1
|
Gondwe T, Ness R, Totten PA, Astete S, Tang G, Gold MA, Martin D, Haggerty CL. Novel bacterial vaginosis-associated organisms mediate the relationship between vaginal douching and pelvic inflammatory disease. Sex Transm Infect 2019; 96:439-444. [PMID: 31810995 PMCID: PMC7476288 DOI: 10.1136/sextrans-2019-054191] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/27/2019] [Accepted: 11/07/2019] [Indexed: 11/29/2022] Open
Abstract
Objectives We sought to determine whether the relationship between a history of vaginal douching and pelvic inflammatory disease (PID) is mediated by endometrial infection with one or more novel bacterial vaginosis (BV)-associated organisms among Atopobium vaginae, the BV-associated bacterium 1 (BVAB1), neathia (Leptotrichia) amnionii and Sneathia sanguinegens. Methods We first conducted log-binomial regression analyses to identify risk factors for endometrial infection in 535 adolescent and adult women with clinically suspected PID in the PID Evaluation and Clinical Health (PEACH) study. We then examined whether endometrial infection by the BV-associated organisms mediated the association between a history of vaginal douching and histologically confirmed PID using inverse probability weighted marginal structural models. Results Vaginal douching was significantly associated with endometrial infection with one or more of the targeted BV-associated organisms (relative risk (RR) 1.21, 95% CI: 1.08 to 1.35). The total effect estimate suggested that vaginal douching increased the risk of endometritis by 24% (RR 1.24, 95% CI: 1.03 to 1.49). The controlled direct effect of this association was attenuated with endometrial infection by one or more BV-associated organisms (adjusted RR (aRR) 1.00, 95% CI: 0.57 to 1.74) and endometrial infection by all four BV-associated organisms (aRR 0.95, 95% CI: 0.53 to 1.70) as intermediate variables. Conclusions Endometrial infection with one or more of the novel BV-associated organisms partially mediated the relationship between vaginal douching and histologically confirmed endometritis in the PEACH study. Frequent vaginal douching may confer risk for endometritis through increasing the risk of endometrial infection by novel-BV-associated organisms. Other potential pathways should be explored.
Collapse
Affiliation(s)
- Tamala Gondwe
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Roberta Ness
- Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas School of Public Health, Houston, Texas, USA
| | - Patricia A Totten
- Department of Medicine, Division of Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Sabina Astete
- Department of Medicine, Division of Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Gong Tang
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Melanie A Gold
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center and Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - David Martin
- Department of Medicine, Louisiana State University, New Orleans, Louisiana, USA
| | - Catherine L Haggerty
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA .,Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
2
|
King C, Llewellyn C, Shahmanesh M, Abraham C, Bailey J, Burns F, Clark L, Copas A, Howarth A, Hughes G, Mercer C, Miners A, Pollard A, Richardson D, Rodger A, Roy A, Gilson R. Sexual risk reduction interventions for patients attending sexual health clinics: a mixed-methods feasibility study. Health Technol Assess 2019; 23:1-122. [PMID: 30916641 PMCID: PMC6452239 DOI: 10.3310/hta23120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) continue to represent a major public health challenge. There is evidence that behavioural interventions to reduce risky sexual behaviours can reduce STI rates in patients attending sexual health (SH) services. However, it is not known if these interventions are effective when implemented at scale in SH settings in England. OBJECTIVES The study (Santé) had two main objectives - (1) to develop and pilot a package of evidence-based sexual risk reduction interventions that can be delivered through SH services and (2) to assess the feasibility of conducting a randomised controlled trial (RCT) to determine effectiveness against usual care. DESIGN The project was a multistage, mixed-methods study, with developmental and pilot RCT phases. Preparatory work included a systematic review, an analysis of national surveillance data, the development of a triage algorithm, and interviews and surveys with SH staff and patients to identify, select and adapt interventions. A pilot cluster RCT was planned for eight SH clinics; the intervention would be offered in four clinics, with qualitative and process evaluation to assess feasibility and acceptability. Four clinics acted as controls; in all clinics, participants would be consented to a 6-week follow-up STI screen. SETTING SH clinics in England. PARTICIPANTS Young people (aged 16-25 years), and men who have sex with men. INTERVENTION A three-part intervention package - (1) a triage tool to score patients as being at high or low risk of STI using routine data, (2) a study-designed web page with tailored SH information for all patients, regardless of risk and (3) a brief one-to-one session based on motivational interviewing for high-risk patients. MAIN OUTCOME MEASURES The three outcomes were (1) the acceptability of the intervention to patients and SH providers, (2) the feasibility of delivering the interventions within existing resources and (3) the feasibility of obtaining follow-up data on STI diagnoses (primary outcome in a full trial). RESULTS We identified 33 relevant trials from the systematic review, including videos, peer support, digital and brief one-to-one sessions. Patients and SH providers showed preferences for one-to-one and digital interventions, and providers indicated that these intervention types could feasibly be implemented in their settings. There were no appropriate digital interventions that could be adapted in time for the pilot; therefore, we created a placeholder for the purposes of the pilot. The intervention package was piloted in two SH settings, rather than the planned four. Several barriers were found to intervention implementation, including a lack of trained staff time and clinic space. The intervention package was theoretically acceptable, but we observed poor engagement. We recruited patients from six clinics for the follow-up, rather than eight. The completion rate for follow-up was lower than anticipated (16% vs. 46%). LIMITATIONS Fewer clinics were included in the pilot than planned, limiting the ability to make strong conclusions on the feasibility of the RCT. CONCLUSION We were unable to conclude whether or not a definitive RCT would be feasible because of challenges in implementation of a pilot, but have laid the groundwork for future research in the area. TRIAL REGISTRATION Current Controlled Trials ISRCTN16738765. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 12. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Carina King
- Institute for Global Health, University College London, London, UK
| | - Carrie Llewellyn
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | | | | | - Julia Bailey
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Fiona Burns
- Institute for Global Health, University College London, London, UK
| | - Laura Clark
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Andrew Copas
- Institute for Global Health, University College London, London, UK
- London Hub for Trials Methodology Research, Medical Research Council Clinical Trials Unit, London, UK
| | - Alison Howarth
- Institute for Global Health, University College London, London, UK
| | - Gwenda Hughes
- Sexually Transmitted Infection Surveillance, Public Health England, London, UK
| | - Cath Mercer
- Institute for Global Health, University College London, London, UK
| | - Alec Miners
