title: Vaginal washing and increased risk of HIV-1 acquisition among African women: a 10-year prospective study.
abstract: BACKGROUND
  No prospective study has examined the risk of HIV-1 acquisition associated with vaginal washing, although intravaginal practices have been identified as potentially important contributors to HIV-1 susceptibility.
  
  
  OBJECTIVE
  To evaluate the contribution of vaginal washing to incident HIV-1 infection.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Data were derived from a 10-year study of risk factors for HIV-1 acquisition among 1270 Kenyan female sex workers. Intravaginal practices were ascertained at study enrollment. At monthly follow-up visits, women completed a standardized interview and specimens were collected for diagnosis of HIV-1 and genital tract infections.
  
  
  RESULTS
  : Compared with women who did not perform vaginal washing, there was an increased risk for acquiring HIV-1 among women who used water [adjusted hazard ratio (HR), 2.64; 95% confidence interval (CI), 1.00-6.97] or soap (adjusted HR 3.84; 95% CI, 1.51-9.77) to clean inside the vagina, after adjustment for demographic factors, sexual behavior, and sexually transmitted infections. Furthermore, women who performed vaginal washing with soap or other substances were at higher risk for HIV-1 compared with those who used water alone (adjusted HR, 1.47; 95% CI, 1.02-2.13).
  
  
  CONCLUSIONS
  In populations where vaginal washing is common, this practice may be an important factor promoting the spread of HIV-1. Intervention strategies aimed at modifying intravaginal practices should be evaluated as a possible female-controlled HIV-1 prevention strategy.
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA 98104, USA. mcclell@u.washington.edu
authors.forename: R Scott
authors.initials: RS
authors.lastname: McClelland
authors.forename: Ludo
authors.initials: L
authors.lastname: Lavreys
authors.forename: Wisal M
authors.initials: WM
authors.lastname: Hassan
authors.forename: Kishorchandra
authors.initials: K
authors.lastname: Mandaliya
authors.forename: Jeckoniah O
authors.initials: JO
authors.lastname: Ndinya-Achola
authors.forename: Jared M
authors.initials: JM
authors.lastname: Baeten
mesh_terms: D000328:Adult; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000209:etiology* / Q000635:transmission; D015497:HIV-1; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D011477:Sex Work; D012915:Soaps / Q000009:adverse effects; D044364:Vaginal Douching / Q000009:adverse effects*
chemical_list: D012915:Soaps