The Implications of Post-coital Intravaginal Cleansing for the Introduction of Vaginal Microbicides in South Africa

Gafos, Mitzy; Pool, Robert; Mzimela, M.; Ndlovu, H.; McCormack, Sheena; Elford, Jonathan

doi:10.1007/s10461-013-0676-9

Cited by 12 publications

(17 citation statements)

References 57 publications

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“…Although oral PrEP in women has been shown to decrease risk of HIV acquisition when taken consistently, studies of PrEP in the form of vaginal gels have shown inconsistent efficacy to date [8,25]. It has yet to be determined if vaginal gels have been unsuccessful at reducing HIV acquisition because of poor adherence, biological factors, or potentially confounding by other practices such as IVPs [26]. Two studies of PrEP in the form of vaginal rings, The Ring Study and ASPIRE, are anticipated to provide results in 2016 [25].…”

Section: Discussionmentioning

confidence: 99%

Intravaginal practices among HIV‐negative female sex workers along the US–Mexico border and their implications for emerging HIV prevention interventions

Seidman

Rusch

Abramovitz

et al. 2016

Intl J Gynecology & Obste

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Objective To describe intravaginal practices (IVPs) among female sex workers (FSWs) who inject drugs in two cities—Tijuana and Ciudad Juarez—on the border between the USA and Mexico. Methods Data for a secondary analysis were obtained from interviews conducted as part of a randomized controlled trial in FSWs who injected drugs between October 28, 2008, and May 31, 2010. Eligible individuals were aged at least 18 years and reported sharing injection equipment and having unprotected sex with clients in the previous month. Descriptive statistics were used to assess frequency and type of IVPs. Logistic regression was used to assess correlates of IVPs. Results Among 529 FSWs who completed both surveys, 229 (43.3%) had performed IVPs in the previous 6 months. Factors independently associated with IVPs were reporting any sexually transmitted infection in the previous 6 months (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI] 1.1–3.1; P=0.03), three or more pregnancies (aOR 1.9, 95% CI 1.1–3.2; P=0.02), and having clients who became violent when proposing condom use (aOR 5.8, 95% CI 1.0–34.3; P=0.05), which are all factors related to inconsistent condom use. Conclusion Screening for IVPs could help to identify FSW at increased risk of HIV, and facilitate conversations about specific risk-reduction methods.

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Section: Discussionmentioning

confidence: 99%

Intravaginal practices among HIV‐negative female sex workers along the US–Mexico border and their implications for emerging HIV prevention interventions

Seidman

Rusch

Abramovitz

et al. 2016

Intl J Gynecology & Obste

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“…Consequently, in this analysis we included interviews with 79 trial participants who were interviewed around the time of their week 4 visit. The interview guide has been described elsewhere and included the following topics: partner involvement in decisions relating to sexual matters and partner involvement in gel use [ 47 ].…”

Section: Methodsmentioning

confidence: 99%

Communication About Microbicide Use Between Couples in KwaZulu-Natal, South Africa

et al. 2014

Self Cite

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The ways in which couples communicate about microbicides is likely to influence microbicide uptake and usage. We collected quantitative data about whether women in a microbicide trial discussed microbicides with their partners and explored communication about microbicides during 79 in-depth-interviews with women enrolled in the trial and 17 focus-group discussions with community members. After 4 weeks in the trial, 60 % of 1092 women had discussed microbicides with their partners; in multivariate analysis, this was associated with younger age, clinic of enrolment and not living in households that owned cattle. After 52 weeks, 84 % of women had discussed microbicides; in multivariate analysis, this was associated with not living in households that owned cattle, not living in a household that relied on the cheapest water source, allocation to 0.5 % PRO2000 gel and consistent gel adherence. Qualitative findings highlighted that women in committed relationships were expected to discuss microbicides with their partners and preferred to use microbicides with their partner’s knowledge. Women had different reasons for, and ways of, discussing microbicides and these were influenced by the couple’s decision-making roles. Although there was tolerance for the use of microbicides without a partner’s knowledge, the women who used microbicides secretly appeared to be women who were least able to discuss microbicides. In KwaZulu-Natal, socio-cultural norms informing sexual communication are amenable to microbicide introduction.

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“…It has been noted that because intravaginal practices present a risk of diluting efficacy through removing or interfering with microbicides, more work is needed to understand motivations and risk reduction around IVP in the context of effective microbicide use. 6 Conducting large-scale behavioral interventions on intravaginal cessation should be an important component to future microbicide trials conducted in areas in which intravaginal practices are prevalent.…”

Section: Discussionmentioning

confidence: 99%

“…5 As outlined by the World Health Organization, 4 these include internal insertion of fingers and other substances including fluids (douching) into the vagina. 6 These practices are associated with a decreased abundance and proportion of Lactobacillus sp., increased BV, and higher risk for HIV-1. 7,8 In longitudinal follow-up of Kenyan FSWs, IVP increased HIV-1 risk *4-fold.…”

Section: Introductionmentioning

confidence: 99%

An Effective Intervention to Reduce Intravaginal Practices Among HIV-1 Uninfected Kenyan Women

Sivapalasingam

McClelland

Ahmed³

et al. 2014

AIDS Research and Human Retroviruses

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Intravaginal practices (IVP) are common among African women and are associated with HIV acquisition. A behavioral intervention to reduce IVP is a potential new HIV risk-reduction strategy. Fifty-eight HIV-1-uninfected Kenyan women reporting IVP and 42 women who denied IVP were followed for 3 months. Women using IVP attended a skill-building, theory-based group intervention occurring weekly for 3 weeks to encourage IVP cessation. Vaginal swabs at each visit were used to detect yeast, to detect bacterial vaginosis, and to characterize the vaginal microbiota. Intravaginal insertion of soapy water (59%) and lemon juice (45%) was most common among 58 IVP women. The group-counseling intervention led to a decrease in IVP from 95% (54/58) at baseline to 0% (0/39) at month 3 ( p = 0.001). After 3 months of cessation, there was a reduction in yeast on vaginal wet preparation (22% to 7%, p = 0.011). Women in the IVP group were more likely to have a Lactobacillus iners-dominated vaginal microbiota at baseline compared to controls [odds ratio (OR), 6.4, p = 0.006] without significant change in the microbiota after IVP cessation. The group counseling intervention was effective in reducing IVP for 3 months. Reducing IVP may be important in itself, as well as to support effective use of vaginal microbicides, to prevent HIV acquisition.

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The Implications of Post-coital Intravaginal Cleansing for the Introduction of Vaginal Microbicides in South Africa

Cited by 12 publications

References 57 publications

Intravaginal practices among HIV‐negative female sex workers along the US–Mexico border and their implications for emerging HIV prevention interventions

Intravaginal practices among HIV‐negative female sex workers along the US–Mexico border and their implications for emerging HIV prevention interventions

Communication About Microbicide Use Between Couples in KwaZulu-Natal, South Africa

An Effective Intervention to Reduce Intravaginal Practices Among HIV-1 Uninfected Kenyan Women

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