Intravaginal practises in Zimbabwe: Which women engage in them and why?

Intravaginal practises are widespread in sub-Saharan Africa. They may increase HIV transmission and interfere with the acceptability and efficacy of barrier methods of HIV prevention. This survey provides detailed quantitative descriptions of intravaginal practises, and predictors and reasons for such practises, in a cohort of Zimbabwean women. Finger-cleansing and wiping were extremely common, practised an average of once or twice per day, and considered an essential part of a woman's routine hygiene. The insertion of traditional substances, mostly used to dry and tighten the vagina, was less common and practised less frequently. Users were more likely than non-users to be of lower socio-economic status, and in search for a steady partner or marital stability. The relationship between intravaginal practises and condom use was unclear, because condom use was rare and strongly associated with sex work in this cohort. The need to determine how much lubrication women and men desire and tolerate during sex in different parts of the world is discussed. We recommend to take intravaginal practises into account when developing new methods of HIV prevention (such as topical vaginal microbicides), and when designing HIV prevention programmes.