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In search of sexual pleasure and fidelity: vaginal practices in KwaZulu-Natal, South Africa.

Cult Health Sex. 2009 Apr;11(3):267-83.

In search of sexual pleasure and fidelity: vaginal practices in KwaZulu-Natal, South Africa.

Scorgie F, Kunene B, Smit JA, Manzini N, Chersich MF, Preston-Whyte EM.

Centre for HIV/AIDS Network (HIVAN), University of KwaZulu-Natal, South Africa. fscorgie@gmail.com

ABSTRACT

Vaginal practices, such as intra-vaginal cleansing, drying and tightening, are suspected of placing women at higher risk of acquiring HIV and STIs. Yet, there is limited understanding of what these practices entail, what motivates women to undertake them and what their socio-cultural and historical meanings are. This paper explores the range of vaginal practices used by women in KwaZulu-Natal, South Africa and locates these within the context of local patterns of migration and understandings of sexual health and pleasure. Study activities took place at an urban and rural site employing qualitative research techniques: semi-structured interviewing and an additional ethnographic component in the rural site. Vaginal practices were believed to be ubiquitous and a wide range of substances and procedures were described. Strong motivations for vaginal practices included women’s desire to enhance men’s sexual pleasure, ensure men’s fidelity and exercise agency and control in their relationships. The common use of traditional medicines in this quest to maintain stable relationships and affect the course of love, suggests a complexity that cannot be captured by simple terms like ‘dry sex’. We argue instead that any interventions to change women’s reliance on vaginal practices must recognise and attend to the broader social contexts in which they are embedded.

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Predictors of vaginal practices for sex and hygiene in KwaZulu-Natal, South Africa: findings of a household survey and qualitative inquiry.

Cult Health Sex. 2011 Apr;13(4):381-98.

Predictors of vaginal practices for sex and hygiene in KwaZulu-Natal, South Africa: findings of a household survey and qualitative inquiry.

Scorgie F, Smit JA, Kunene B, Martin-Hilber A, Beksinska M, Chersich MF

Maternal, Adolescent and Child Health, Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg, South Africa. fscorgie@match.org.za

Abstract

Vaginal practices in sub-Saharan Africa may increase HIV transmission and have important implications for development of microbicides and future HIV prevention technologies. It remains unclear which women undertake vaginal practices and what factors predict prevalence, practice type and choice of products. Using cross-sectional data from mixed research methods, we identify factors associated with vaginal practices among women in KwaZulu-Natal, South Africa. Data were gathered through focus group discussions, in-depth and key-informant interviews, followed by a province-wide, multi-stage cluster household survey, using structured questionnaires in face-to-face interviews with 867 women. This paper details six types of vaginal practices, which–despite their individual distinctiveness and diverse motivations–may be clustered into two broad groups: those undertaken for purposes of ‘hygiene’ (genital washing, douching and application) and those for ‘sexual motivations’ (application, insertion, ingestion and incisions). Multivariate analysis found significant associations between ‘hygiene’ practices and media access, religiosity and transactional sex. ‘Sexual’ practices were associated with partner concurrency, religiosity and use of injectable hormonal contraceptives. Future interventions relating to vaginal practices as well as microbicides need to reflect this characterisation of practices as sexual- and/or hygiene-related.

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Male and female circumcision associated with prevalent HIV infection in virgins and adolescents in Kenya, Lesotho and Tanzania

Ann Epidemiol. 2007 Mar;17(3):217.26.

Male and female circumcision associated with prevalent HIV infection in virgins and adolescents in Kenya, Lesotho and Tanzania

Brewer DD, Potterat JJ, Roberts Jr, Brody S

Interdisciplinary Scientific Research, Seattle, WA 98115, USA. Via www.interscientific.net/contact.html

ABSTRACT

PURPOSE:

Remarkable proportions of self-reported virgins and adolescents in eastern and southern Africa are infected with HIV, yet non-sexual routes of transmission have not been systematically investigated in such persons. Many observers in this region have recognized the potential for HIV transmission through unhygienic circumcision procedures. We assessed the relation between male and female circumcision (genital cutting) and prevalent HIV infection in Kenyan, Lesothoan, and Tanzanian virgins and adolescents.

METHODS:

We analyzed data from recent cross-sectional national probability sample surveys of adolescents and adults in households, focusing on populations in which circumcision was common and usually occurred in puberty or later.

RESULTS:

Circumcised male and female virgins were substantially more likely to be HIV infected than uncircumcised virgins (Kenyan females: 3.2% vs. 1.4%, odds ratio [OR] = 2.38; Kenyan males: 1.8% vs. 0%, OR undefined; Lesothoan males: 6.1% vs. 1.9%, OR 3.36; Tanzanian males: 2.9% vs. 1.0%, OR 2.99; weighted mean phi correlation = 0.07, 95% confidence interval, 0.03 to 0.11). Among adolescents, regardless of sexual experience, circumcision was just as strongly associated with prevalent HIV infection. However, uncircumcised adults were more likely to be HIV positive than circumcised adults. Self-reported sexual experience was independently related to HIV infection in adolescent Kenyan females, but was unrelated to HIV infection in adolescent Kenyan, Lesothoan, and Tanzanian males.

CONCLUSIONS:

HIV transmission may occur through circumcision-related blood exposures in eastern and southern Africa.

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Female genital mutilation: medico-legal issues

Med Law. 2010 Dec; 29 (4):523-36
Female genital mutilation: medico-legal issues
Mswela M
ABSTRACT
The rising prevalence and severe impact of HIV/AIDS in relation to women still persists in South Africa. Both economically and socially the HIV/AIDS pandemic strikes women the hardest, with disadvantaged black women mainly at risk of higher infection. The theoretical framework of this paper focuses on the connection between HIV/AIDS, sexual inequalities and sexual violence, and more precisely, female genital mutilation, a cultural practice and custom which amplifies women’s exposure to HIV. Pertinent to this focus is inescapably an analysis of apparent threats to precise essential human rights as a result of the continued use of the practice of female genital mutilation in South Africa.