Vaginal washing and lubrication among female sex workers in the Mexico-US border region: implications for the development of vaginal PrEP for HIV prevention

Abstract

BackgroundTo assess the potential acceptability and inform the development of behaviorally-congruent vaginal douche- or gel-based HIV pre-exposure prophylaxis (PrEP) products, we examined vaginal washing and lubrication practices among female sex workers (FSWs) in Tijuana and Ciudad Juarez, two northern Mexico cities bordering the United States (US).MethodsTwo hundred and ninety-five HIV-negative FSWs (145 Tijuana; 150 Ciudad Juarez) enrolled in a behavioral HIV prevention intervention trial completed surveys assessing vaginal washing and lubrication practices, as well as motivators and barriers to performing each practice. Logistic regression was used to identify potential predictors of each practice in the past month.ResultsIn the past month, vaginal washing was performed by 56 and 22% of FSWs in Tijuana and Ciudad Juarez (p < 0.0001), respectively, while vaginal lubrication was performed by 64 and 45% of FSWs in Tijuana and Ciudad Juarez (p = 0.001), respectively. Vaginal washing was positively associated with living in Tijuana (adjusted odds ratio [AOR] = 4.35, 95% confidence interval [CI]: 2.60–7.30), older age (AOR = 1.04 per year, 95% CI: 1.01–1.06), and vaginal lubrication (AOR = 2.99, 95% CI: 1.67–5.35), while it was negatively associated with being born in the same state as the study site (AOR = 0.50, 95% CI: 0.31–0.82), earning a monthly income ≥3500 pesos (AOR = 0.53, 95% CI: 0.28–1.00), and hazardous alcohol consumption (AOR = 0.56, 95% CI: 0.33–0.95). Vaginal lubrication was positively associated with living in Tijuana (AOR = 2.21, 95% CI: 1.37–3.54) and vaginal washing (AOR = 2.91, 95% CI: 1.64–5.18), while it was negatively associated with being born in the same state as the study site (AOR = 0.47, 95% CI: 0.29–0.75).ConclusionsThe moderate and high prevalence of vaginal washing and lubrication, respectively, suggest behaviorally-congruent, multi-purpose, vaginal douche- and gel-based PrEP products that simultaneously address FSWs’ needs and prevent HIV infection may be acceptable to many FSWs along the Mexico-US border. Future product development and implementation should also consider the link between vaginal washing and lubrication to ensure existing practices do not undermine vaginal PrEP product effectiveness.Trial registrationClincialTrials.gov (NCT02447484).Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5946-z) contains supplementary material, which is available to authorized users.

A Review of Pre-Exposure Prophylaxis Adherence among Female Sex Workers

“…35 A study that examined vaginal washing and vaginal lubrication among FSWs in Tijuana and Ciudad Juarez, Mexico documented moderate (39%) and high (54%) prevalences of vaginal washing and lubrication in the past month, respectively, suggesting that vaginal PrEP products formulated as douches or gels may be acceptable HIV prevention methods to many FSWs in the Mexico-US border region. 42 The authors of the study also identified several predictors of each vaginal practice, providing insight into the characteristics of FSWs for whom these vaginal PrEP products may be most acceptable. 42 Lifestyle factors, such as substance use, can affect PrEP adherence.…”

“…42 The authors of the study also identified several predictors of each vaginal practice, providing insight into the characteristics of FSWs for whom these vaginal PrEP products may be most acceptable. 42 Lifestyle factors, such as substance use, can affect PrEP adherence. One study found that combined use of illicit drugs and tenofovir disoproxil fumarate can be nephrotoxic.…”

“…32 A study among FSWs in the Mexico-US border region reported that the study participants preferred monthly product use to daily and on-demand use, with which they may have perceived as less burdensome and easier to comply. 42…”

The Epidemiology of HIV Among Sex Workers Around the World: Implications for Research, Programmes, and Policy

“…For other innovative biomedical HIV prevention tools, such as oral PrEP and vaginal microbicides, the development of behaviourally congruent products can play a primary role in uptake and adherence [94,129,130]. Overall, the studies described demonstrate that improving comprehensive HIV prevention packages with innovative tools means integrating sexual and reproductive health services, multi-purpose prevention products, and awareness of structural determinants experienced by sex workers that affect engagement in care.…”

Drug stability and product performance characteristics of a dapivirine-releasing vaginal ring under simulated real-world conditions

“…In a previous study, between 4 and 18% of women reported removing the ring either during menses or for periodic cleaning (Montgomery et al, 2012). Application of a variety of different substances to the vagina for general health, cleaning or sexual function has also been reported in different populations (Gafos et al, 2010;Low et al, 2011;Martin Hilber et al, 2010;Pines et al, 2018). Further, previous clinical studies have observed ring discolouration following use (Spence et al, 2016).…”