What is HIV research telling us about women’s sexuality? Exploring the construction of sexuality during the Phase III clinical trial of a microbicide gel in Mwanza, Tanzania Shelley Lees Lecturer/Social Science Coordinator for MDP Mwanza Site London School of Hygiene and Tropical Medicine, UK National Institute for Medical Research, Tanzania Microbicides Development Programme, UK

Social scientists have tended to focus on one aspect of sexuality – sexual behaviour Partly because behaviour is easier to quantify, albeit through retrospective and unreliable means Through the social science work during the MDP Phase III clinical trial we have attempted to explore sexuality in broader depth, using in depth interviews and focus group discussions In order to explore sexuality through different means I have adapted the PLA method of body mapping as a research tool Body maps were drawn by women either at community meetings or in focus groups and two of these are presented in this poster These have produced different discourses of sexuality from that of the IDIs/FGDs ‘Discoursing on sex shapes the way people understand sex and how it should be, their understanding of themselves as sexual beings, and their interpretation of sexual experience’ (Cameron and Kulick, Language and Sexuality p. 18)

Discourse from In depth interviews –Our questions concerning sex for the purpose of the trial focus on anal sex, sex during menstruation and vaginal washing, which produces discourses concerning risk, dirt, and male control ‘ I mean being content doesn’t mean that you don’t get satisfied with sex, no. But you worry about your welfare – “is my health alright as a consequence of the sex I have had today?” You take chances – “Ok I have used protection which has been brought by the government, let me have my pleasure”. But you are doubtful because the amount of protection is small.’ (IDI participant) –Little discussion of pleasure except in relation to the gel (Often this pleasure is newly discovered) ! (see Montgomery et al poster) ‘ When a man touched me [before], I just felt as if he was troubling me, it was a bother. But since I started using the gel…I feel good, I feel that the smoothness of the gel gives me the desire for sex’ Discourse from body maps –Sexuality not just focused on the vagina but throughout the body –Women’s own bodily pleasure –Attractiveness for the man – his pleasure

Implications for our understanding of sexuality in the HIV epidemic –Acknowledge the importance of understanding specific behaviours, especially for the uptake and use of existing and potential prevention technologies (condoms/vaginal gels) –However, focusing our attention on discourses of risk and not pleasure around sexuality can: confuse our understanding of motives for sex focus attention for prevention on risky behaviour without understanding the importance of pleasure (as discussed by Wendy Knerr and colleagues on Monday) –Women participants like (love) the microbicide gel – whilst its potential ability to protect them from harm is a great attraction it’s benefit of enhanced feelings of desire, pleasure and attractiveness (the men like it!) is highly appealing In conclusion –Microbicides have the potential to combine protection and address pleasure