Blockage and flow: intimate experiences of condoms and microbicides in a South African clinical trial.

Based on qualitative research undertaken during a phase-three microbicide gel trial, this paper explores female participants' experiences and perceptions of gel and condom use and the opinions of their male partners and community members. Participants were aware that condoms were effective in preventing HIV infection and that the efficacy of the microbicide was unproven. Yet, in narratives about gel and condom use, participants ascribed improvements to their reproductive health and intimate relationships with men to gel use. In contrast, condoms were believed to prevent disease, yet also embodied mistrust, were believed to contain dangerous substances and were felt to block the womb. These apparently contradictory views about condoms and gels are explored in the light of conceptions of flow and blockage. Health is achieved by maintaining a steady balance of substances within the body, while preventing fluid flow results in illness. We argue that women enrolled in the trial broadened the meaning of the gel beyond its primary intended effect of preventing HIV. Through their accounts of gel use, women 'reinvented' the gel as a substance that transformed their bodies and sexual relations. This has implications for understanding how local knowledge of health and illness intersects with biomedical knowledge.