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Alex Pollard
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | | | - Alison Rodger
- Institute for Global Health, University College London, London, UK
| | - Anupama Roy
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Richard Gilson
- Institute for Global Health, University College London, London, UK
| |
Collapse
|
3
|
Alcaide ML, Rodriguez VJ, Fischl MA, Jones DL, Weiss SM. Addressing intravaginal practices in women with HIV and at-risk for HIV infection, a mixed methods pilot study. Int J Womens Health 2017; 9:123-132. [PMID: 28280394 PMCID: PMC5339018 DOI: 10.2147/ijwh.s125883] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Intravaginal practices (IVPs), include intravaginal cleansing (cleansing the inside of the vagina) or intravaginal insertion of products for hygiene, health or sexuality reasons. IVPs are associated with adverse female health outcomes, development of bacterial vaginosis, HIV acquisition and transmission. A mixed methods approach was used in this study to examine the prevalence of IVP, assess reasons for engagement, and perceptions of IVP among a sample of minority (African-American and Hispanic) women infected, or at-risk, for HIV in Miami, USA, a city with increasing numbers of sexually transmitted infections (STIs) and HIV. Three focus groups (total n=20) and quantitative assessments (n=72) were conducted with women infected or uninfected with HIV. In the qualitative assessments, most women reported engaging in both intravaginal cleansing and intravaginal insertion, and stated the main motivation for IVP was hygiene. The quantitative assessments confirmed that cleansing with water alone, soap with water or using commercial douches was common, as well as intravaginal insertion using a cloth or a rag in both HIV-infected and uninfected women. Women with HIV infection reported less use of water and water and soap for IVPs, and reported learning about the potential harm of IVP from their HIV health care providers. Despite their health risks, IVP appeared common in both HIV-infected and at-risk minority women, and interventions to decrease IVP could have important health implications among populations with high rates of IVP, STIs and HIV.
Collapse
Affiliation(s)
- Maria L Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine
| | - Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Margaret A Fischl
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stephen M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
4
|
Long L, Abraham C, Paquette R, Shahmanesh M, Llewellyn C, Townsend A, Gilson R. Brief interventions to prevent sexually transmitted infections suitable for in-service use: A systematic review. Prev Med 2016; 91:364-382. [PMID: 27373209 DOI: 10.1016/j.ypmed.2016.06.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 05/26/2016] [Accepted: 06/27/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sexually transmitted infections (STIs) are more common in young people and men who have sex with men (MSM) and effective in-service interventions are needed. METHODS A systematic review of randomized controlled trials (RCTs) of waiting-room-delivered, self-delivered and brief healthcare-provider-delivered interventions designed to reduce STIs, increase use of home-based STI testing, or reduce STI-risk behavior was conducted. Six databases were searched between January 2000 and October 2014. RESULTS 17,916 articles were screened. 23 RCTs of interventions for young people met our inclusion criteria. Significant STI reductions were found in four RCTs of interventions using brief one-to-one counselling (2 RCTs), video (1 RCT) and a STI home-testing kit (1 RCT). Increase in STI test uptake was found in five studies using video (1 RCT), one-to-one counselling (1 RCT), home test kit (2 RCTs) and a web-based intervention (1 RCT). Reduction in STI-risk behavior was found in seven RCTs of interventions using digital online (web-based) and offline (computer software) (3 RCTs), printed materials (1 RCT) and video (3 RCTs). Ten RCTs of interventions for MSM met our inclusion criteria. Three tested for STI reductions but none found significant differences between intervention and control groups. Increased STI test uptake was found in two studies using brief one-to-one counselling (1 RCT) and an online web-based intervention (1 RCT). Reduction in STI-risk behavior was found in six studies using digital online (web-based) interventions (4 RCTs) and brief one-to-one counselling (2 RCTs). CONCLUSION A small number of interventions which could be used, or adapted for use, in sexual health clinics were found to be effective in reducing STIs among young people and in promoting self-reported STI-risk behavior change in MSM.
Collapse
Affiliation(s)
- L Long
- Psychology Applied to Health Group, University of Exeter Medical School, University of Exeter, UK
| | - C Abraham
- Psychology Applied to Health Group, University of Exeter Medical School, University of Exeter, UK.
| | - R Paquette
- Research Department of Infection and Population Health, University College London, UK
| | - M Shahmanesh
- Research Department of Infection and Population Health, University College London, UK
| | - C Llewellyn
- Division of Public Health and Primary Care, Brighton and Sussex Medical School, UK
| | - A Townsend
- Psychology Applied to Health Group, University of Exeter Medical School, University of Exeter, UK
| | - R Gilson
- Research Department of Infection and Population Health, University College London, UK
| |
Collapse
|
5
|
Kasaro MP, Husnik MJ, Chi BH, Reid C, Magure T, Makanani B, Tembo T, Ramjee G, Maslankowski L, Rabe L, Brad Guffey M. Impact of targeted counseling on reported vaginal hygiene practices and bacterial vaginosis: the HIV Prevention Trials Network 035 study. Int J STD AIDS 2016; 28:467-475. [PMID: 27277555 DOI: 10.1177/0956462416653001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study was to describe the impact of intense counseling to reduce vaginal hygiene practices and its effect on bacterial vaginosis. A secondary data analysis of the HIV Prevention Trials Network 035 study was undertaken, focusing on HIV-negative, nonpregnant women who were at least 18 years old, in seven African sites and one US site. At enrollment and during follow-up quarterly visits, vaginal hygiene practices were determined by face-to-face administration of a behavioral assessment questionnaire. Vaginal hygiene practices were categorized as insertion into the vagina of (1) nothing, (2) water only, and (3) other substances with or without water. Each practice was quantified by frequency and type/combination of inserted substances. At quarterly visits, diagnosis of bacterial vaginosis was made using the Nugent score. Trends for vaginal hygiene practices and bacterial vaginosis were evaluated using generalized estimating equation models. A total of 3087 participants from the HIV Prevention Trials Network 035 study were eligible for this analysis. At enrollment, 1859 (60%) reported recent vaginal hygiene practices. By one year, this figure had decreased to 1019 (33%) with counseling. However, bacterial vaginosis prevalence remained consistent across the study observation period, with 36%-38% of women testing positive for the condition ( p for trend = 0.27). Overall, those who reported douching with water only (AOR = 1.03, 95%CI: 0.94-1.13) and those who reported inserting other substances (AOR= 0.98, 95%CI: 0.88-1.09) in the past quarter were not more likely to have bacterial vaginosis compared to those who reported no insertions. However, in South Africa, an increase in bacterial vaginosis was seen among those who reported inserting other substances (AOR: 1.48, 95%CI: 1.17, 1.88). In conclusion, targeted counseling against vaginal hygiene practices resulted in change in self-reported behavior but did not have an impact on bacterial vaginosis diagnosis in all but one site.
