title: Predictors of vaginal practices for sex and hygiene in KwaZulu-Natal, South Africa: findings of a household survey and qualitative inquiry.
abstract: Vaginal practices in sub-Saharan Africa may increase HIV transmission and have important implications for development of microbicides and future HIV prevention technologies. It remains unclear which women undertake vaginal practices and what factors predict prevalence, practice type and choice of products. Using cross-sectional data from mixed research methods, we identify factors associated with vaginal practices among women in KwaZulu-Natal, South Africa. Data were gathered through focus group discussions, in-depth and key-informant interviews, followed by a province-wide, multi-stage cluster household survey, using structured questionnaires in face-to-face interviews with 867 women. This paper details six types of vaginal practices, which--despite their individual distinctiveness and diverse motivations--may be clustered into two broad groups: those undertaken for purposes of 'hygiene' (genital washing, douching and application) and those for 'sexual motivations' (application, insertion, ingestion and incisions). Multivariate analysis found significant associations between 'hygiene' practices and media access, religiosity and transactional sex. 'Sexual' practices were associated with partner concurrency, religiosity and use of injectable hormonal contraceptives. Future interventions relating to vaginal practices as well as microbicides need to reflect this characterisation of practices as sexual- and/or hygiene-related.
authors.affiliation: Maternal, Adolescent and Child Health, Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg, South Africa. fscorgie@match.org.za
authors.forename: Fiona
authors.initials: F
authors.lastname: Scorgie
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Smit
authors.forename: Busisiwe
authors.initials: B
authors.lastname: Kunene
authors.forename: Adriane
authors.initials: A
authors.lastname: Martin-Hilber
authors.forename: Mags
authors.initials: M
authors.lastname: Beksinska
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Chersich
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003469:Culture; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D006920:Hygiene; D008875:Middle Aged; D015999:Multivariate Analysis; D036301:Qualitative Research; D012111:Residence Characteristics; D012307:Risk Factors; D012725:Sexual Behavior; D013019:South Africa; D011795:Surveys and Questionnaires; D014621:Vagina / Q000502:physiology / Q000821:virology; D016387:Women's Health; D055815:Young Adult