title: Intravaginal practices are associated with greater odds of high-risk HPV infection in Haitian women.
abstract: Haitian women have the highest incidence of cervical cancer within the Western hemisphere. Intravaginal hygiene practices have been linked with human papilloma virus (HPV) infection and cervical dysplasia. These practices, known as 'twalet deba' in Haitian Creole, are common among Haitian women and are performed with various natural and synthetic agents. As part of a community-based participatory research initiative aimed at reducing cervical cancer disparities in rural Haiti, we explored the use of intravaginal agents and their associations with high-risk HPV infection.
  
  
  
  Community Health Workers recruited 416 women for cervical self-sampling from two neighborhoods within Thomonde, Haiti. Participants were interviewed regarding intravaginal hygiene practices and completed a cervical self-sampling procedure. Cervical samples were analyzed for the presence of high-risk HPV infection. Associations between each intravaginal agent and high-risk HPV infection were examined via univariate logistic regression analyses, as well as via multivariate analyses controlling for sociodemographic factors and concurrent agent use.
  
  
  
  Nearly all women (97.1%) performed twalet deba, using a variety of herbal and commercially produced intravaginal agents. Approximately 11% of the participants tested positive for high-risk HPV. Pigeon pea and lime juice were the only agents found to be associated with high-risk HPV in the univariate analyses, with women who used these agents being approximately twice as likely to have high-risk HPV as those who did not. Only pigeon pea remained significantly associated with high-risk HPV after controlling for sociodemographic factors and concurrent agent use.
  
  
  
  Two agents, pigeon pea and lime juice, may contribute to risk for HPV infection in this population. Results suggest that in addition to cervical cancer screening interventions, future preventive initiatives should focus on minimizing risk by advocating for the use of less-toxic twalet deba alternatives.
authors: a Miller School of Medicine , University of Miami , Miami , FL , USA.
authors: Julia S
authors: JS
authors: Seay
authors: a Miller School of Medicine , University of Miami , Miami , FL , USA.|b Department of Gynecology and Obstetrics , Johns Hopkins University School of Medicine , Baltimore , MD , USA.
authors: Morgan
authors: M
authors: Mandigo
authors: c Xcenda , Palm Harbor , FL , USA.
authors: Jonathan
authors: J
authors: Kish
authors: d Center for Multicultural Wellness & Prevention, Inc. , Orlando , FL , USA.
authors: Janelle
authors: J
authors: Menard
authors: e Private Consultant , Austin , TX , USA.
authors: Sarah
authors: S
authors: Marsh
authors: a Miller School of Medicine , University of Miami , Miami , FL , USA.
authors: Erin
authors: E
authors: Kobetz
mesh_terms: D000282:Administration, Intravaginal; D000328:Adult; D000534:Alum Compounds / Q000008:administration & dosage; D036561:Cajanus; D032082:Citrus aurantiifolia; D055812:Community-Based Participatory Research; D005260:Female; D000067030:Fruit and Vegetable Juices; D006205:Haiti / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006801:Humans; D006920:Hygiene; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000208:ethnology* / Q000821:virology; D028321:Plant Preparations / Q000008:administration & dosage; D011196:Potassium Permanganate / Q000008:administration & dosage; D012307:Risk Factors; D012915:Soaps / Q000008:administration & dosage; D044364:Vaginal Douching / Q000009:adverse effects* / Q000379:methods; D016387:Women's Health / Q000208:ethnology
chemical_list: D000534:Alum Compounds; D028321:Plant Preparations; D012915:Soaps; D011196:Potassium Permanganate; C041524:aluminum sulfate
keywords: HPV; Haitian women; Intravaginal practices; cervical cancer