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Brody C, Berkowitz RL, Chhoun P, Kaplan KC, Tuot S, Yi S. "Feeling clean": stigma and intravaginal practices among female entertainment workers in Cambodia. BMC WOMENS HEALTH 2021; 21:127. [PMID: 33765990 PMCID: PMC7993474 DOI: 10.1186/s12905-021-01271-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 03/17/2021] [Indexed: 11/17/2022]
Abstract
Background Intravaginal practices (IVPs), methods used by women most often to manage vaginal hygiene and address perceived disruptions to vaginal health, may increase the risk of contracting human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). This qualitative study explores the social, professional, and peer context surrounding IVPs, the experiences of self-cleaning or getting cleaned from a health professional, and the perceived impacts of IVPs among female entertainment workers (FEWs) in Cambodia. Methods In 2017, we conducted 27 focus group discussions from four provinces, and 16 follow-up semi-structured in-depth interviews with purposively selected participants in two provinces. Data collection occurred over three weeks, with concurrent data transcription and translation. The data from the transcripts were analyzed using Dedoose, an online, open-access qualitative analysis software. Two researchers independently labeled sections of transcripts associated with broader categories and subcategories based on the initial content analysis matrix and created codes. This process continued iteratively until a final coding schema and conceptual model was created. Results We found that IVPs are widely practiced among FEWs in Cambodia and are associated with internalized and enacted stigma. Stigma was an overarching theme that impacted the sub-themes of (1) messages about cleaning, (2) the cleaning process, and (3) the impact of cleaning. Experiences of enacted stigma and internalized stigma permeated conversations about IVP, including feeling pressured by peers to keep themselves clean, practicing internal cleaning after transactional sex, and being called dirty by health providers. Conclusions FEWs who practice IVP talk about it in the context of their lived experiences stigma and discrimination. Highly stigmatized practices such as IVP among FEWs may benefit from a harm reduction approach that emphasizes positive changes without judgment, coercion, or discrimination.
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Affiliation(s)
- Carinne Brody
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, 94592, USA.
| | | | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Kathryn C Kaplan
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Siyan Yi
- KHANA Center for Population Health Research, Phnom Penh, Cambodia.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
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Ziba FA, Yakong VN, Asore RA, Frederickson K, Flynch M. Douching practices among women in the Bolgatanga municipality of the upper east region of Ghana. BMC WOMENS HEALTH 2019; 19:32. [PMID: 30736772 PMCID: PMC6368746 DOI: 10.1186/s12905-019-0720-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 01/18/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Vaginal douching is a common practice among women all over the world. Women douche for various reasons, despite evidence indicating the harmful health effects of the practice. There is lack of data on the practice in Ghana but health behaviors like vaginal douching may be influenced by differences in culture and geography. Therefore, this study sought to assess prevalence and predictors of vaginal douching practices among women of the Bolgatanga Municipality of Ghana. METHODS This cross-sectional study was conducted among 200 women from January to March 2016. RESULTS Sixty-seven percent of the women practiced vaginal douching, from which a similar proportion did it daily. Over two-thirds (67.7%) of the women used water for douching. The reasons for douching were cleansing the vagina (67.7%), therapeutic effects (12.8%) and tightening of the vaginal muscles (19.5%). The majority (87.2%) of women who douched were unaware of the harmful health effects associated with the practice. The educational level of the women (p = 0.025) and having knowledge of the dangers associated with douching (p < 0.001) were then significantly associated with douching practices. CONCLUSION Vaginal douching is commonly practiced by women in the Bolgatanga Municipality. Most of these women douche because they did not know that there are health problems associated with the practice. Health education on the issues of women health is very vital for the improvement of women's health.
