Use of Intravaginal Preparations, Presence of Lactobacillus in the Vagina, and Risk for HIV in Zimbabwean Women
To study use of intravaginal preparations, and its association with gynecological problems, presence of lactobacillus in the vaginal flora, and risk for HIV in commercial sex workers (CSWs) in Harare, Zimbabwe.
149 CSWs were enrolled and followed up biweekly for 12 weeks. The following procedures were carried out at each visit: interview about demographics and sexual behavior, review of a selfadministered coital log, supply of female and male condoms, and treatment of STI's when applicable. A physical exam and microbiologic sampling was carried out at enrollment, 6 and 12 weeks, and a blood draw and HIV counseling at enrollment and 12 weeks.
69.1% of the women reported ever having inserted preparations inside the vagina whereas 30.2% of the women practiced insertion currently. Herbal preparations were most frequently mentioned (20.8%) but douching with water and soap (18.8%), wiping inside the vagina with newspaper, cloth or tissues (16.8%), douching with dettol or betadine (14.8%), and inserting cotton wool (14.1%) were also frequently mentioned. Most women who currently insert preparations do so to dry vaginal secretions (68.9%) or to constrict the vagina (15.6%). Single women with a regular boyfriend were more likely to prepare for sex than divorced women (p = 0.0087) or single women without a boyfriend (p = 0.0158). There was a strong association between inserting preparations (ever and current) and reported abnormal vaginal discharge in the last 3 months (p = 0.0069 and p = 0.0290), and reported deep pain during sex in the last 3 months (p = 0.0673 and p = 0.0363). The prevalence of lactobacillus was 25.5%. Women who douche with dettol or betadine (OR = 0.44; p = 0.3144) or insert herbs (OR = 0.52; p = 0.3108) seem to be somewhat less likely to have lactobacillus in their vagina. We also found a strong association between the absence of lactobacillus in the vagina and being HIV positive (OR = 3.70; p = 0.0090) in this cohort.
The use of intravaginal preparations is widespread in Zimbabwe. Our data suggest that the use of such preparations might cause or are prompted by gynecological problems. The use of certain intravaginal preparations, but not all of them, was associated with the absence of lactobacillus, and the absence of lactobacillus was associated with being HIV positive. We are currently investigating these relationships in more detail in a prospective cohort study of "low-risk" women.
Janneke van de Wijgert
ZAPP, Savvas flats ground floor,
114 Baker Avenue,
Phone: 263-4-707780 / 739406; Fax: 263-4-739406;