title: Intravaginal practices and microbicide acceptability in Papua New Guinea: implications for HIV prevention in a moderate-prevalence setting.
abstract: BACKGROUND
  The acceptability of female-controlled biomedical prevention technologies has not been established in Papua New Guinea, the only country in the Pacific region experiencing a generalised, moderate-prevalence HIV epidemic. Socio-cultural factors likely to impact on future product uptake and effectiveness, such as women's ability to negotiate safer sexual choices, and intravaginal hygiene and menstrual practices (IVP), remain unclear in this setting.
  
  
  METHODS
  A mixed-method qualitative study was conducted among women and men attending a sexual health clinic in Port Moresby. During in-depth interviews, participants used copies of a hand-drawn template to indicate how they wash/clean the vulva and/or vagina. Interviewers pre-filled commercially available vaginal applicators with 2-3mL KY Jelly® to create a surrogate vaginal microbicide product, which was demonstrated to study participants.
  
  
  RESULTS
  A total of 28 IDIs were conducted (women=16; men=12). A diverse range of IVP were reported. The majority of women described washing the vulva only with soap and water as part of their daily routine; in preparation for sex; and following sexual intercourse. Several women described cleaning inside the vagina using fingers and soap at these same times. Others reported cleaning inside the vagina using a hose connected to a tap; using vaginal inserts, such as crushed garlic; customary menstrual 'steaming' practices; and the use of material fragments, cloth and newspaper to absorb menstrual blood. Unprotected sex during menstruation was common. The majority of both women and men said that they would use a vaginal microbicide gel for HIV/STI protection, should a safe and effective product become available. Microbicide use was considered most appropriate in 'high-risk' situations, such as sex with non-regular, transactional or commercial partners. Most women felt confident that they would be able to negotiate vaginal microbicide use with male sexual partners but if necessary would be prepared to use product covertly.
  
  
  CONCLUSIONS
  Notional acceptability of a vaginal microbicide gel for HIV/STI prevention was high among both women and men. IVP were diverse in nature, socio-cultural dimensions and motivators. These factors are likely to impact on the future acceptability and uptake of vaginal microbicides and other biomedical HIV prevention technologies in this setting.
authors.affiliation: The Kirby Institute, The University of New South Wales, Sydney, NSW, 2052, Australia. avallely@kirby.unsw.edu.au
authors.forename: Andrew
authors.initials: A
authors.lastname: Vallely
authors.forename: Lisa
authors.initials: L
authors.lastname: Fitzgerald
authors.forename: Voletta
authors.initials: V
authors.lastname: Fiya
authors.forename: Herick
authors.initials: H
authors.lastname: Aeno
authors.forename: Angela
authors.initials: A
authors.lastname: Kelly
authors.forename: Joyce
authors.initials: J
authors.lastname: Sauk
authors.forename: Martha
authors.initials: M
authors.lastname: Kupul
authors.forename: James
authors.initials: J
authors.lastname: Neo
authors.forename: John
authors.initials: J
authors.lastname: Millan
authors.forename: Peter
authors.initials: P
authors.lastname: Siba
authors.forename: John M
authors.initials: JM
authors.lastname: Kaldor
mesh_terms: D000282:Administration, Intravaginal; D000293:Adolescent; D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D044383:Black People; D003075:Coitus / Q000523:psychology; D005260:Female; D053566:Hygiene Products / Q000600:supply & distribution; D006678:HIV; D015658:HIV Infections / Q000208:ethnology / Q000517:prevention & control*; D006801:Humans; D006920:Hygiene / Q000193:education*; D008297:Male; D010219:Papua New Guinea / Q000453:epidemiology; D015995:Prevalence; D012725:Sexual Behavior / Q000208:ethnology; D012747:Sexual Partners / Q000523:psychology; D014622:Vaginal Creams, Foams, and Jellies / Q000627:therapeutic use*; D016387:Women's Health / Q000208:ethnology
chemical_list: D000890:Anti-Infective Agents; D053566:Hygiene Products; D014622:Vaginal Creams, Foams, and Jellies