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Affiliation(s)
| | - Vida Nyagre Yakong
- Department of Midwifery, University for Development Studies, Tamale, Ghana
| | | | | | - Michele Flynch
- Lienhard School of Nursing, Pace University, Pleasantville, New York City, USA
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Pines HA, Strathdee SA, Hendrix CW, Bristow CC, Harvey-Vera A, Magis-Rodríguez C, Martinez G, Semple SJ, Patterson TL. Oral and vaginal HIV pre-exposure prophylaxis product attribute preferences among female sex workers in the Mexico-US border region. Int J STD AIDS 2018; 30:45-55. [PMID: 30170533 DOI: 10.1177/0956462418793038] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
To assess the potential uptake of HIV pre-exposure prophylaxis (PrEP) products among female sex workers (FSWs) vulnerable to HIV infection, we examined the influence of product attributes on willingness to use products among 271 HIV-negative FSWs in Tijuana and Ciudad Juarez, Mexico (2016-2017). Via five-point Likert scale ratings, participants indicated their willingness to use hypothetical products with six attributes: formulation (pill, gel, liquid, or ring), frequency of use (daily, on-demand, or monthly), cost per use (10 or 200 pesos), effectiveness (40% or 80%), side effects (none or mild), and access point (healthcare clinic or non-governmental organization). Conjoint analysis was used to determine the impact of attributes on product ratings and identify preferred product attributes. Multinomial logistic regression was used to identify factors associated with formulation preferences. In both cities, formulation and frequency of use had the greatest impact on ratings. Participants in Ciudad Juarez indicated a strong preference for oral pills, whereas participants in Tijuana indicated roughly equal preferences for oral pills and vaginal gels. Monthly product use was preferred in both cities. Compared to preferring oral pills (38%), preferring vaginal gels (28%) was associated with practicing vaginal lubrication (adjusted odds ratio = 2.08; 95% confidence interval: 1.07-4.04). Oral PrEP may be acceptable to many FSWs in Tijuana and Ciudad Juarez; however, continued development of behaviorally-congruent vaginal PrEP products may also facilitate uptake and ensure sufficient coverage.
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Affiliation(s)
- H A Pines
- 1 Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - S A Strathdee
- 1 Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - C W Hendrix
- 2 Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - C C Bristow
- 1 Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - A Harvey-Vera
- 1 Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - C Magis-Rodríguez
- 3 Centro Nacional para la Prevención y Control del VIH/SIDA (CENSIDA; National Center for HIV/AIDS Prevention and Control), Ministry of Health, Mexico City, Mexico
| | - G Martinez
- 4 Federacion Mexicana de Asociaciones Privadas, Ciudad Juarez, Chihuahua, Mexico
| | - S J Semple
- 5 Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - T L Patterson
- 5 Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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Pines HA, Semple SJ, Strathdee SA, Hendrix CW, Harvey-Vera A, Gorbach PM, Magis-Rodríguez C, Martinez G, Patterson TL. Vaginal washing and lubrication among female sex workers in the Mexico-US border region: implications for the development of vaginal PrEP for HIV prevention. BMC Public Health 2018; 18:1009. [PMID: 30107833 PMCID: PMC6092873 DOI: 10.1186/s12889-018-5946-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 08/09/2018] [Indexed: 11/11/2022] Open
Abstract
Background To 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). Methods Two 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. Results In 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). Conclusions The 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 registration ClincialTrials.gov (NCT02447484). Electronic supplementary material The online version of this article (10.1186/s12889-018-5946-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Heather A Pines
- Department of Medicine, University of California, San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093, USA.
