were related to being more likely to have a conversation. Concrete events related to the study (i.e. receiving phone call from the researcher, having an appointment, or seeing the product) or inquiries by mothers appeared to promote conversation. Barriers to conversation included the private nature of the information and relationship issues between the mother and daughter. Conversations often addressed issues related to girls' participation in the study, although some conversations included global issues related to sexuality.

CONCLUSIONS

Girls may talk to their mothers about new products for STI prevention, and such conversations may provide opportunities to promote use.

When adolescent girls say, "I don't know"

STUDY OBJECTIVE

To understand adolescent girls' use of "I don't know" within the context of discussing information related to sexual attitudes and behaviors.

DESIGN

Qualitative analysis of seven focus groups with adolescent girls.

SETTING

Urban primary care clinic.

PARTICIPANTS

Adolescent girls (n = 23) with a mean age of 16.4 years (range 14 to 18 years). Fifty-two percent were African-American, 26% were Caucasian, 17% were Hispanic/Latino, and 5% were Asian.

RESULTS

The use of "I don't know" served three functions: (1) place holder, (2) lack of commitment to an opinion; and (3) reduction of commitment to an opinion or belief.

CONCLUSIONS

These results suggest that girls use "I don't know" when asked about their thoughts and opinions related to sexual health, and that its use can have varying implications. Discriminating the intent may help providers respond appropriately. Responses should include providing a safe and nonjudgmental environment in which girls can express their feelings and opinions regarding their sexual health.