Research Article: Intravaginal Practices, Bacterial Vaginosis, and HIV Infection in Women: Individual Participant Data Meta-analysis

Date Published: February 15, 2011

Publisher: Public Library of Science

Author(s): Nicola Low, Matthew F. Chersich, Kurt Schmidlin, Matthias Egger, Suzanna C. Francis, Janneke H. H. M. van de Wijgert, Richard J. Hayes, Jared M. Baeten, Joelle Brown, Sinead Delany-Moretlwe, Rupert Kaul, Nuala McGrath, Charles Morrison, Landon Myer, Marleen Temmerman, Ariane van der Straten, Deborah Watson-Jones, Marcel Zwahlen, Adriane Martin Hilber, Lynne Mofenson

Abstract: Pooling of data from 14,874 women in an individual participant data meta-analysis by Nicola Low and colleagues reveals that some intravaginal practices increase the risk of HIV acquisition.

Partial Text: HIV-infected women outnumber men in many sub-Saharan African countries [1]. Novel female-initiated preventive methods have, so far, proved elusive [2],[3], so identifying new modifiable factors that affect women’s vulnerability to HIV might help in the development of new preventive interventions [4]. Women use a wide range of products, applied in a variety of ways inside the vagina, to manage their sexual relationships, menstruation, and to improve wellbeing [5].

The study protocol specified hypotheses, inclusion criteria, and methods of analysis, and is available at The review was reported according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) group (Text S1).

This study combined individual participant data from ten prospective studies in six sub-Saharan African countries. Intravaginal use of cloth or paper remained associated with HIV acquisition after controlling for age, marital status, number of sex partners in the past 3 mo, and in models that controlled for BV. Insertion of products to dry or tighten the vagina and intravaginal cleaning with soap were associated with HIV acquisition in univariable and multivariable analyses controlling for demographic and behavioural variables, but not in models that controlled for BV. Intravaginal cleaning with soap was also associated with the development of intermediate vaginal flora and BV at follow-up in women with normal vaginal flora at baseline. Disrupted vaginal flora measured at baseline or at the visit before the estimated data of HIV infection was associated with HIV acquisition in both univariable and multivariable analyses.



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