Collapse
Affiliation(s)
- Margaret P Kasaro
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,2 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Marla J Husnik
- 3 Fred Hutchinson Cancer Research Center, Statistical Center for HIV/AIDS Research & Prevention, Seattle, WA, USA
| | - Benjamin H Chi
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Cheri Reid
- 2 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Tsitsi Magure
- 4 Department of Obstetrics and Gynecology, College of Health Science, University of Zimbabwe, Harare, Zimbabwe
| | - Bonus Makanani
- 5 College of Medicine-John Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Tchangani Tembo
- 6 UNC Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Gita Ramjee
- 7 HIV Prevention Research Unit 1, South African Medical Research Council, Durban, South Africa
| | | | - Lorna Rabe
- 9 Magee-Women's Research Institute, Pittsburgh, PA, USA
| | - M Brad Guffey
- 2 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.,1 0Family Legacy, Lusaka, Zambia
| |
Collapse
|
6
|
Luo L, Xu JJ, Wang GX, Ding GW, Wang N, Wang HB. Vaginal douching and association with sexually transmitted infections among female sex workers in a prefecture of Yunnan Province, China. Int J STD AIDS 2015; 27:560-7. [PMID: 26016725 DOI: 10.1177/0956462415589044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 05/06/2015] [Indexed: 11/15/2022]
Abstract
Vaginal douching is a common practice and has been hypothesised to increase a woman's risk for human of contracting HIV and sexually transmitted infections (STIs). Our objective was to assess the prevalence of douching and its association with STIs, genital symptoms and HIV/STI knowledge among female sex workers (FSWs). We conducted a cross-sectional study of 837 FSWs with interviews and laboratory tests for HIV/STIs in a prefecture of Yunnan Province in southern China. Vaginal douching was reported by 84% of the women. We found a higher prevalence of vaginal douching practice among FSWs of Han ethnicity, and who were single or cohabitating. Douching was also significantly more common among more educated FSWs and those with greater knowledge of HIV/STIs, and as well as in FSWs who had experienced clinical symptoms in the previous 12 months. Douching was linked to higher risks of HIV (adjusted odds ratio = 2.29; 95% confidence interval 1.01-5.23) and herpes simplex virus type 2 infections (adjusted odds ratio = 2.18; 95% confidence interval 1.46-3.24) after adjusting for confounding factors. Medical professionals and public health workers should correct women's misconception about the effectiveness of douching and discourage women from douching through educational activities. More prospective studies among FSWs are urgently required to identify the relationship between vaginal douching and HIV/STIs.
Collapse
Affiliation(s)
- Li Luo
- Chinese Center for Disease Control and Prevention, Beijing, PR China
| | - Jun-Jie Xu
- Key Laboratory of Immunology of AIDS, Ministry of Health, First Affiliated Hospital, China Medical University, Shenyang, PR China
| | - Gui-Xiang Wang
- Kaiyuan Center for Disease Control and Prevention, Yunnan, PR China
| | - Guo-Wei Ding
- National Center for AIDS/STD Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing, PR China
| | - Ning Wang
- National Center for AIDS/STD Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing, PR China
| | - Hai-Bo Wang
- Peking University Clinical Research Institute, Beijing, PR China
| |
Collapse
|
7
|
Esber A, Moyo P, Munjoma M, Francis S, van de Wijgert J, Chipato T, Turner AN. Cessation of intravaginal practices to prevent bacterial vaginosis: a pilot intervention in Zimbabwean women. Sex Transm Infect 2015; 91:183-8. [PMID: 25355772 DOI: 10.1136/sextrans-2014-051764] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 10/05/2014] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Intravaginal practices--including behaviours such as washing with soap or other materials, using fingers or cloth, or insertion of herbs, powders or other products to dry, cleanse or 'tighten' the vagina--may increase women's risk of bacterial vaginosis by disrupting the vaginal microbiota. In Zimbabwe, intravaginal practices are common. The objective of this study was to assess the feasibility of an intervention based on the transtheoretical model of behaviour change (also called the 'stages of change' model) to encourage cessation of vaginal practices among a sample of Zimbabwean women. METHODS We conducted a 12-week behaviour change intervention to encourage cessation of intravaginal practices (other than cleansing with water) among 85 Zimbabwean women who reported these practices. RESULTS Self-reported intravaginal practices declined significantly over follow-up, with 100% of women reporting at least one intravaginal practice at enrolment compared with 8% at the final visit. However, we found no significant effect of this reduction on bacterial vaginosis prevalence in unadjusted or adjusted multivariable models (adjusted prevalence ratio for any practice vs none: 0.94, 95% CI 0.61 to 1.43). CONCLUSIONS While the intervention was successful in reducing women's self-reported engagement in intravaginal practices, we observed no corresponding benefit to vaginal health.
