Examining Targets for HIV Prevention: Intravaginal Practices in Urban Lusaka, Zambia

Abstract

Intravaginal practices (IVP) are the introduction of products inside the vagina for hygienic, health, or sexuality reasons. The influence of men and Alengizis, traditional marriage counselors for girls, in promoting IVP has not been explored. We conducted gender-concordant focus groups and key informant interviews with Alengizis. The responses were conducted grouped into three themes: (1) cultural norms, (2) types and reasons for IVP, and (3) health consequences. We found that IVP were used by all participants in our sample and were taught from generation to generation by friends, relatives, or Alengizis. The reasons for women to engage in IVP were hygienic, though men expect women to engage in IVP to enhance sexual pleasure. Approximately 40% of women are aware that IVP can facilitate genital infections, but felt they would not feel clean discontinuing IVP. All men were unaware of the vaginal damage caused by IVP, and were concerned about the loss of sexual pleasure if women discontinued IVP. Despite the health risks of IVP, IVP continue to be widespread in Zambia and an integral component of hygiene and sexuality. The frequency of IVP mandates exploration into methods to decrease or ameliorate their use as an essential component of HIV prevention.

Determinants of intravaginal practices among HIV-infected women in Zambia using conjoint analysis

“…In Zambia, IVP use begins at an early age and is typically practiced frequently using a variety of products. 8 Although in general, hygiene appears to be the most important driver of IVPs; among subgroups, different factors emerged as potential predictors of the decision to engage in IVPs. Results indicate that women who believed that IVPs were associated with enhanced health had a history of exchanging sex for money and using a cloth for IVPs.…”

“…It was hypothesised that when comparing hygiene, male preferences and health, women would be most likely to engage in IVPs for hygienic reasons. 8,9 …”

A cross-sectional study of bacterial vaginosis, intravaginal practices and HIV genital shedding; implications for HIV transmission and women's health

“…In order to develop questionnaires addressing IVP, focus groups, key informant interviews and introductory meetings with the clinic staff and local Community Advisory Boards were conducted at the community health centre; results have previously been described. 24 Participants of the focus groups, key informants and members of the advisory boards, did not participate in the study. Participants were self-referred after hearing about the study from enrolled participants or clinic staff, and presented documentation of HIV-1 infection and treatment at the time of enrolment.…”

“…Products used for IVP and reasons for engaging in IVP were identified in the focus groups and key informant interviews. 24 Questions to assess product used and reason for use in the prior month were on a dichotomous scale, ‘yes’=1, ‘no’=0; and each product was assessed individually. Frequency of each product was scored using ‘daily’=1, ‘weekly’=2 and ‘monthly’=3, respectively.…”

Cessation of intravaginal practices to prevent bacterial vaginosis: a pilot intervention in Zimbabwean women

“…Even though women may be told by healthcare providers that intravaginal practices may be harmful, many women choose to continue these behaviours for a range of cultural reasons related to personal hygiene, genital health and to increase sexual pleasure 3 10. In some communities, intravaginal cleansing is culturally normative and habitual 11 12.…”