Page 396 - SAHCS HIVMed Journal Vol 20 No 1 2019

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 7 Original Research

Vaginal practices among women at risk for HIV

acquisition in Soweto, South Africa

Authors: Background: Vaginal practices (VP) may adversely affect normal vaginal flora and mucosal
Erica Lazarus integrity, and increase acquisition risk of HIV and other genital tract infections.
1
Kennedy Otwombe 1
Janan Dietrich 1 Objective: The aim of this study was to describe self-reported VP, changes in the reported
Michele P. Andrasik 2
Cecilia A. Morgan number of VP over time and factors associated with VP in a cohort of young Sowetan women
2
James G. Kublin 2 enrolled in the HVTN 915 observational study.
Glenda E. Gray 1,2,3
Abby J. Isaacs 4 Method: We longitudinally assessed self-reported VP in 50 young women at risk of
Fatima Laher 1 HIV acquisition aged 18–25 years in a prospective study over 3 months in Soweto, South
Africa. Interviewer-administered HIV behavioural risk questionnaires were completed. No
Affiliations:
1 Perinatal HIV Research intervention to reduce VP was specified per protocol, but clinicians provided education
Unit, Faculty of Health at their discretion. The generalised estimating equation with inverse probability weights
Sciences, University assessed VP over time.
of the Witwatersrand,
Johannesburg, South Africa Results: The mean age at screening was 22 years; women reported multiple sexual partnerships
with a mean of one main and 2 casual partners in the last 30 days. Consistent condom use was
2 HIV Vaccine Trials Network, 2% (n = 1), 25% (n = 12) and 43% (n = 3) with main, casual and new partners, respectively.
Fred Hutchinson Cancer
Research Center, Seattle, Commonly reported VP included washing the vagina with water (44%) and using fingers (48%).
United States VP decreased significantly over time (p < 0.001). Women who used condoms inconsistently or
whose last sex was with a casual partner were 3 times more likely to report VP ( p = 0.001).
3 South African Medical
Research Council, Cape Conclusion: Despite the high incidence of HIV in our setting, VP are still common and are
Town, South Africa associated with other behavioural risks for HIV. Further study is needed to assess whether
clinician education may reduce VP and therefore should be included in HIV risk reduction
4 Statistical Center for HIV/AIDS counselling.
Research and Prevention,
Seattle, United States Keywords: Vaginal hygiene; Vaginal practices; HIV risk; Young women; Soweto; South Africa.

Corresponding author:
Erica Lazarus,
[email protected] Introduction
1
Dates: In 2016, an estimated 17 million women aged 15 years and older were living with HIV. In Eastern
2
Received: 04 May 2018 and Southern Africa, women aged 15–24 years accounted for 26% of new infections. In
Accepted: 14 Feb. 2019 South Africa, the sub-Saharan African country with the highest number of people living with HIV,
Published: 20 June 2019
HIV prevalence among 20–24-year-olds was 16%. 3
How to cite this article:
Lazarus E, Otwombe K, Young women in South Africa are twice as likely to acquire HIV compared with their male peers.
3
Dietrich J, et al. Vaginal Various biological, social and behavioural factors increase the susceptibility of women to HIV
practices among women 4,5
at risk for HIV acquisition in acquisition. Vaginal practices (VP) have been shown to increase the acquisition risks of HIV in
Soweto, South Africa. S Afr J women. While all intravaginal washing increased the risk of HIV, women who washed
6
HIV Med. 2019;20(1), a866. intravaginally with soap or other substances were at higher risk than those who washed with
https://doi.org/10.4102/ water alone. In addition, VP increased the risk of other genital tract infections (GTIs) that
6
sajhivmed.v20i1.866
themselves are associated with increased HIV acquisition risk, including Herpes Simplex Virus
8
Copyright: type 2, Human Papillomavirus and bacterial vaginosis. 9,10,11,12,13 Furthermore, VP may also reduce
7
© 2019. The Authors. the effectiveness of HIV prevention methods like microbicides. 14
Licensee: AOSIS. This work
is licensed under the
Creative Commons Vaginal practices (VP) include a range of practices, such as washing the external genitalia,
Attribution License. vaginal washing with water alone or with water and soap, 8,9,12,15,16,17,18,19,20,21,22 which may be
performed with or without a cloth. 10,13,23,24 In addition, insertion of substances for enhancement of
Read online: sexual pleasure, particularly vaginal drying, has also been reported by women from as young as
Read online:
Scan this QR
Scan this QR 16 years of age. 9,21,25,26
code with your
code with your
smart phone or
smart phone or
mobile device Vaginal practices are commonly self-reported by women in African communities. Among female
mobile device
13
to read online.
to read online.
sex workers in Kenya, 86% – 100% of women report VP. 10,12,19,20,27 In the KwaZulu-Natal Province
http://www.sajhivmed.org.za 389 Open Access