Collapse
Affiliation(s)
- Allahna Esber
- Division of Epidemiology, The Ohio State University, Columbus, Ohio, USA
| | - Precious Moyo
- UZ-UCSF Collaborative Research Programme, Harare, Zimbabwe
| | | | - Shelley Francis
- School of Health Sciences, College of Health Sciences, Walden University
| | | | - Tsungai Chipato
- UZ-UCSF Collaborative Research Programme, Harare, Zimbabwe Department of Obstetrics and Gynaecology, University of Zimbabwe, Harare, Zimbabwe
| | - Abigail Norris Turner
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
8
|
Sivapalasingam S, McClelland RS, Ravel J, Ahmed A, Cleland CM, Gajer P, Mwamzaka M, Marshed F, Shafi J, Masese L, Fajans M, Anderson ME, Jaoko W, Kurth AE. An effective intervention to reduce intravaginal practices among HIV-1 uninfected Kenyan women. AIDS Res Hum Retroviruses 2014; 30:1046-54. [PMID: 25265254 DOI: 10.1089/aid.2013.0251] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Sumathi Sivapalasingam
- Division of Infectious Diseases, Department of Medicine, New York University School of Medicine, New York, New York
| | - R. Scott McClelland
- University of Washington School of Medicine, Seattle, Washington
- University of Nairobi, Nairobi, Kenya
| | - Jacques Ravel
- University of Maryland School of Medicine, Institute for Genomic Sciences, Baltimore, Maryland
| | | | | | - Pawel Gajer
- University of Maryland School of Medicine, Institute for Genomic Sciences, Baltimore, Maryland
| | - Musa Mwamzaka
- University of Maryland School of Medicine, Institute for Genomic Sciences, Baltimore, Maryland
| | | | - Juma Shafi
- Ganjoni Municipal Clinic, Mombasa, Kenya
| | - Linnet Masese
- University of Washington School of Medicine, Seattle, Washington
| | - Mark Fajans
- Division of Infectious Diseases, Department of Medicine, New York University School of Medicine, New York, New York
| | | | | | - Ann E. Kurth
- College of Nursing, New York University, New York, New York
| |
Collapse
|
9
|
Ahn S, Cho K. Personal Hygiene Practices related to Genito-urinary Tract and Menstrual Hygiene Management in Female Adolescents. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2014; 20:215-224. [PMID: 37684797 DOI: 10.4069/kjwhn.2014.20.3.215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023] Open
Abstract
PURPOSE The study was to survey personal hygiene practice related to genito-urinary tract and menstrual hygiene management in female adolescents in order to obtain basic information for health education. METHODS With a descriptive survey design, 389 adolescents were recruited via convenience sampling in Korea. Survey instrument was the feminine and menstrual hygiene practice and perception of vaginal douching. Data were collected from a self-administered structured questionnaire. RESULTS Mean age of adolescents was 16.09 and menarche was at 13.21. While washing hands after urination/defecation was highly performed, wipe front to back and wash with soap and water were reported as being not well done. Twenty-eight percent reported douching habit. More positive beliefs about douching were reported by adolescents who practiced douching. Menstrual hygiene management was very appropriate with changing sanitary pads regularly with hand washing; but less performed for limiting bathing activity during menstrual periods and washing hands after activity of genito-urinary area. CONCLUSION Some adolescents practiced inadequate hygiene practices especially for body cleansing during menstrual period and vaginal douching. It is important to develop and implement school health education programs on feminine and personal hygiene for adolescents to help them perform adequate health behaviors.
Collapse
Affiliation(s)
- Sukhee Ahn
- College of Nursing, Chungnam National University, Daejeon, Korea
| | - Kyungmi Cho
- College of Nursing, Chungnam National University, Daejeon, Korea
| |
Collapse
|
10
|
The implications of post-coital intravaginal cleansing for the introduction of vaginal microbicides in South Africa. AIDS Behav 2014; 18:297-310. [PMID: 24337726 PMCID: PMC3905171 DOI: 10.1007/s10461-013-0676-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Post-coital intravaginal cleansing (IVC) could counteract the protective effect of a vaginal microbicide. IVC less than 1 h after sex is discouraged in most microbicide trials. During a microbicide trial in KwaZulu-Natal, we collected quantitative data on post-coital IVC. We discussed IVC during in-depth-interviews (IDIs) and focus-group discussions (FGDs) with women enrolled in the trial, and during FGDs with community members. Nearly one-third (336/1,143) of women reported IVC less than an hour after sex. In multivariate analysis, post-coital IVC was associated with younger age, larger household size, greater sexual activity, consistent gel use, and clinic of enrolment. During IDIs and FGDs, respondents described post-coital IVC as a common hygiene practice motivated by the need to remove semen, vaginal fluids and sweat, although this practice may be amenable to change in the context of microbicide use. We need to consider strategies for influencing post-coital IVC practices in future microbicide trials and delivery programmes.
Collapse
|
11
|
Farage MA, Miller KW, Davis A. Cultural aspects of menstruation and menstrual hygiene in adolescents. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.11.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
12
|
Lees S, Zalwango F, Andrew B, Vandepitte J, Seeley J, Hayes RJ, Francis SC. Understanding motives for intravaginal practices amongst Tanzanian and Ugandan women at high risk of HIV infection: the embodiment of social and cultural norms and well-being. Soc Sci Med 2013; 102:165-73. [PMID: 24565154 PMCID: PMC3979101 DOI: 10.1016/j.socscimed.2013.12.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 12/03/2013] [Accepted: 12/03/2013] [Indexed: 11/30/2022]
Abstract
Some types of intravaginal practices (IVP) may increase the risk for HIV acquisition. This is particularly worrisome for populations with dual high prevalence of HIV and IVP. Women involved in transactional sex are at increased risk for HIV infection in sub-Saharan Africa. Social, cultural and economic influences are strong drivers of IVP in this population. To explore this, we carried out a qualitative research study to investigate the drivers and motivations for using IVP within a large observational study of women at high risk of HIV in Tanzania and Uganda from September 2008 to September 2009. Of the 201 women selected, 176 women took part in a semi-structured in-depth interview. Additionally, in Tanzania, eight focus group discussions among study participants and community members were carried out to obtain information on community norms and expectations. IVP were motivated by overlapping concerns with hygiene, morality, sexual pleasure, fertility, relationship security, and economic security. These motives were driven by the need to meet cultural and social expectations of womanhood, and at the same time attend to personal well-being. Among women involved in transactional sex in East Africa, interventions aimed at modifying or eliminating IVP should attend to local cultural and social norms as well as the individual as an agent of change. Previous research has shown that some types of intravaginal practice (IVP) may increase HIV risk. The motives of women at high risk of HIV to carry out IVP fulfil sociocultural norms of womanhood and well-being. Economic factors for women involved in transactional sex are an important motive. Interventions aimed at reducing or eliminating IVP should address these issues.