| | - Shirley J Semple
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, MC 0680, La Jolla, CA, 92093, USA
| | - Steffanie A Strathdee
- Department of Medicine, University of California, San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093, USA
| | - Craig W Hendrix
- Department of Medicine, Johns Hopkins University, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Alicia Harvey-Vera
- Department of Medicine, University of California, San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093, USA
| | - Pamina M Gorbach
- Department of Epidemiology, University of California, Los Angeles, 650 Charles E Young Drive S, BOX 951772, Los Angeles, CA, 90095, USA
| | - Carlos Magis-Rodríguez
- Centro Nacional para la Prevención y Control del VIH/SIDA (CENSIDA) Ministry of Health, Mexico City, Mexico
| | - Gustavo Martinez
- Federacion Mexicana de Asociaciones Privadas, Ciudad Juarez, Chihuahua, Mexico
| | - Thomas L Patterson
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, MC 0680, La Jolla, CA, 92093, USA
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Bui TC, Scheurer ME, Pham VTT, Tran LTH, Hor LB, Vidrine DJ, Ross MW, Markham CM. Intravaginal practices and genital human papillomavirus infection among female sex workers in Cambodia. J Med Virol 2018; 90:1765-1774. [PMID: 30016541 DOI: 10.1002/jmv.25268] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/17/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Intravaginal practices (IVPs) include washing, wiping, or inserting something inside the vagina. This study investigates the associations between IVPs and genital human papillomavirus (HPV) infection. METHODS We conducted a cross-sectional study of 200 female sex workers aged 18 to 35 years in Phnom Penh, Cambodia. From August to September 2014. Data on sociodemographic characteristics, IVPs, and other behaviors were collected through face-to-face interviews. Self-collected cervicovaginal specimens were tested for 37 HPV genotypes. RESULTS Multivariable Poisson regression models showed that a lower number of infecting HPV genotypes were associated with intravaginal washing in the past 3 months (incident rate ratios [IRR] = 0.65, 95% confidence interval [CI]: 0.46-0.94) and often performing intravaginal washing shortly after sex (IRR = 0.89, 95% CI: 0.81-0.99). Intravaginal washing before vaginal sex, intravaginal wiping, and intravaginal insertion were not associated with HPV infection. CONCLUSION These findings challenge the existing view that all types of vaginal cleansing are harmful. Specifically, intravaginal washing shortly after sex (mainly with water) may help prevent HPV infection in female sex workers, who have several partners and thus frequently expose to sources of HPV infection with different genotypes.
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Affiliation(s)
- Thanh Cong Bui
- Department of Family and Preventive Medicine, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Michael E Scheurer
- Department of Pediatrics, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Vy Thi-Tuong Pham
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
| | - Ly Thi-Hai Tran
- Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas
| | - Leng Bun Hor
- Cambodian National AIDS Authority, Phnom Penh, Cambodia
| | - Damon J Vidrine
- Department of Family and Preventive Medicine, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Michael W Ross
- Department of Family Medicine and Community Health, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Christine M Markham
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas
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Bui TC, Tran LTH, Hor LB, Scheurer ME, Vidrine DJ, Markham CM. Intravaginal Practices in Female Sex Workers in Cambodia: A Qualitative Study. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:935-943. [PMID: 26742508 PMCID: PMC4821710 DOI: 10.1007/s10508-015-0675-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 11/12/2015] [Accepted: 11/26/2015] [Indexed: 06/05/2023]
Abstract
Intravaginal practices (IVPs) are associated with several adverse health outcomes, including HIV infection. However, few studies have examined this topic in Asian cultures, particularly in female sex workers (FSWs). This theory-based qualitative study aimed to describe the IVPs and to identify salient determinants of these practices in FSWs in Phnom Penh, Cambodia. We conducted in-depth interviews using open-ended questions with 30 FSWs in July-August 2014. We analyzed data using thematic content analysis, with thematic codes based on the constructs of the theory of planned behavior. The results showed that the most common IVP was a combination of intravaginal washing and wiping, to which we refer as intravaginal cleansing. There was a clear and close connection between IVP and sex work. Perceived benefits of intravaginal cleansing were numerous, while the perceived risks were few. As a result, the attitude toward intravaginal cleansing was favorable. A common misperception of benefit was that intravaginal cleansing could prevent sexually transmitted infections. Local physicians considerably influenced the subjective norm related to IVP. Intention to quit IVPs was suboptimal. In conclusion, the psychological factors associated with IVPs in FSWs were somewhat different from those in the general population of Cambodian women and women in other countries. Behavioral beliefs, attitude, and subjective norms appeared salient and important factors in IVPs. Interventions aimed at reducing IVPs should target these constructs as well as the sex-work-associated economic motives. Local physicians may be an agent to change IVP and an effective channel to deliver interventions.
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Affiliation(s)
- Thanh Cong Bui
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Unit 1330, P.O. Box 301439, Houston, TX, 77230-1439, USA.
| | - Ly Thi-Hai Tran
- Department of Epidemiology, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Michael E Scheurer
- Department of Pediatrics, Dan L. Duncan Cancer Center, Baylor College of Medicine and Texas Children's Cancer Center, Houston, TX, USA
| | - Damon J Vidrine
- Stephenson Cancer Center and Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Christine M Markham
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
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