Women's Willingness to Pay for Barrier Methods for HIV Prevention in South Africa : A Comparison of the Female Condom, Diaphragm, and Microbicides

Background: Women have the highest rate of HIV incidence and are a priority group for HIV prevention measures. The female condom is the only available product specifically for women, however, phase 3 trials are testing the effectiveness of microbicides and the diaphragm in preventing HIV-infections among women. Use of women's barrier methods is likely to be influenced by key product characteristics, including ability to be used secretly (female condoms being the least discreet of the three products); and durability (the diaphragm being reusable for up to two years). Future distribution systems for potentially effective barrier methods must be informed by evidence on factors influencing women's valuations of each product. This study is the first to examine key determinants of women's willingness-to-pay (WTP) for women's barrier methods, comparing the diaphragm, microbicides and female condom. Methods: 1017 adult women were randomly selected from three township communities in Greater Johannesburg and interviewed in their homes. Women were asked if they would be willing to try each product, if they thought they would use it regularly, and the most they would be willing and able to pay to purchase the product. Factor analysis was used to identify product categories (groupings of preferred product and distribution attributes) and cluster analysis was used to group women into market segments with similar product attribute and distribution preferences. ANOVA showed the key demographic differences between the clusters, and provided guidance on which demographic variables to include in the regression analyses. Key determinants of WTP for each product are estimated using OLS, Tobit, and Interval regression. Results: Women were most willing to try microbicides (74%) followed by the diaphragm 60% and female condom (56%); 78%-95% of women who were willing to try the products thought they would/could use the products regularly if available. Median WTP was 5 Rand for the female condom, 10 Rand for microbicides and 20 Rand for the reusable diaphragm. Estimation by OLS, Tobit, and Interval regression gave similar results. Ranges of p-values from the OLS estimates for each product are presented. Significantly higher WTP values for all products were reported among women who lived in higher socio-economic status (SES) households (p-value 0.00-0.01), who were employed (p-value 0.01-0.07), and who were younger (p-value 0.00-0.05). Women who were living with a partner valued the diaphragm and microbicides higher than non-cohabitating women (p-value 0.06-0.07), while for the female condom WTP values were lower (but not significant) than those given by cohabitating women. Conclusions: Women are interested in new barrier methods for HIV prevention, with women of higher SES willing to pay more. The strongly negative age coefficient for microbicides predicts that the highly vulnerable younger group value these new HIV prevention products more and are thus likely to be earlier adopters. Interest in the diaphragm and microbicides appears highest among cohabitating women, known to lack long term prevention options. The results suggest that these methods are complementary to existing male condom use, reassuring decision-makers, who fear substitution from condoms to these newer and possibly less effective methods