A new study has advised women to refrain from washing the vagina with soap, as such intravaginal practices may increase the acquisition of HIV infection.
Nicola Low, from the University of Bern, Switzerland, and colleagues said that encouraging women to use less harmful intravaginal practices should therefore be included in female-initiated HIV prevention research strategies in sub-Saharan Africa.
The authors pooled individual participant data from 13 prospective cohort studies in sub-Saharan Africa involving nearly 15,000 women, 791 of whom acquired HIV, and found that HIV infection within two years of enrolment in the studies was associated with self-reported intravaginal practices.
After controlling for age, marital status, and the number of recent sex partners, women who used cloth or paper to clean their vagina were nearly one and half times more likely to have acquired HIV infection as women who did not use this practice.
Furthermore, the insertion of products to dry or tighten the vagina and intravaginal cleaning with soap also increased women's chances of acquiring HIV.
Intravaginal cleaning with soap was associated with the development of bacterial vaginosis, and disrupted vaginal flora-two conditions associated with an increased risk of HIV acquisition.
These findings have added to the results of a recent systematic review, which suggested that a pathway linking intravaginal cleaning practices with vaginal infections that increase susceptibility to HIV infection is plausible, but conclusive evidence is lacking.
"New female-initiated interventions also need to be developed despite the challenges involved in measuring the impact on preventing HIV acquisition. Behavioural interventions that have been successful in helping young US women to stop vaginal douching might be adapted for women in sub-Saharan Africa to encourage less harmful practices," said the authors.
The findings have published in the journal PLoS Medicine.