Collapse
Affiliation(s)
- Shelley Lees
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom; Mwanza Intervention Trials Unit, National Institute for Medical Research Mwanza Centre, P.O. Box 11936, Mwanza, Tanzania.
| | - Flavia Zalwango
- Medical Research Council/Uganda Research Unit on AIDS, P.O. Box 49, Entebbe, Uganda
| | - Bahati Andrew
- Mwanza Intervention Trials Unit, National Institute for Medical Research Mwanza Centre, P.O. Box 11936, Mwanza, Tanzania
| | - Judith Vandepitte
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom; Medical Research Council/Uganda Research Unit on AIDS, P.O. Box 49, Entebbe, Uganda
| | - Janet Seeley
- Medical Research Council/Uganda Research Unit on AIDS, P.O. Box 49, Entebbe, Uganda; University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, United Kingdom
| | - Richard J Hayes
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - Suzanna C Francis
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom; Mwanza Intervention Trials Unit, National Institute for Medical Research Mwanza Centre, P.O. Box 11936, Mwanza, Tanzania
| |
Collapse
|
13
|
Intravaginal Practices and Risk of Bacterial Vaginosis and Candidiasis Infection Among a Cohort of Women in the United States. Obstet Gynecol 2013; 121:773-780. [DOI: 10.1097/aog.0b013e31828786f8] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
14
|
HIV incidence rates and risk factors for urban women in Zambia: preparing for a microbicide clinical trial. Sex Transm Dis 2012; 36:129-33. [PMID: 19174729 DOI: 10.1097/olq.0b013e318190191d] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES A preparedness study was conducted to evaluate the suitability of sites and populations following the same study procedures intended for a larger scale microbicide efficacy trial. In the process the study evaluated human immunodeficiency virus (HIV) incidence, prevalence, and risk profiles for HIV-acquisition among young women in urban Zambia. METHODS Women aged 16 to 49 years were screened for participation in the study that involved HIV/sexually transmitted infection testing and the assessment of sexual behavioral characteristics. Two hundred thirty-nine eligible women were enrolled and followed up for 12 months. RESULTS Baseline HIV prevalence at screening was 38.7% (95% CI: 34.2%-43.3%). The highest age-specific prevalence of HIV was 54.1% (95% CI: 46.3%-61.8%) seen in women aged 26 to 34 years. HIV incidence was 2.6% per 100 woman years. Pregnancy rates were high at 17.4 per 100 woman years (95% CI: 12.2-24.1). CONCLUSION It was concluded that our general population sample, characterized by high HIV prevalence and ongoing incidence rates despite receiving regular risk reduction counseling and free condoms qualifies for future microbicide studies.A microbicide preparedness study conducted in Lusaka, Zambia found high HIV prevalence and appreciable HIV incidence in a population of women in an urban setting.
Collapse
|
15
|
Gao W, Li Z, Yan H, Wang D, Li Y, Dang S, Qiao X. Preventive measures against sexually transmitted infections among female sex workers in Lanzhou, China. ACTA ACUST UNITED AC 2011; 44:374-80. [PMID: 22200110 DOI: 10.3109/00365548.2011.644250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND We assessed the effects of preventive practices on sexually transmitted infections (STIs) and reproductive tract infections (RTIs) among female sex workers (FSWs) in Lanzhou, China. METHODS A cross-sectional survey was conducted among 350 FSWs from November 2008 to January 2009. Demographic information and behavioural factors associated with STIs were collected from all the participants. Blood samples and cervical swabs were obtained, and genital and cervical examinations were done at the collection site. A multivariate logistic regression model was used to analyze the relationships between preventive measures and the incidences of STIs and RTIs. RESULTS The utilization rates of vaginal douching (VD), regular intravenous infusion (RII), and prophylactic oral antibiotics (POA) among FSWs were 72.9%, 35.7%, and 36.3%, respectively. The preventive measures had no impact on diagnosed STIs. On the contrary, the use of VD + POA could increase the risk of vaginal infection by 2-fold (odds ratio (OR) 2.9, 95% credible interval (95% CI) 1.3-6.7). Moreover, the risk for cervical infection increased with the use of POA alone (OR 4.0, 95% CI 1.1-15.4), VD + POA (OR 4.2, 95% CI 1.7-10.3), and VD + RII (OR 2.5, 95% CI 1.1-5.7). CONCLUSIONS VD, RII, and POA, which were used widely by FSWs to prevent STIs after sex with their clients, were assumed to prevent STIs. Instead, our study indicates that they could increase the risk of vaginal or cervical infections. Therefore, FSWs should be informed of proper preventive strategies to reduce the incidence.
Collapse
Affiliation(s)
- Wenlong Gao
- Department of Epidemiology and Biostatistics, College of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| | | | | | | | | | | | | |
Collapse
|
16
|
Erbil N, Alışarlı A, Terzi HÇ, Ozdemir K, Kuş Y. Vaginal douching practices among Turkish married women. Gynecol Obstet Invest 2011; 73:152-7. [PMID: 22122972 DOI: 10.1159/000332372] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 08/17/2011] [Indexed: 11/19/2022]
Abstract
AIM This study was conducted to investigate the prevalence of the practice of vaginal douching among Turkish married women and associations between their douching status, predisposing factors, and effects on their health. METHODS This cross-sectional survey of women between 17 and 61 years of age was conducted between February 1, 2007, and May 18, 2007, in the Maternity-Gynecology and Children's Hospital in Ordu, Turkey. The sample of this study included 427 women. A confidential and anonymous self-reported questionnaire was collected in a convenient sample of the women. RESULTS Of the 427 women in the study, 165 women (38.6%) had douched at some time. Housewives [odds ratio (OR) 2.660, 95% confidence interval (CI) 1.162-6.090], women who had experienced a spontaneous abortion (OR 4.676, 95% CI 1.606-13.618), or had beliefs about positive health effects of vaginal douching (OR 29.603, 95% CI 14.090-62.192) also had risk factors associated with vaginal douching practices. CONCLUSION In conclusion, this study found that vaginal douching is a common practice among women. Many of the women who practiced vaginal douching believed in its health benefits. The results may enhance healthcare practitioners' knowledge and efforts to educate their patients.
