Women’s health, hygiene and HIV in Sub-Saharan Africa : the role of vaginal practices

Abstract

In 2010, half of the 22.5 million people living with HIV in Sub-Saharan Africa were women and girls.203 Increased biological susceptibility to HIV infection, legal and social inequalities and sexual-social behaviours contribute to tipping the burden of ill health and infection toward women.3-4 Researchers studying HIV vaccines and vaginal microbicides have long suspected that relative variations in vaginal health play an important role in HIV rates. These differences might be linked to reproductive tract infections or behaviours that increase inflammation, lesions or change the vaginal microbiota.5-7 It is difficult to determine how important vaginal factors are in increasing a woman’s risk for HIV acquisition, because of the many other factors also influence HIV transmissibility. In this thesis we use qualitative and quantitative research methods to investigate vaginal practices used by women in Sub-Saharan Africa, and to determine whether their use increases women’s risk of acquiring HIV infection. The results of country studies in Mozambique and South Africa have shown that vaginal practices are more varied and diverse than previously thought and some practices such as intravaginal cleansing are extremely common. An aggregate systematic review and an individual patient data meta-analysis showed that some practices are clearly not benign; indeed women’s use of some practices to address sexual or reproductive health concerns through self-treatment or increased hygiene practices may in fact be placing them at greater risk. Results however between studies are inconsistent leaving the critical question about harm of some practices unanswered.93 A meta-ethnography gave insight that practices are an important source of power for women to control their relationships and health indicating that changing practices will require an appreciation of the role they play in women’s lives. As new HIV prevention technologies become available, it will be critical for programmes to develop introduction strategies that take into account women’s vaginal practice preferences whether they are for health, sexual or hygiene purposes