Young women's preferences for timing of microbicide application: Implications for sexual health and microbicide promotion

Background: Currently in clinical trials, vaginal microbicides are chemical barriers to reduce HIV/STI transmission. Acceptability research indicates that timing of application will impact women's use. However, little is known about how individuals' timing preferences will affect the ability to negotiate use within sexual interactions.

Methodology: Daily diaries were collected and in-depth interviews conducted with 40 young women (aged 18-23) following four weeks of use of a vaginal moisturizer (VM) during coital events in one of three timing conditions: 5-10 minutes post-coitus, 1 hour pre-coitus, or 5-10 minutes pre-coitus.

Results: Women completed multiple cycles of VM use in different timing conditions. In the pre-interview diary period the majority (72.5%) used the VM as assigned while four (10%) women did not. Analysis of interview and diary data identified lubrication as an integral factor in timing preference. Most women (67.5%) preferred use directly preceding coitus, noting the positive effects of lubrication—“before sex is best because when you use condoms without it, it's dry.” Nine (22.5%) women preferred post-coital VM application in order to avoid partner communication and "because then you know you really did it."

Conclusion: The results suggest that timing preferences will impact women's microbicide use. Pre-coital preference was influenced by enjoyment of the lubricating characteristics, especially when used with condoms. Post-coital preferences were related to comfort with covert use and not interrupting the sexual interaction. The results have implications for the promotion of microbicides to young women to reduce HIV/STI transmission.