Collapse
Affiliation(s)
- Nülüfer Erbil
- Department of Nursing, School of Health, Ordu University, Ordu, Turkey
| | | | | | | | | |
Collapse
|
17
|
Mark H, Sherman SG, Nanda J, Chambers-Thomas T, Barnes M, Rompalo A. What has changed about vaginal douching among African American mothers and daughters? Public Health Nurs 2011; 27:418-24. [PMID: 20840711 DOI: 10.1111/j.1525-1446.2010.00874.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To explore African American mothers' and daughters' practices and influences related to vaginal douching. DESIGN AND SAMPLE Our overall study used a sequential mixed-method design with 3 phases. Phase 1, the focus of this report, used grounded theory methods and in-depth, semistructured individual interviews. Two generations of African American girls and women: 24 girls ("daughters") aged 14-18 and 17 women ("mothers" or "mother figures") aged 22-43, recruited from 1 adolescent health clinic in Baltimore, MD. MEASURES In-depth interviews were taped and transcribed and data analysis used the constant comparison method. RESULTS Daughters were much less likely to douche or to have been exposed to douching information than mothers. Many mothers and daughters were influenced by health care providers and/or family members to not initiate, to decrease, or to stop douching. Women who currently douche often do so because of the perception of improved smell and cleanliness around menstruation and sexual intercourse. CONCLUSIONS These data indicate that although some women continue to believe that vaginal douching has therapeutic value, others have been influenced to stop or not start douching by family and health care providers. Health care providers should continue efforts to educate patients on the risks of vaginal douching.
Collapse
Affiliation(s)
- Hayley Mark
- Department of Community-Public Health, Johns Hopkins University School of Nursing, Baltimore, Maryland 21205-2110, USA.
| | | | | | | | | | | |
Collapse
|
18
|
Beksinska ME, Smit J, Scorgie F, Dube S, Kunene B, Martin-Hilber A, Chersich M. Use of modern and traditional products to self-treat symptoms of sexually transmitted infections in South African women. Int J STD AIDS 2011; 21:797-801. [PMID: 21297085 DOI: 10.1258/ijsa.2010.010252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The objective of the study is to investigate products used by women self-treating symptoms of reproductive tract infections (RTIs), including sexually transmitted infections (STIs), and their methods of administration. A household survey using a multi-stage cluster sample design was undertaken in KwaZulu-Natal, South Africa. Women aged 18-60 years were interviewed (n = 867) and information was collected on demographics, reproductive health and sexual behaviours. A fifth of women reported having RTI/STI symptoms (20.5%), of whom 41.9% were treating these symptoms (mostly discharge [79.1%], ulcers [6.8%] and itching [7.7%]). Only three women were using medication prescribed by a health provider, while the remainder were self-treating using traditional medicines and modern products, including antiseptics, soaps, petroleum jelly, menthol creams and alum. Products were administered in various ways. Although RTI/STI treatment is widely available and free in public health facilities, many women are still self-treating. Potential harm of products for self-treatment requires further investigation and efforts should be made to improve STI service uptake.
Collapse
Affiliation(s)
- M E Beksinska
- Maternal, Adolescent and Child Health and Reproductive Health and HIV Research Unit, Department of Obstetrics & Gynaecology, University of The Witwatersrand, Durban, South Africa.
| | | | | | | | | | | | | |
Collapse
|
19
|
Intravaginal practices, bacterial vaginosis, and HIV infection in women: individual participant data meta-analysis. PLoS Med 2011; 8:e1000416. [PMID: 21358808 PMCID: PMC3039685 DOI: 10.1371/journal.pmed.1000416] [Citation(s) in RCA: 188] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 01/05/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Identifying modifiable factors that increase women's vulnerability to HIV is a critical step in developing effective female-initiated prevention interventions. The primary objective of this study was to pool individual participant data from prospective longitudinal studies to investigate the association between intravaginal practices and acquisition of HIV infection among women in sub-Saharan Africa. Secondary objectives were to investigate associations between intravaginal practices and disrupted vaginal flora; and between disrupted vaginal flora and HIV acquisition. METHODS AND FINDINGS We conducted a meta-analysis of individual participant data from 13 prospective cohort studies involving 14,874 women, of whom 791 acquired HIV infection during 21,218 woman years of follow-up. Data were pooled using random-effects meta-analysis. The level of between-study heterogeneity was low in all analyses (I(2) values 0.0%-16.1%). Intravaginal use of cloth or paper (pooled adjusted hazard ratio [aHR] 1.47, 95% confidence interval [CI] 1.18-1.83), insertion of products to dry or tighten the vagina (aHR 1.31, 95% CI 1.00-1.71), and intravaginal cleaning with soap (aHR 1.24, 95% CI 1.01-1.53) remained associated with HIV acquisition after controlling for age, marital status, and number of sex partners in the past 3 months. Intravaginal cleaning with soap was also associated with the development of intermediate vaginal flora and bacterial vaginosis in women with normal vaginal flora at baseline (pooled adjusted odds ratio [OR] 1.24, 95% CI 1.04-1.47). Use of cloth or paper was not associated with the development of disrupted vaginal flora. Intermediate vaginal flora and bacterial vaginosis were each associated with HIV acquisition in multivariable models when measured at baseline (aHR 1.54 and 1.69, p<0.001) or at the visit before the estimated date of HIV infection (aHR 1.41 and 1.53, p<0.001), respectively. CONCLUSIONS This study provides evidence to suggest that some intravaginal practices increase the risk of HIV acquisition but a direct causal pathway linking intravaginal cleaning with soap, disruption of vaginal flora, and HIV acquisition has not yet been demonstrated. More consistency in the definition and measurement of specific intravaginal practices is warranted so that the effects of specific intravaginal practices and products can be further elucidated. Please see later in the article for the Editors' Summary.
