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

Shelley Lees,Flavia Zalwango,Bahati Andrew,Judith Vandepitte,Janet Seeley,Richard J Hayes,Suzanna C Francis

doi:10.1016/j.socscimed.2013.12.005

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.

Highlights

Intravaginal practices (IVP) are a collection of behaviours in which women modify the structure and environment of the vagina, including intravaginal cleansing and insertion of substances in the vagina
IVP are highly prevalent amongst women involved in transactional sex in sub-Saharan Africa (Allen et al, 2010; Fonck et al, 2001; Francis et al, 2013; McClelland et al, 2006; Nagot et al, 2007; Watson-Jones et al, 2007), and this population is at increased risk of HIV infection (Baral et al, 2012; Kapiga et al, 2002; Vallely et al, 2007; Watson-Jones et al, 2007)
This study has reported qualitative findings on intravaginal cleansing and insertion practices among women living in urban and peri-urban environments involved in transactional sex, either as their main source of income or as a supplement to other sources of income, and represent a continuum of transactional sex (MacPherson et al, 2012)

Summary

Introduction

Intravaginal practices (IVP) are a collection of behaviours in which women modify the structure and environment of the vagina, including intravaginal cleansing and insertion of substances in the vagina (e.g. finger washing with soapy water, insertion of pulverised herbs). Some types of IVP and HIV acquisition, as well as reproductive tract infections, such as bacterial vaginosis (Low et al, 2011; Martin Hilber, Francis, et al, 2010; Myer et al, 2004). It is presumed that IVP disrupts the vaginal environment, increasing susceptibility to infection. These practices may interfere with female controlled HIV prevention methods such as microbicides (Van Der Straten, Cheng, Chidanyika, De Bruyn, & Padian, 2010). The study in Kenya focused on individual behaviour change, and individual motivations and social support for IVP cessation

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