Page 397 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 2 of 7 Original Research

of South Africa, a household survey found that 90% of aged 20–24 years; (3) women who engaged in transactional
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women practised some form of VP, whereas data from Cape sex; (4) unmarried women living together with a partner;
Town in the Western Cape Province reflects much lower (5) women who engaged in unprotected vaginal or anal sex
practice, around 26% – 29%. 23,24 (sex without a condom); (6) women who lived or worked in
informal settlements and taverns, and (7) women with any
We were unable to find any study in the literature reporting history of genital ulcer disease. Volunteers for the study
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on whether partner type has an effect on VP. However, provided written informed consent for study procedures and
Scorgie et al. reported that women in KwaZulu-Natal, who data collection prior to beginning screening procedures.
were in stable relationships but also had other partners, were Women were excluded if they were pregnant or breastfeeding,
significantly more likely to use VP for sexual motivations or if they were unwilling to use contraception for the duration
than women who did not have casual partners. 29 of the study. Mandated contraceptives were condoms,
diaphragm or cervical cap, intrauterine device, hormonal
Furthermore, there are limited longitudinal data on the contraception, vasectomy of male partners or no reproductive
change in VP over time among South African women. Only potential such as hysterectomy. Women who became
one study including South African women assessed, and pregnant during the study were terminated from study
counselled against, VP at all study visits. In this study, follow-up and referred for antenatal care at local health
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quarterly counselling decreased vaginal washing practices facilities. Women who became infected with HIV during the
by less than 10%. 30 study were to be referred to local health facilities for care, but
could continue in the study.
We describe self-reported VP in a cohort of young Sowetan
women enrolled in the HVTN 915 observational study. In Procedures
addition, we assess the change in the reported number of VP
over time as well as factors associated with VP, including Eligible participants attended 9 study visits over 3 months.
casual sexual partnerships. To fulfil the primary objectives of the study (not reported
in this article), participants self-collected a daily vaginal
Methods swab. At each study visit, participants answered a
Study design quantitative interviewer-administered, pen-and-paper-based
HIV behavioural risk questionnaire. Recall period at
HVTN 915 was a prospective observational study of screening was 30 days and 7 days at subsequent visits. The
50 women deemed to be at risk of HIV acquisition, in questionnaire included questions on sexual behaviour,
Soweto, South Africa. The study was conducted between alcohol and drug use, and VP. VP were assessed through
August 2014 and April 2015, and aimed to evaluate the 12 items addressing vaginal washing, insertion of medicines
feasibility of self-administered vaginal swabs for the or other items (paper, cloth, sponges, cotton wool, tampon)
detection of HIV-1 virions transferred through vaginal and use of gels, lubricants or creams, including haemorrhoid
sexual intercourse and to compare sexual and behavioural creams. These items were derived from the literature and are
risk data collected via in-person interview versus daily in line with the WHO policy brief on gender, sexuality and
mobile phone survey. In this article, we focus on the VP VP. Participants were asked to report the frequency of
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reported by women in HVTN 915. each practice during the recall period: never, once a week,
2–3 times per week, 4–5 times per week or every day. Staff
Study setting were trained on the administration of the questionnaire and
the use of interviewer cards to remind participants of the
The study was conducted at the Perinatal HIV Research Unit
in Soweto, South Africa. Soweto, with a population of about frequency options.
1 million people, is located south-west of Johannesburg in the
Gauteng Province of South Africa. The HIV prevalence in Participants received individualised HIV risk reduction
adults in Gauteng is 18%. Women were recruited from counselling at every visit and HIV counselling and testing at
3
surrounding areas, including local taverns, and invited to screening, and weeks 6 and 9. In addition, participants were
come to the site to receive more information about the study. assessed for GTIs at enrolment by screening for symptoms
and signs of GTIs as well as laboratory testing. Symptom
screening and treatment for GTI syndromes were performed
Participants using the South African standard of care syndrome-based
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Women were eligible for participation in the study if they approach. The following GTI syndromes were assessed:
were between the ages of 18 and 25 years, healthy on the lower abdominal pain, vaginal discharge syndrome, genital
basis of medical history and physical examination and ulcer syndrome, bubo, syphilis, pubic lice, genital warts and
HIV-uninfected. Epidemiological data on HIV prevalence in any other genital tract symptoms. In addition, a Pap smear,
South Africa guided the eligibility criteria for women who blood test for syphilis and urine polymerase chain reaction
may be at risk of HIV acquisition: (1) women who had vaginal for Chlamydia trachomatis and Neisseria gonorrhoea were
intercourse with one or more males 4 or more times per week collected on all participants. Where vaginal discharge was
in the 30 days preceding screening; (2) black African women reported or found on speculum examination, pH testing,

http://www.sajhivmed.org.za 390 Open Access