Academic journal article
By Tanner, Amanda E.; Zimet, Greg; Fortenberry, J. Dennis; Reece, Michael; Graham, Cynthia; Murray, Maresa
The Journal of Sex Research , Vol. 46, No. 1
Fortenberry, J. Dennis
The desire for a woman-initiated disease prevention method has increased the attention on vaginal microbicides as a method for the prevention of sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). Microbicides are substances that may reduce transmission of STIs (Wulf, Frost, & Darroch, 1999) and may also prevent pregnancy, although not all microbicides will be contraceptive (Harrison, Rosenberg, & Bowcut, 2003). Currently there are more than 30 microbicide formulas in differing phases of clinical trials, including two products in the final phase of clinical trials (Alliance for Microbicide Development, 2007). Development delays have primarily been attributed to the complex physiology of the vaginal environment and research funding mechanisms (Global Campaign for Microbicides, 2007). Similar to spermicides, which have shown a range of acceptability (Elias & Coggins, 2001), including women's discontent with timing of insertion (Raymonda et al., 2005), microbicides would be inserted into the vagina at each coital event. In addition to prevention properties, microbicides may impact sexual comfort and pleasure, as most formulas will have lubricating qualities (Braunstein & Van de Wijgert, 2005; Philpott, Knerr, & Maher, 2006; Zubowicz et al., 2006). Therefore, microbicides offer a unique compromise between the reduction of infection risk and potential influence on sexual performance and pleasure.
Historically, microbicide development has been situated in the need for a woman-controlled method of protection against STIs, as it is suggested that underlying gender inequalities limit women's abilities to protect themselves and ensure condom use (Elias & Heise, 1994; Potts, 1994; Stein, 1990). Thus, the anticipated arrival of microbicides, a woman-controlled method, is considered by many to be a significant advancement in public health's efforts to control STI and HIV incidence. An inherent contradiction exists, however, in the promotion of a "woman-controlled" method to be used by a woman for the protection of her own body. The rationale for microbicide development has been based on the assumption that women have less control than men in sexual decision making (Pulerwitz, Amaro, De Jong, Gortmaker, & Rudd, 2002). In suggesting that women actually do not have control of their bodies or their sexual behaviors, this argument implies that women may not, in fact, be able to effectively adopt a woman-initiated method. Much research has documented a gendered power imbalance in heterosexual relationships, for example, in terms of sexual and contraceptive negotiation and violence (Blanc, 2001), which will be problematic for women as they negotiate and use microbicides within this relational context. Recent work in the United States has indicated, however, that some women describe more equal relational power dynamics and feel in control of their sexual bodies (Carpenter, 2002; Harvey, Bird, Galavotti, Duncan, & Greenberg, 2002). Thus, microbicides--if they become available--may be helpful in facilitating dialogue around these gender power issues, at least in the United States.
To more fully understand how microbicides may (or may not) be used, it is essential to understand how people, more specifically women, negotiate heterosexual norms. The social rules governing relationships often transform women's bodies into a shared space. The physical requirements of heterosexual intercourse (vagina accepting the penis) suggest that a woman's body, specifically her genitals, becomes a cooperative space where others, primarily male partners, have significant influence on how the space is defined. This is particularly relevant in the context of previous research suggesting women's sexual motivation is often based on a desire to please their male partners (Nicolson & Burr, 2003). The construction of women's bodies as a shared space suggests that women's preferences for microbicides need to be situated within the social context in which they will be used. …