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Multi-Country Study on Gender, Sexuality and Vaginal Practices IAS Satellite Symposium 20 July 2009 Adriane Martin Hilber (ISPM - Switzerland) Terence.

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Presentation on theme: "Multi-Country Study on Gender, Sexuality and Vaginal Practices IAS Satellite Symposium 20 July 2009 Adriane Martin Hilber (ISPM - Switzerland) Terence."— Presentation transcript:

1 Multi-Country Study on Gender, Sexuality and Vaginal Practices IAS Satellite Symposium 20 July 2009 Adriane Martin Hilber (ISPM - Switzerland) Terence Hull (ANU - Australia) Matthew Chersich (U.Gent - Belgium & RHRU- South Africa) for the GSVP Study Group

2 Classification of Vaginal Practices 1.Washing of external genitalia 2.Intravaginal cleansing (wiping/douching) 3.Application of (substances or steam) to external genitalia 4.Intravaginal insertion 5.Oral ingestion 6.Anatomical modification of vagina (surgery, traditional scarification or labial elongation).. a variety of behaviours undertaken for diverse motives, with the common element that they involve some modification of the labia, clitoris or vagina.

3 Study objectives 1.What is the prevalence and frequency of vaginal practices within each study population? 2.What are the reasons women undertake these vaginal practices? 3.What impact do these practices have on women’s and men’s self-perceived sexual satisfaction and experience? 4.What impact do these practices have on women’s and men’s self-perceived reproductive health? 5.To what extent are the practices promoted by women’s sexual partners, or by other members of the community, including traditional and modern health service providers?

4 Project Overview Phase 1 ( ) Qualitative Study to improve understanding of the nature, motivations and circumstances of these complex practicesPhase 1 ( ) Qualitative Study to improve understanding of the nature, motivations and circumstances of these complex practices Phase 2 ( ) Household Survey to determine the population-level prevalence of practices, and the intended and adverse effects of practicesPhase 2 ( ) Household Survey to determine the population-level prevalence of practices, and the intended and adverse effects of practices Study in Mozambique (Tete), South Africa (Kwa- Zulu, Natal), Indonesia (Yogyakarta), & Thailand (Chonburi); Kenya in Study in Mozambique (Tete), South Africa (Kwa- Zulu, Natal), Indonesia (Yogyakarta), & Thailand (Chonburi); Kenya in

5 GSVP Survey Methods (1) Phase 1 qualitative: Key Informant & In Depth Interviews; FGDs – results informed the questionnairePhase 1 qualitative: Key Informant & In Depth Interviews; FGDs – results informed the questionnaire Phase 2 Household Survey:Phase 2 Household Survey: –850 randomly selected women years –multi-stage cluster sample design –clusters were census enumeration areas (+/-100 HH) –HH selection per cluster: 20/Asia, 30/Africa –generic structured questionnaire; with local adaptations and additional categories

6 GSVP Survey Methods (2) –Descriptive analysis of practices characteristics within a standard framework –Multivariate analysis to identify population groups with high levels of practices –Study estimates were weighted for differential probabilities of inclusion and response. WHO and local ethical approvalsWHO and local ethical approvals

7 Qualitative findings Vaginal Practices are motivated by:Vaginal Practices are motivated by: –Desire for improved sexual relations to tighten, warm, close or dry the vagina (e.g.Dry Sex) –hygiene (e.g. douching, washing, cleansing, steaming, application) and are done in association with specific life events (e.g. menses, marriage, child birth, menopause) –health (e.g. to eliminate discharge, self treat a suscepted STI, induce an abortion) Women use a variety of products (natural and commercial preparations) in their vaginal practicesWomen use a variety of products (natural and commercial preparations) in their vaginal practices Frequency of practices varies depending on motivation, product used, life event, desired effectFrequency of practices varies depending on motivation, product used, life event, desired effect

8 External washing External application Anatomical modification Intravaginal cleansing Intravaginal insertion Oral Ingeston Products Prevalence Timing Motivation Intended effects Adverse effects Framework for measuring vaginal practices

9 Prevalence

10 Prevalence of practices-African sites Mozambique n=1025 South Africa n= 867

11 Adverse events Mozambique

12 Adverse events South Africa

13 Conclusions

14 General Patterns HygieneHygiene –Cleanliness –Odor HealthHealth –Disease prevention, control or treatment SexualitySexuality –Competition for sexual partners among young women –Competition against young women among married middle aged women –“Performance enhancement” –Self-fulfillment – less clear

