Sexual Behavior and Vaginal Practices During Pregnancy and Postpartum: Implications for HIV Prevention Strategies.
BACKGROUND
Understanding sexual behaviors and vaginal practices of pregnant and breastfeeding women in sub-Saharan Africa is critical to inform HIV prevention strategies during these periods.


METHODS
HIV-uninfected women presenting for antenatal care in western Kenya were enrolled and followed through 36 weeks postpartum. Sexual behavior and vaginal practices were ascertained by structured questionnaires. Logistic regression was used to assess correlates of unprotected sex, vaginal washing, and vaginal drying.


RESULTS
Among 1252 women enrolled, 78.4% were married (of whom 15.1% were in polygamous unions), 1.4% had a known HIV-infected partner, and 33.6% had a partner of unknown HIV status. At enrollment, 58.5% reported sex in the past month (94.3% unprotected) and 4.5% reported forced sex. Odds of unprotected sex at enrollment was >11-fold higher in married than in unmarried women (P < 0.001) and lower among women who reported partners of unknown HIV status or HIV-infected compared with HIV-uninfected partners. Median time to postpartum resumption of sex was 7 weeks (interquartile range 4-12). Prevalence of unprotected sex in the past week increased from 6.6% to 60.0% between 2 and 36 weeks postpartum (P < 0.001). Vaginal washing was reported by 60.1% of women at enrollment and prevalence remained stable postpartum; vaginal drying was reported by 17.9% at enrollment and decreased to 6.1% at 36 weeks postpartum (P < 0.001). Vaginal washing and drying were associated with forced sex.


CONCLUSIONS
High rates of unknown partner HIV status, polygamy, and less frequent condom use among pregnant/postpartum women underscore the need for female-controlled HIV prevention interventions. Vaginal washing and drying may present challenges to microbicide use.
Departments of *Research and Programs; †Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya; and Departments of ‡Biostatistics; §Global Health, University of Washington, Seattle, WA.
John
J
Kinuthia
Barbra A
BA
Richardson
Alison L
AL
Drake
Daniel
D
Matemo
Jennifer A
JA
Unger
Raymond S
RS
McClelland
Grace
G
John-Stewart
D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D006920:Hygiene; D007630:Kenya; D049590:Postpartum Period; D011247:Pregnancy; D011446:Prospective Studies; D012725:Sexual Behavior; D011795:Surveys and Questionnaires; D014621:Vagina / Q000502:physiology*; D055815:Young Adult