A qualitative component of the study, interviewing 214 study
participants, provides insight into women’s experience using the vaginal rings
and their appreciation of the product’s qualities. Elizabeth Montgomery and Ariane van der Straten of RTI
International presented results in two posters.
The women who were interviewed (either in an in-depth
interview, a series of in-depth interviews or as part of a focus group) were
recruited from 6 of the 15 study sites. Their demographics broadly reflected
those of the larger study: average age of 26, 45% were married, and 73% had
completed secondary school.
The ring was felt to be simple and discreet, as this woman
explained:
“I like them because
once you wear it, you don’t feel it, and nobody can suspect you are wearing something.
I like it because nothing changes regarding how we live as women.”
While some women had initial concerns about the appearance
of the ring and potential side-effects, these were generally overcome through group
discussion, counselling and increasing familiarity with the product. Continuing
to provide this kind of support may be important if vaginal rings are rolled
out.
“When you are seeing
the ring for the first time you get shocked. I was too and almost quit because
of the size of the ring… During education I learned that the ring was soft, I
thought the ring was hard and painful. They showed that to insert the ring you
need to twist it like 8 and when I tried it, it was easy and doable.”
The researchers asked some women to compare vaginal rings
with other ways in which prevention drugs could be delivered – oral
tablets, injections, implants, vaginal suppositories, vaginal films and vaginal
gels. Women often preferred methods that were familiar to them – the vaginal
rings they had been using as part of ASPIRE or products similar to contraceptives
they knew about.
They tended to appreciate long-acting products rather than
those which needed to be remembered daily or applied at the time of sex.
“The ring is better
than a condom because when you are going to have sex the ring is already inside
you, unlike the condom that you have to wear before every sex act.”
Nonetheless, there could be some anxiety about the
side-effects, invasiveness and lack of reversibility of long-acting products.
“I am afraid… I don’t
know how it [the injection] is going to be like inside my body, I don’t know if
it going to affect my health.”
Such concerns in relation to vaginal rings diminished with
education and through experience.
Several potential products (including rings, gels, suppositories
and films) need to be applied inside the vagina and this was off-putting for
some participants, especially those under the age of 25. Some women removed the
vaginal ring during menstruation.
Women described negotiating use of the vaginal ring with
male partners. Partners often had an influence (either positive or negative) on
women’s attitudes to and use of the ring.
“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.”
Women could be concerned that a partner would feel the ring during sex.
“Sometimes you find
your partner is fingering you and finds a ring, then that’s followed by 21
questions.”
Elizabeth Montgomery told aidsmap.com that some participants’ misgivings about the research process could
have contributed to lower adherence. Women expressed concerns about not knowing if they had received an
active or placebo ring, the unknown efficacy and unproven safety of the
ring, and the idea of being ‘researched on’. Therefore the fact of taking part
in a placebo-controlled study may have had an impact on non-use of the ring.
Nonetheless, many women said they liked taking part in the
study. They felt that they were part of a ‘team’ and were doing something for a
broader, communal good. They valued the free healthcare and other study
benefits that were provided. Of course, this could have influenced some of the women's responses during interviews.