15 Tightening or drying? Friction favored by both men and womenFriction favored by both men and women This could be achieved through warming, tightening, closing (or elongated labia in Mozambique)This could be achieved through warming, tightening, closing (or elongated labia in Mozambique) “Dryness” per se was only intended where there was obvious wetness to such an extent that the partner complained of infidelity or discomfort“Dryness” per se was only intended where there was obvious wetness to such an extent that the partner complained of infidelity or discomfort

16 Health Implications Life-time experience of side effects common, and asymptomatic genital lesions or inflammation are likely even more common. Genital bleeding and sores more frequent in Asian sites though the higher prevalence of practices in Africa makes side effects here more concerningLife-time experience of side effects common, and asymptomatic genital lesions or inflammation are likely even more common. Genital bleeding and sores more frequent in Asian sites though the higher prevalence of practices in Africa makes side effects here more concerning Women are less likely to use a condom or other barrier methods for contraception or for dual protection as most practices imply ‘skin to skin’ contactWomen are less likely to use a condom or other barrier methods for contraception or for dual protection as most practices imply ‘skin to skin’ contact There was significant use of a myriad of practices to address other SRH concerns including induced abortion and self treatment of vaginal discharge and other symptoms of STIsThere was significant use of a myriad of practices to address other SRH concerns including induced abortion and self treatment of vaginal discharge and other symptoms of STIs

17 Acknowledgements of partners and funders Partnering organisations – ANU (Australia), CRDS (Mozambique), ICRH (Kenya & Mozambique, Beligum), ISPM (Switzerland), Mahidol University (Thailand), RHRU (South Africa), Women‘s Health Foundation (Indonesia), WHOPartnering organisations – ANU (Australia), CRDS (Mozambique), ICRH (Kenya & Mozambique, Beligum), ISPM (Switzerland), Mahidol University (Thailand), RHRU (South Africa), Women‘s Health Foundation (Indonesia), WHO Funders – AUSAid,Australian National Research Council, Flemish Government, Ford Foundation, International Partnership for Microbicides, UNAIDS, USAID, WHOFunders – AUSAid,Australian National Research Council, Flemish Government, Ford Foundation, International Partnership for Microbicides, UNAIDS, USAID, WHO

18 Asia Indonesia Team Ninuk Widyantoro, Women’s Health FoundationNinuk Widyantoro, Women’s Health Foundation Herna Lestari, Mintra Inti FoundationHerna Lestari, Mintra Inti Foundation Laily Hanifah, Mintra Inti FoundationLaily Hanifah, Mintra Inti Foundation Besral Madras, Mintra Inti FoundationBesral Madras, Mintra Inti Foundation Iwu Utomo, Australia National UniversityIwu Utomo, Australia National University Thai Team Aree Prommho, Institute for Population and Social Research, Mahidol UniversityAree Prommho, Institute for Population and Social Research, Mahidol University Kullawee Siriratmongkon, Mahidol UniversityKullawee Siriratmongkon, Mahidol University Susinee Worasrisothon, Mahidol UniversitySusinee Worasrisothon, Mahidol University Chintana Wacharasin, Faculty of Nursing, Burapha UniversityChintana Wacharasin, Faculty of Nursing, Burapha University Monruedee Lapimon, Thai Women AIDS Task ForceMonruedee Lapimon, Thai Women AIDS Task Force

19 Africa Mozambique Team Brigitte Bagnol, ICRH Mozambique (consultant)Brigitte Bagnol, ICRH Mozambique (consultant) Esmeralda Mariano, Eduardo Mondlane UniversityEsmeralda Mariano, Eduardo Mondlane University Francisco Mbofana, CRDS/MISAUFrancisco Mbofana, CRDS/MISAU Isabel François, ICRH Mozambique (consultant)Isabel François, ICRH Mozambique (consultant) Elise Kenter, ICRH Mozambique (consultant)Elise Kenter, ICRH Mozambique (consultant) Hipolito Nzwalo, Ministry of Health, Mozambique (MISAU)Hipolito Nzwalo, Ministry of Health, Mozambique (MISAU) South Africa Team Jenni Smit, RHRUJenni Smit, RHRU Busi Kunene, RHRUBusi Kunene, RHRU Ntsiki Manzini, RHRUNtsiki Manzini, RHRU Matthew Chersich, RHRU/ICRHMatthew Chersich, RHRU/ICRH Mags Beksinska, RHRUMags Beksinska, RHRU


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