title: A cross-sectional study of bacterial vaginosis, intravaginal practices and HIV genital shedding; implications for HIV transmission and women's health.
abstract: OBJECTIVE
  Bacterial vaginosis (BV) is associated with an increased risk of HIV transmission, and intravaginal practices (IVP) are an important risk factor for developing BV. The relationship between IVP, BV and HIV lower genital shedding, responsible for HIV transmission, has not been examined in women receiving antiretrovirals in Zambia.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Community Health Center in Lusaka, Zambia.
  
  
  METHODS
  Participants were HIV-infected women receiving antiretroviral therapy and engaging in IVP (n=128). Participants completed audio computer-administered self-interviews to assess IVP and underwent a vaginal examination. BV was diagnosed using Nugent criteria. HIV-1 lower genital shedding was assessed by measuring HIV-1 RNA in cervicovaginal lavages.
  
  
  RESULTS
  Most women engaged in IVP daily (114, 89.0%) and 81 (63.3%) of the participants had BV. HIV-1 genital shedding was detected in 18 (14.2%) participants. BV was associated with daily use of IVP (prevalence ratio, PR=4.58, CI 1.26 to 16.64, p=0.02) and weekly use of traditional medicines for IVP (PR=1.33, CI 1.05 to 1.68, p=0.02). The only factor associated with HIV-1 lower genital shedding was plasma viraemia (PR=4.61, CI 2.02 to 10.54, p<0.001). Neither IVP nor BV were associated with HIV shedding.
  
  
  CONCLUSIONS
  Despite the frequency of IVP and high prevalence of BV, plasma viraemia was the primary factor associated with HIV lower genital shedding. These findings support early initiation of antiretrovirals as an HIV prevention tool. Given adverse health outcomes associated with BV, the association between frequent IVP and BV, and the powerful local norms and traditions encouraging IVP, there is a need for studies assessing culturally tailored interventions to decrease BV in high-prevalence settings.
authors.affiliation: Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, Florida, USA.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Alcaide
authors.affiliation: University of Zambia, University Teaching Hospital, Lusaka, Zambia.
authors.forename: Maureen
authors.initials: M
authors.lastname: Chisembele
authors.affiliation: University of Zambia, University Teaching Hospital, Lusaka, Zambia.
authors.forename: Emeria
authors.initials: E
authors.lastname: Malupande
authors.affiliation: Department of Epidemiology and Public Health, University of Miami, Miller School of Medicine, Miami, Florida, USA.
authors.forename: Kristopher
authors.initials: K
authors.lastname: Arheart
authors.affiliation: Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, Florida, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Fischl
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Miami, Miller School of Medicine, Miami, Florida, USA.
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Jones
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D012725:Sexual Behavior; D014621:Vagina / Q000821:virology; D044364:Vaginal Douching / Q000009:adverse effects; D016585:Vaginosis, Bacterial / Q000453:epidemiology* / Q000209:etiology / Q000821:virology; D017201:Virus Shedding; D016387:Women's Health; D055815:Young Adult; D015024:Zambia / Q000453:epidemiology