Addressing intravaginal practices in women with HIV and at-risk for HIV infection, a mixed methods pilot study

Abstract

Intravaginal practices (IVPs), include intravaginal cleansing (cleansing the inside of the vagina) or intravaginal insertion of products for hygiene, health or sexuality reasons. IVPs are associated with adverse female health outcomes, development of bacterial vaginosis, HIV acquisition and transmission. A mixed methods approach was used in this study to examine the prevalence of IVP, assess reasons for engagement, and perceptions of IVP among a sample of minority (African-American and Hispanic) women infected, or at-risk, for HIV in Miami, USA, a city with increasing numbers of sexually transmitted infections (STIs) and HIV. Three focus groups (total n=20) and quantitative assessments (n=72) were conducted with women infected or uninfected with HIV. In the qualitative assessments, most women reported engaging in both intravaginal cleansing and intravaginal insertion, and stated the main motivation for IVP was hygiene. The quantitative assessments confirmed that cleansing with water alone, soap with water or using commercial douches was common, as well as intravaginal insertion using a cloth or a rag in both HIV-infected and uninfected women. Women with HIV infection reported less use of water and water and soap for IVPs, and reported learning about the potential harm of IVP from their HIV health care providers. Despite their health risks, IVP appeared common in both HIV-infected and at-risk minority women, and interventions to decrease IVP could have important health implications among populations with high rates of IVP, STIs and HIV.

<p>Adolescent and young adult couples&rsquo; views of intravaginal practices: a qualitative analysis of a pilot study</p>

“…The girls interviewed indicated having learned about IVPs in both formal and informal settings from peers, mothers, and grandmothers as early as age 10 or 11, soon after the onset of puberty and prior to becoming sexually active. These results are in line with those of previous studies on IVP3,4 which reported that women are introduced to IVPs at an early age by elderly women and use is motivated by male sexual preferences. This finding is also in agreement with Mwenda’s finding which showed that although practices such as IVP may place women at risk for sexually transmitted diseases, these practices are customary in many parts of Africa, culturally driven, and difficult to change 9…”

“…Data presented in this report are part of a large national qualitative study aimed at exploring vulnerability of adolescent girls and young women to HIV in Zambia. Results from the primary study have been previously published 1–3,4,5,17. Focus group discussions were held with adolescent and young adult couples in one urban and two peri-urban public health facilities of Lusaka city, Zambia.…”

“…A recent meta-analysis concluded that women who used specific IVP are at nearly 20% greater risk of incident bacterial vaginosis (BV) compared to women who do not use IVP and a 30% increased risk of acquiring HIV 1. BV is also associated with acquisition of HIV 4. In contrast, a pilot intervention to reduce IVP and BV in HIV-infected women in Zambia reported a decrease in self-reported use of IVPs at 12 months and increased the importance placed on health when considering engagement in IVP 5.…”

“…In Zambia, female initiation rites, marking the “coming of age” for girls and young women, serve to introduce them to the cultural, gender, and sexual norms that they are expected to follow as women, perpetuating specific culturally driven IVP 4,9. While these initiation practices are a more formal introduction to womanhood, a recent study conducted by Scorgie et al in KwaZulu-Natal, South Africa found that knowledge about such practices is also “garnered through informal and implicit processes of information-sharing and gossip with close female friends, neighbors and members of one’s peer group” 10…”

“…In Tanzania, Uganda, and Zambia, women use IVPs without explicitly informing their partners, while men express suspicion of IVP, drawing associations between IVP and infidelity and promiscuity 11,12. Further, the body of research on IVPs seldom includes men, though studies that have included men indicate that they may play a valuable role in better understanding IVPs in SSA and that behaviors preferred by men for sexual satisfaction are the most difficult to influence 4,13,14. This is not to suggest that men’s views should be considered the gold standard from which we develop and implement women’s health programs; rather, we suggest that programs developed without a comprehensive understanding of the target population may be less likely to succeed, particularly when there is a conflict between the goals and objectives of the target population.…”