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Intravaginal practices among female sex workers in Kibera, Kenya
  1. Maria F Gallo1,
  2. Anjali Sharma2,3,4,
  3. Elizabeth A Bukusi2,3,5,6,
  4. Betty Njoroge2,5,
  5. Rosemary Nguti7,
  6. Denise J Jamieson1,
  7. April J Bell1,
  8. David A Eschenbach3
  1. 1Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  2. 2Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
  3. 3Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
  4. 4International Training and Education Center on HIV (I-TECH), University of Washington, Seattle, Washington, USA
  5. 5Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
  6. 6Department of Global Health, University of Washington, Seattle, Washington, USA
  7. 7School of Mathematics, University of Nairobi, Nairobi, Kenya
  1. Correspondence to Dr Maria F Gallo, Division of Reproductive Health, 4770 Buford Highway, Mail Stop K-34, Atlanta, Georgia 30341-3724, USA; mgallo{at}cdc.gov

Abstract

Objectives To assess vaginal cleansing and lubricant use among female sex workers (FSW) in Kenya participating in a 6-month, prospective study of the acceptability of the use of the diaphragm.

Methods The study is based on 140 FSW in Nairobi, who completed 140 baseline visits and 390 bi-monthly follow-up visits. Participants were instructed to wear the diaphragm for all coital acts during follow-up and to refrain from vaginal cleansing while wearing the diaphragm. Logistic regression was used to identify predictors of recent vaginal cleansing to ‘tighten’ the vagina reported at baseline; recent vaginal cleansing to prevent infection reported at baseline; recent vaginal cleansing with the diaphragm in place reported during follow-up; and recent use of oil-based lubricant during coitus reported at baseline.

Results At baseline, 99% of women reported vaginal cleansing in the previous 2 weeks for purposes of hygiene or to remove evidence of past coitus. Approximately 41% of women also reported cleansing in the past 2 weeks to ‘tighten’ the vagina. Women reported vaginal cleansing with the diaphragm in place in the past 2 weeks at 14% of follow-up visits in which the diaphragm was used. Predictors of such cleansing included young age, 6-month study visit, being divorced or widowed and higher educational level.

Conclusions While vaginal cleansing is a modifiable behaviour, given that cleansing for hygiene was almost universal among this study population at baseline and that more women reported cleansing while wearing the diaphragm as the study progressed, the complete eradication of the practice would probably be difficult.

  • HIV/sexually transmitted infection prevention
  • sex workers
  • vaginal cleansing
  • vaginal diaphragm

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Footnotes

  • Anjali Sharma and April J Bell – Affiliation at the time of the research.

  • Funding This study was funded by the US Centers for Disease Control and Prevention (CDC) through an interagency agreement with the US Agency for International Development and CONRAD. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of CDC, nor does mention of trade names, commercial products, or organisations imply endorsement by the US government.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the ethical review committees at the University of Nairobi, the University of Washington, the University of California, San Francisco, and the US Centers for Disease Control and Prevention.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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