title: Understanding motives for intravaginal practices amongst Tanzanian and Ugandan women at high risk of HIV infection: the embodiment of social and cultural norms and well-being.
abstract: Some types of intravaginal practices (IVP) may increase the risk for HIV acquisition. This is particularly worrisome for populations with dual high prevalence of HIV and IVP. Women involved in transactional sex are at increased risk for HIV infection in sub-Saharan Africa. Social, cultural and economic influences are strong drivers of IVP in this population. To explore this, we carried out a qualitative research study to investigate the drivers and motivations for using IVP within a large observational study of women at high risk of HIV in Tanzania and Uganda from September 2008 to September 2009. Of the 201 women selected, 176 women took part in a semi-structured in-depth interview. Additionally, in Tanzania, eight focus group discussions among study participants and community members were carried out to obtain information on community norms and expectations. IVP were motivated by overlapping concerns with hygiene, morality, sexual pleasure, fertility, relationship security, and economic security. These motives were driven by the need to meet cultural and social expectations of womanhood, and at the same time attend to personal well-being. Among women involved in transactional sex in East Africa, interventions aimed at modifying or eliminating IVP should attend to local cultural and social norms as well as the individual as an agent of change.
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom; Mwanza Intervention Trials Unit, National Institute for Medical Research Mwanza Centre, P.O. Box 11936, Mwanza, Tanzania. Electronic address: Shelley.lees@lshtm.ac.uk.
authors.forename: Shelley
authors.initials: S
authors.lastname: Lees
authors.affiliation: Medical Research Council/Uganda Research Unit on AIDS, P.O. Box 49, Entebbe, Uganda.
authors.forename: Flavia
authors.initials: F
authors.lastname: Zalwango
authors.affiliation: Mwanza Intervention Trials Unit, National Institute for Medical Research Mwanza Centre, P.O. Box 11936, Mwanza, Tanzania.
authors.forename: Bahati
authors.initials: B
authors.lastname: Andrew
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom; Medical Research Council/Uganda Research Unit on AIDS, P.O. Box 49, Entebbe, Uganda.
authors.forename: Judith
authors.initials: J
authors.lastname: Vandepitte
authors.affiliation: Medical Research Council/Uganda Research Unit on AIDS, P.O. Box 49, Entebbe, Uganda; University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, United Kingdom.
authors.forename: Janet
authors.initials: J
authors.lastname: Seeley
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Hayes
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom; Mwanza Intervention Trials Unit, National Institute for Medical Research Mwanza Centre, P.O. Box 11936, Mwanza, Tanzania.
authors.forename: Suzanna C
authors.initials: SC
authors.lastname: Francis
mesh_terms: D000282:Administration, Intravaginal; D000293:Adolescent; D000328:Adult; D003466:Cultural Characteristics; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D008875:Middle Aged; D009042:Motivation; D036301:Qualitative Research; D018570:Risk Assessment; D012309:Risk-Taking; D060386:Sex Workers / Q000523:psychology* / Q000706:statistics & numerical data; D012938:Social Perception; D012959:Socioeconomic Factors; D013636:Tanzania / Q000453:epidemiology; D014454:Uganda / Q000453:epidemiology; D044364:Vaginal Douching / Q000009:adverse effects / Q000523:psychology*; D055815:Young Adult
keywords: HIV; Hygiene; Intravaginal practices; Sexuality; Tanzania; Uganda