All ETDs from UAB

Advisory Committee Chair

Sadeep Shrestha

Advisory Committee Members

William Geisler

Dustin Long

Jeanne Marrazzo

Janet Turan

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Public Health


Sexual and reproductive health (SRH) needs for women are not being met globally. In addition to efforts towards providing widespread access to currently available contraceptives and sexually transmitted infection (STI) treatment or prevention products, another focus is the development of multipurpose prevention technologies (MPTs). These MPTs are combination methods that prevent pregnancy, and protect against HIV and/or additional STIs. The objective of this dissertation research was to assess factors related to sexual and reproductive decision-making that may influence interest in MPTs and inform MPT implementation strategies for African and African American (AA) women. The first aim of this research, I used hierarchical cluster analysis to assess attitudes toward menstrual suppression of Kenyan women randomized to cyclic or continuous use of an ideal MPT delivery method, the vaginal ring (VR) (N=45), and evaluated the potential relevance of these findings for high risk AA women. We found that overall attitudes toward menstrual suppression were negative and three distinct clusters were identified by the cluster analysis. Women in the 3rd cluster (N=6) were more likely to report worry about side effects and partner perception of the VR. The second and third aim combined, I used a sequential mixed-method design to assess interest in MPTs in AA women in the Southeast US. I conducted in-depth interviews with iv AA women in Birmingham, AL to understand how socio-cultural menstruation norms, perceived risk of STI/HIV and unintended pregnancy, and contraceptive preferences impact MPT perceptions (N=19). Participants expressed favorable responses to MPTs, however, potential barriers to uptake included concerns about menstrual suppression, low perceived sexual risk, and silence surrounding sexual health in the AA community. Qualitative results helped develop an MPT interest survey completed by AA women in the Deep South (N=1,638). I used proportional odds logistic regression models to report interest in MPTs by sexual or reproductive factors. Women had higher odds of interest in MPTs if they currently used hormonal contraceptives, had high perceived risk for pregnancy or STIs/HIV, and had previously been pregnant. AA women expressed interest in MPTs, and preferences included pill or VR forms that could be used monthly or annually. Future implementation strategies should include SRH education and AA community-engaged strategies to mitigate potential barriers to uptake and adherence.

Included in

Public Health Commons



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