Social disclosures in relation to perceived HIV protection provided by the dapivirine vaginal ring



Despite significant advances in biomedical HIV prevention technologies, little evidence exists regarding their adoption or diffusion of information about these technologies through social networks. We used diffusion of innovation theory to understand if perceived HIV protection by the dapivirine vaginal ring (DVR), including changes in knowledge about efficacy of the technology, were associated with disclosure to participants’ social network.


Women who participated in both the MTN-020/ASPIRE phase III trial and the open-label extension MTN-025/HOPE trial of the DVR were included. We examined differences in the number and type of reported social disclosures between ASPIRE and HOPE, and estimated prevalence ratios or count ratios for associations between perceived protection in HOPE, and features of these social disclosures (relationship, sex, importance of their opinion and if they were in favor of the DVR). Generalized estimating equations with an exchangeable correlation matrix were used to account for multiple social disclosures per person.


Of the 1428 participants who enrolled in both trials, almost all reported choosing to participate in HOPE following ASPIRE because the DVR was protective against HIV (N=1431; 98%). During ASPIRE, women reported disclosing participation to a median of five people (Inter-quartile range (IQR) 3-10) compared to four in HOPE (IQR 2-5). Other features of social disclosures were similar by trial. Nevertheless, perceived effectiveness of the DVR in HOPE (N=1095; 77% reported a lot of protection) was associated with speaking to a greater number of people about the trial (Count ratio 0.14; 95% CI 0.09, 0.20), the importance of the person’s opinion of the DVR (Prevalence Ratio (PR) 1.12; 95% CI: 1.05, 1.20), and whether the person was also a participant in HOPE (PR 1.52; 95% CI 1.20, 1.93).


Demonstrated effectiveness of the DVR was a key consideration in continuing to participate in HOPE but was not related to type of social disclosure between trials (sex, relationship etc.). Women who perceived the DVR to be effective in HOPE were more likely to socialize with other trial participants and spread information by talking to more people and with people whose opinions they valued about the DVR.