Abstract
BackgroundTo 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).MethodsTwo 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.ResultsIn 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).ConclusionsThe 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 registrationClincialTrials.gov (NCT02447484).
Highlights
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)
Sample characteristics To ensure the relevance of data collected at baseline to our analysis of past month vaginal washing and vaginal lubrication, we restricted our analysis sample to 295 participants (145 Tijuana; 150 Ciudad Juarez) who completed the supplemental survey within 3 months of their baseline visit
Given that vaginal washing is linked to bacterial vaginosis (BV) and recent evidence suggests that BV-associated bacteria reduce the efficacy of vaginal PrEP formulated as tenofovir-containing gels [18], alternative ARV formulations for vaginal gel-based PrEP products may be more effective for FSWs who practice vaginal washing
Summary
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). Antiretroviral (ARV) pre-exposure prophylaxis (PrEP) products are user-controlled HIV prevention methods that can be formulated as oral pills, long-acting injectables, or topical gels, douches, suppositories/tablets, films, or rings for vaginal or rectal application [4,5,6]. On the other hand, do not appear to be impacted by the presence of BV-associated bacteria [20] Taken together, these findings suggest that the efficacy of dapivirine-containing vaginal PrEP products may not be affected by the vaginal microbiome, while adherence to more frequent dosing regimens may be required for tenofovir-containing vaginal PrEP products to confer protection against HIV among women with non-Lactobacillus dominant vaginal microbiota [18]. The body of evidence to-date suggests that regardless of the ARV formulation and its impact on the vaginal microbiome, adherence will be critical to vaginal PrEP’s real-world effectiveness
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