Collapse
|
20
|
Hilber AM, Francis SC, Chersich M, Scott P, Redmond S, Bender N, Miotti P, Temmerman M, Low N. Intravaginal practices, vaginal infections and HIV acquisition: systematic review and meta-analysis. PLoS One 2010; 5:e9119. [PMID: 20161749 PMCID: PMC2817741 DOI: 10.1371/journal.pone.0009119] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Accepted: 01/07/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intravaginal practices are commonly used by women to manage their vaginal health and sexual life. These practices could, however, affect intravaginal mucosal integrity. The objectives of this study were to examine evidence for associations between: intravaginal practices and acquisition of HIV infection; intravaginal practices and vaginal infections; and vaginal infections and HIV acquisition. METHODOLOGY/PRINCIPAL FINDINGS We conducted a systematic review of prospective longitudinal studies, searching 15 electronic databases of journals and abstracts from two international conferences to 31(st) January 2008. Relevant articles were selected and data extracted in duplicate. Results were examined visually in forest plots and combined using random effects meta-analysis where appropriate. Of 2120 unique references we included 22 publications from 15 different studies in sub-Saharan Africa and the USA. Seven publications from five studies examined a range of intravaginal practices and HIV infection. No specific vaginal practices showed a protective effect against HIV or vaginal infections. Insertion of products for sex was associated with HIV in unadjusted analyses; only one study gave an adjusted estimate, which showed no association (hazard ratio 1.09, 95% confidence interval, CI 0.71, 1.67). HIV incidence was higher in women reporting intravaginal cleansing but confidence intervals were wide and heterogeneity high (adjusted hazard ratio 1.88, 95%CI 0.53, 6.69, I(2) 83.2%). HIV incidence was higher in women with bacterial vaginosis (adjusted effect 1.57, 95%CI 1.26, 1.94, I(2) 19.0%) and Trichomonas vaginalis (adjusted effect 1.64, 95%CI 1.28, 2.09, I(2) 0.0%). CONCLUSIONS/SIGNIFICANCE A pathway linking intravaginal cleaning practices with vaginal infections that increase susceptibility to HIV infection is plausible but conclusive evidence is lacking. Intravaginal practices do not appear to protect women from vaginal infections or HIV and some might be harmful.
Collapse
Affiliation(s)
| | - Suzanna C. Francis
- Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Matthew Chersich
- Faculty of Medicine and Health Sciences, International Center for Reproductive Health, Ghent University, Ghent, Belgium
- Reproductive Health and HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa
| | - Pippa Scott
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Shelagh Redmond
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Nicole Bender
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Paolo Miotti
- Office of AIDS Research, United States National Institutes of Health, Bethesda, Maryland, United States of America
| | - Marleen Temmerman
- Faculty of Medicine and Health Sciences, International Center for Reproductive Health, Ghent University, Ghent, Belgium
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- * E-mail:
| |
Collapse
|
21
|
Bhatta MP, Vermund SH, Hoesley CJ. Human immunodeficiency virus infection in Alabama women: sociodemographic, behavioral, and reproductive health characteristics and factors associated with lack of human immunodeficiency virus-1 viral control. Am J Med Sci 2010; 339:133-140. [PMID: 20087169 DOI: 10.1097/maj.0b013e3181c300f9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection among women in the southern United States is on the rise. This study examined sociodemographic profile and behavioral risk factors for HIV and sexually transmitted infections and assessed factors associated with HIV-1 viral control in a cohort of 280 HIV-infected Alabama women aged 17 to 66 years. METHODS Women receiving care for HIV infection at a university outpatient HIV clinic were enrolled in the study. Women completed a self-administered questionnaire on demographics and behavioral risk factors at enrollment. They were followed up with appointments at least every 6 months with Papanicolaou smears, cervicovaginal lavages, cervical and vaginal swabs, and blood specimens collected at each visit. RESULTS Of the women in the study, 69% were black, had mean age of 36 years, and approximately three fourths were mothers with annual household income <$20,000. White women were likely to have been HIV infected for a longer period (50.2 versus 36.3 months; P = 0.02) and had significantly lower viral loads at enrollment (P = 0.04) than black women. Factors associated with lack of HIV-1 control (> or =10,000 RNA copies/mL) at enrollment included black race/ethnicity (odds ratio [OR]: 2.8; 95% confidence interval [CI]: 1.2-6.8), CD4+ T-cell count <200 cells/microL (OR: 20.1; CI: 8.6-47.0), being diagnosed with HIV <6 months (OR: 3.5; CI: 1.4-8.9) and not being on any antiretroviral therapy (OR: 2.5; CI: 1.1-5.7). CONCLUSION Poorer HIV-1 viral control in black women at enrollment may indicate suboptimal access to HIV testing, delays in receipt of medical care after HIV-1 diagnosis, and/or some underlying biologic or social race-related influence.
Collapse
Affiliation(s)
- Madhav P Bhatta
- Department of Biostatistics, Epidemiology and Environmental Health Science, Kent State University, OH 44242, USA.
| | | | | |
Collapse
|
22
|
McKee D, Baquero M, Anderson M, Karasz A. Vaginal hygiene and douching: perspectives of Hispanic men. CULTURE, HEALTH & SEXUALITY 2009; 11:159-171. [PMID: 19247860 PMCID: PMC2760380 DOI: 10.1080/13691050802541666] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Vaginal douching is widely practised by women in the USA, particularly among minority ethnic groups, and is associated with increased risk of pelvic and vaginal infections. Douching practices are shaped by social and cultural norms regarding female hygiene, reproduction and sexuality. Little previous research has addressed the beliefs and practices of Latina women and none has included the perspective of men, though limited data suggests that women may douche to please male partners. The present study seeks to identify the socially and culturally shaped beliefs and attitudes that influence douching practices from the perspective of Latino men. We conducted in-depth qualitative interviews in English or Spanish with adult Latino men seeking primary care at a community health centre in New York City. Results indicate that these Latino men (mostly of Caribbean descent) are emphatic about the role of cleanliness in vaginal health, reporting that it substantially influences their choice of partner. Most are very supportive of douching, which they consider a necessary hygiene activity. Vaginal health is perceived as a state that must be attained and maintained through proactive hygiene measures that remove seminal residue, menstrual blood, sweat and bacteria that contaminate the vagina. The implications of these findings for interventions with Latina women are discussed.
