Health Practices and Vaginal Microbicide Acceptability among Urban Black Women

Background: Intravaginal topical microbicides are being investigated for prevention of HIV transmission. Useof vaginal microbicides will constitute a new type of practice, occurring in the context of other vaginal practicesrelated to contraception, hygiene, and self-care, which are affected by cultural norms and personal beliefs.Given the high rate of HIV infection among black women, research on practices and decision making relevantto microbicide acceptability is needed in this population.Methods: Twenty-three black women in New York City, aged 25–64, completed in-person semistructured interviewsand self-administered questionnaires. Quantitative analyses examined vaginal practices and willingnessto use microbicides. Qualitative analyses explored underlying decision-making processes involved inchoices regarding vaginal practices and general healthcare.Results: Willingness to use vaginal products for HIV prevention was high, especially among more educatedwomen. Safety was a major concern, and women were cautious about using vaginal products. Whereas someviewed synthetic products as having potentially harmful side effects, others perceived natural products as riskybecause of insufficient testing. Choices about vaginal practices were affected by assessments of risk and efficacy,prior experience, cultural background, and general approach to healthcare.Conclusions: The majority of women in the sample expressed willingness to use a vaginal product for HIV prevention.Decision-making processes regarding vaginal practices were complex and were affected by social, cultural,and personal factors. Although specific preferences may vary, attitudes toward using a vaginal productare likely to be positive when side effects are minimal and the product is considered safe.

Vaginal practices among women at risk for HIV acquisition in Soweto, South Africa

Background: Vaginal practices (VP) may adversely affect normal vaginal flora and mucosal integrity, and increase acquisition risk of HIV and other genital tract infections.Objective: The aim of this study was to describe self-reported VP, changes in the reported number of VP over time and factors associated with VP in a cohort of young Sowetan women enrolled in the HVTN 915 observational study.Method: We longitudinally assessed self-reported VP in 50 young women at risk of HIV acquisition aged 18–25 years in a prospective study over 3 months in Soweto, South Africa. Interviewer-administered HIV behavioural risk questionnaires were completed. No intervention to reduce VP was specified per protocol, but clinicians provided education at their discretion. The generalised estimating equation with inverse probability weights assessed VP over time.Results: The mean age at screening was 22 years; women reported multiple sexual partnerships with a mean of one main and 2 casual partners in the last 30 days. Consistent condom use was 2% (n = 1), 25% (n = 12) and 43% (n = 3) with main, casual and new partners, respectively. Commonly reported VP included washing the vagina with water (44%) and using fingers (48%). VP decreased significantly over time (p < 0.001). Women who used condoms inconsistently or whose last sex was with a casual partner were 3 times more likely to report VP (p = 0.001).Conclusion: Despite the high incidence of HIV in our setting, VP are still common and are associated with other behavioural risks for HIV. Further study is needed to assess whether clinician education may reduce VP and therefore should be included in HIV risk reduction counselling.