Intravaginal and Menstrual Practices among Women Working in Food and Recreational Facilities in Mwanza, Tanzania: Implications for Microbicide Trials

Abstract

Intravaginal and menstrual practices may potentially influence results of trials of microbicides for HIV prevention through effects on the vaginal environment and on adherence to microbicide and placebo products. As part of the feasibility study for the Microbicides Development Programme Phase 3 trial of a vaginal microbicide in Mwanza, a variety of quantitative and qualitative methods were used to describe these practices, associations with behaviour and underlying social norms among women working in food and recreational facilities. Intravaginal cleansing by inserting fingers and either water alone or soap and water was thought necessary to remove “uchafu” (dirt), referring to vaginal secretions, including menstrual blood and post-coital discharge. Vaginal cleansing was carried out within 2 hours after 45% of sex acts. Sexual enhancement practices were less common. Intravaginal and menstrual practices and associated behaviours and demographic factors should be measured and monitored throughout microbicide trials to enable analyses of their impacts on microbicide effectiveness.

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

“…21,23,25,26 In contrast, women in Africa use a variety of other products. 4,15,16 In our study, women used fingers, soap, water, roots, leaves, traditional medicines, vinegar, lemon, and beer. Despite being broadly used, information regarding IVP is rarely collected as part of routine medical or gynecological care, which results in underestimation of its potential risk by medical professionals.…”

“…19 The coding themes were developed following a review of the literature and using data from a previous pilot study. 4,12,13,15,16,20 Results Participants (women, men, and Alengizis) asserted that IVP were widespread among women in Zambia. All women reported having engaged in IVP and all men knew women engaged in IVP.…”

“…[1][2][3][4][5] Vaginal practices can involve the external genitalia (external washing and external application) or the vaginal canal (intravaginal cleansing or intravaginal insertion). 6,7 Intravaginal practices (IVP) are those that involve the vaginal canal and have been associated with an increased risk of human immunodeficiency virus (HIV) and STI acquisition.…”

“…IVP that include insertion of products to promote dry sex leads to genital abrasions that can facilitate HIV acquisition and transmission. 3,4,7,8,[13][14][15] IVP are strongly influenced by social and cultural beliefs, introduced to women at an early age, and normally taught by older females (relatives, friends, or traditional marriage counselors). 15,16 Although IVP are female initiated and intended to be conducted without the explicit knowledge of men, many IVP are driven by male preferences.…”

Emergent HIV technology: urban Tanzanian women's narratives of medical research, microbicides and sexuality

“…As Beckmann (2010) also found with Zanzibari women, for these women fluids linked with reproduction are polluting when they are of no further use and are therefore 'out of place'. Thus, as with other women working in social venues in Mwanza, removal of these out of place substances is an important way of addressing concerns with moral and sexual health (Allen et al 2010;Lees et al 2014). The gel was experienced as a substance that was cleansing and removed 'dirt'.…”