Collapse
Affiliation(s)
- Diane McKee
- Department of Family and Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, New York 10461, USA.
| | | | | | | |
Collapse
|
23
|
Tsai CS, Shepherd BE, Vermund SH. Does douching increase risk for sexually transmitted infections? A prospective study in high-risk adolescents. Am J Obstet Gynecol 2009; 200:38.e1-8. [PMID: 18667177 DOI: 10.1016/j.ajog.2008.06.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Revised: 03/30/2008] [Accepted: 06/05/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of the study was to examine the association between douching and 4 sexually transmitted infections (STIs). STUDY DESIGN We followed up 411 high-risk human immunodeficiency virus-infected and uninfected female adolescents aged 12-19 years over a median 3-year period, both by time from study entry/first STI-free visit until an incident STI for participants who never, intermittently, and always douched and also by reported douching at a given STI-free visit and incidence of STI at the next visit, using adjusted Cox proportional hazards models to calculate hazard ratios (HR). RESULTS The time to STI was shorter for adolescents who always (HR, 2.1; 95% confidence interval [CI], 1.2-3.4) and intermittently (HR, 1.5; 95% CI, 1.0-2.2) douched, compared with never-douchers. An adjusted hazard for STI was 1.8 times larger for always-douchers (95% CI, 1.1-3.1) and 1.4 times larger for intermittent douchers (95% CI, 0.9-2.0), compared with never-douchers. When classifying by follow-up after an STI-free visit, always-douchers had a shorter STI-free time than never-douchers (HR(adj), 2.1; 95% CI, 1.5-3.1). CONCLUSION Counseling to discourage douching may reduce STI risk in adolescents.
Collapse
|
24
|
McKee MD, Baquero M, Anderson MR, Alvarez A, Karasz A. Vaginal douching among Latinas: practices and meaning. Matern Child Health J 2008; 13:98-106. [PMID: 18297379 DOI: 10.1007/s10995-008-0327-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Accepted: 02/07/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Vaginal douching is widely practiced by American women, particularly among minority groups, and is associated with increased risk of pelvic and vaginal infections. This research sought to investigate vaginal hygiene practices and meaning associated with them among Latina women and adolescents. Study results would guide development of an intervention to decrease douching among Latinas. METHODS In depth qualitative interviews conducted with English- and Spanish-speaking women aged 16-40, seeking care for any reason who reported douching within the last year (n = 34). Interviews were audiotaped, transcribed and analyzed using qualitative methods. One-third of interviews were conducted in Spanish. RESULTS Two explanatory models for douching motives emerged: one stressed cosmetic benefits; the other, infection prevention and control. Most women reported douching to eliminate menstrual residue; a small number reported douching in context of sexual intercourse or vaginal symptoms. Many were unaware of associated health risks. Respondents typically learned about douching from female family members and friends. Male partners were described as having little to no involvement in the decision to douche. Women varied in their willingness to stop douching. Two-thirds reported receiving harm reduction messages about "overdouching". About half indicated previous discussion about douching with health care providers; some had reduced frequency in response to counseling. A number of previously unreported vaginal hygiene practices and products were described, including use of a range of traditional hygiene practices, and products imported from outside the US. CONCLUSIONS Respondents expressed a range of commitment to douching. Counseling messages acknowledging benefits women perceive as well as health risks should be developed and delivered tailored to individual beliefs. Further research is needed to assess prevalence and safety of previously unreported practices.
Collapse
Affiliation(s)
- M Diane McKee
- Department of Family and Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY 10461, USA.
| | | | | | | | | |
Collapse
|
25
|
Hilber AM, Chersich MF, van de Wijgert JHHM, Rees H, Temmerman M. Vaginal practices, microbicides and HIV: what do we need to know? Sex Transm Infect 2008; 83:505-8. [PMID: 18024709 DOI: 10.1136/sti.2007.028597] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
26
|
Weisman CS, Grimley DM, Annang L, Hillemeier MM, Chase GA, Dyer AM. Vaginal douching and intimate partner violence: is there an association? Womens Health Issues 2007; 17:310-5. [PMID: 17659883 DOI: 10.1016/j.whi.2007.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Revised: 05/14/2007] [Accepted: 05/14/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study tests the hypothesis that vaginal douching among women of reproductive age is associated with exposure to intimate partner violence (IPV). METHODS The data source is a cross-sectional population-based sample of 2,002 women ages 18-45 in the Central Pennsylvania Women's Health Study. The survey included measures of IPV, douching behavior, and relevant sociodemographic and health-related covariates. FINDINGS Six percent of the sample reported experiencing any type of IPV in the past year, and 23% reported douching in the past year. IPV is significantly associated with douching after controlling for sociodemographic and health-related covariates. This finding holds for women with and without current reproductive capacity. CONCLUSIONS This is the first study to identify an association between vaginal douching and IPV. Because vaginal douching is a risk factor for sexually transmitted infections, bacterial vaginosis, and adverse pregnancy outcomes, the findings could have important implications for prevention. Further research is needed to identify the reasons why women who have been exposed to IPV are more likely to douche.
Collapse
Affiliation(s)
- Carol S Weisman
- Department of Public Health Sciences, The Pennsylvania State University, Hershey, Pennsylvania 17033, USA.
| | | | | | | | | | | |
Collapse
|
27
|
Klebanoff MA, Andrews WW, Yu KF, Brotman RM, Nansel TR, Zhang J, Cliver SP, Schwebke JR. A pilot study of vaginal flora changes with randomization to cessation of douching. Sex Transm Dis 2006; 33:610-3. [PMID: 16614585 DOI: 10.1097/01.olq.0000216050.41305.c1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objectives of this study were to determine whether women who douche regularly would enter a randomized trial of douching cessation or continuation, whether they would adhere to the assigned behavior, and whether there was a dramatic impact on vaginal flora. GOAL The goal of this study was to determine the feasibility of a large, definitive trial of douching cessation. STUDY DESIGN Women who douched at least weekly and who had either bacterial vaginosis or normal flora by Gram stain were assigned at random either to continue douching or to stop for 8 weeks. Vaginal Gram stains were obtained every 7 days from each woman. RESULTS Forty-eight women were randomized. Those assigned to continue reported douching during 77% of study weeks; those assigned to stop denied douching in 94% of weeks. No dramatic differences in flora were observed between women in the continue versus stop groups. CONCLUSION A large randomized trial of douching cessation is feasible.
Collapse
Affiliation(s)
- Mark A Klebanoff
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892, USA.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
|