Page 401 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 6 of 7 Original Research

Young women who receive positive GTI test results might HVTN 915 team: Yunda Huang, Protocol Statistician; Philip
be motivated to change their vaginal hygiene practices, Renzullo, DAIDS/NIAID Representative; Robert Coombs,
particularly when education has been provided about the Laboratory Consultant; Eva Chung, HVTN Laboratory Program
link between VP and GTIs; however in our study, laboratory- Representative; Denelle Reilly, HVTN Regulatory Affairs;
confirmed GTIs at enrolment were not associated with VP Busisiwe Buthelezi, PHRU Community Advisory Board;
over time. There was a significant difference in the prevalence Shelly Ramirez, Clinical Trial Manager; Huguette Redinger,
of laboratory-confirmed GTIs at enrolment compared to Data Project Manager; Gina Escamilla, HVTN Program
reported symptomatic infections This supports data from Manager; Ramey Fair, Protocol Development Coordinator;
other South African cohorts, highlighting the urgency to Genevieve Meyer, HVTN Community Engagement
introduce routine laboratory screening for GTIs into primary Unit Representative; Celokuhle Tshabalala, PHRU
healthcare settings. 38,39 Community Educator/Recruiter; Adi Ferrara, Protocol
Technical Editor.
Studies show that women use VP as a means to reduce GTI
25
risk. We hypothesised that women would be more likely Competing interests
to engage in VP and use condoms consistently with
partners who they thought posed a greater risk for GTIs, The authors declare that they have no financial or personal
such as casual partners, transactional partners or partners relationship(s) that may have inappropriately influenced
who they knew had other partners. However, despite the them in writing this article.
high prevalence of casual sexual partnerships, self-reported
transactional sex with casual partners and casual or new Authors’ contributions
partners with concurrent partners, condom use was poor J.G.K. and G.E.G. conceived of the idea. C.A.M. was the
with all partner types. We also found that women who protocol leader and E.L. was the site principal investigator.
used condoms inconsistently and where last sex was with a E.L., K.O., J.D., M.P.A., C.A.M., J.G.K., G.E.G., and F.L.
casual partner were 3 times more likely to report VP. It is contributed to the study design. E.L. and F.L. contributed
possible that these women used VP to compensate for to the acquisition of data. K.O. led the statistical analysis
unprotected sex with partners that they perceived as posing with support from A.J.I. All authors contributed to the
a higher risk of GTIs. The use of VP after higher risk sex data interpretation. E.L. drafted the manuscript, which was
emphasises the need to include VP during risk reduction revised and approved by all the authors.
counselling.
References
Our study has limitations. HVTN 915 was 3 months long,
so the sustainability of the reduction in VP could not be 1. Joint United Nations Programme on HIV/AIDS (UNAIDS). UNAIDS data 2018
assessed. Data were collected through an interviewer- [homepage on the Internet]. [cited 2018 July 23]. Available from http://www.
unaids.org/sites/default/files/media_asset/unaids-data-2018_en.pdf.
administered questionnaire, which may have introduced 2. Joint United Nations Programme on HIV/AIDS (UNAIDS). UNAIDS data 2017
social desirability bias in the self-report of study information. [homepage on the Internet]. [cited 2018 July 23]. Available from http://www.
unaids.org/sites/default/files/media_asset/20170720_Data_book_2017_en.pdf.
The interview technique of the interviewers may have biased 3. Human Sciences Research Council. The Fifth South African National HIV
the data. Although there may have been some recall bias at prevalence, incidence, behaviour and communication survey, 2017 [homepage on
the screening assessment, the 7-day recall period thereafter the Internet]. 2018 [cited 2018 July 23]. Available from http://www.hsrc.ac.za/
uploads/pageContent/9225/SABSSMV_Impact_Assessment_Summary_ZA_ADS_
would have reduced this during the study. The content of cleared1%20(002).pdf.
the education provided on reducing VP was not required to 4. Addo MM, Altfeld M. Sex-based differences in HIV type 1 pathogenesis. J Infect
Dis. 2014;209 Suppl 3:S86–S92. https://doi.org/10.1093/infdis/jiu175
be documented, and thus the consistency of the messaging 5. Sia D, Onadja Y, Nandi A, Foro A, Brewer T. What lies behind gender inequalities in
about avoidance of VP cannot be proven. HIV/AIDS in sub-Saharan African countries: Evidence from Kenya, Lesotho and
Tanzania. Health Pol Plan. 2014;29:938–949. https://doi.org/10.1093/heapol/
czt075
In the context of the disproportionate risk of HIV in young 6. McClelland RS, Lavreys L, Hassan WM, Mandaliya K, Ndinya-Achola JO, Baeten JM.
Vaginal washing and increased risk of HIV-1 acquisition among African women: A
South African women, further interventions are required 10-year prospective study. AIDS. 2006;20(2):269–273. https://doi.org/10.1097/01.
aids.0000196165.48518.7b
to modify VP. We strongly recommend the development 7. Okuku HS, Sanders EJ, Nyiro J, et al. Factors associated with herpes simplex virus
and evaluation of interventions, such as the use of simple type 2 incidence in a cohort of human immunodeficiency virus type 1-seronegative
educational messages during HIV risk reduction counselling, Kenyan men and women reporting high-risk sexual behavior. Sex Transm Dis.
2011;38(9):837–844. https://doi.org/10.1097/OLQ.0b013e31821a6225
that may be beneficial to reduce the added risks of VP on 8. Houlihan CF, de Sanjose S, Baisley K, et al. Prevalence of human papillomavirus in
HIV acquisition. adolescent girls before reported sexual debut. J Infect Dis. 2014;210(6):837–845.
https://doi.org/10.1093/infdis/jiu202
9. Baisley K, Changalucha J, Weiss HA, et al. Bacterial vaginosis in female facility
Acknowledgements workers in north-western Tanzania: Prevalence and risk factors. Sex Transm Infect.
2009;85(5):370–375. https://doi.org/10.1136/sti.2008.035543
The HVTN 915 study is supported by the National Institute 10. Hassan WM, Lavreys L, Chohan V, et al. Associations between intravaginal
practices and bacterial vaginosis in Kenyan female sex workers without symptoms
of Allergy and Infectious Diseases (NIAID) U.S. Public Health of vaginal infections. Sex Transm Dis. 2007;34(6):384–388.
Service Grants UM1 AI068614 [LOC: HIV Vaccine Trials 11. Low N, Chersich MF, Schmidlin K, et al. Intravaginal practices, bacterial vaginosis,
and HIV infection in women: Individual participant data meta-analysis. PLoS Med.
Network], UM1 AI068618 [LC: HIV Vaccine Trials Network], 2011;8(2):e1000416.
UM1 AI068635 [SDMC: HIV Vaccine Trials Network] and 12. McClelland RS, Richardson BA, Graham SM, et al. A prospective study of risk
factors for bacterial vaginosis in HIV-1-seronegative African women. Sex Transm
UM1 AI069453 [Soweto-Bara Clinical Research Site]. Dis. 2008;35(6):617–623. https://doi.org/10.1371/journal.pmed.1000416

http://www.sajhivmed.org.za 394 Open Access