Thesis on the association of vaginal practices to bacterial vaginosis among adolescent girls and young women in South Africa: A risk for HIV

South Africa has one of the highest prevalence of HIV globally with adolescent girls and young women (AGYW) being mostly affected. Increased vulnerability to HIV acquisition among adolescent girls and young women in South Africa is due to a combination of behavioral, socio-structural, demographic, clinical, and biological factors. Some of these factors are prevalent in South Africa and they are inclusive of bacterial vaginosis (BV), an effect in part of vaginal practices (VPs). VPs comprise a variety of behaviors used by women for cleanliness, health, and sexuality of the vagina and they’re practices that have been shown to have associations with BV. Major pathogenic organisms involved in presentations of BV have been found to encourage the replication of HIV and therefore, its acquisition. This project aimed to measure the prevalence of VPs and to assess the varying types of VPs among HIV-uninfected or HIV-unknown dis-gender AGYW aged 16-24 years. It also measured the prevalence of BV in this population and its association to VPs .We used a cross sectional study design to assess baseline data of the AYAZAZI, a prospective cohort study whose longitudinal design analyses varying aspects of the sexual and reproductive health of adolescents and youth in South Africa. We employed the estimation Framework to evaluate VPs and their relationship to BV. For both our analyses (Chapters 2 and 3) we create a directed acyclic graph (DAG) to help establish the interrelationship of covariates and to determine the adjustment variables for each model. We then assessed VPs before measuring their prevalence and association to BV. Seventy seven percent of AGYW use VPs and this is mostly by washing with water only inside the vagina (66%). Bacterial vaginosis was reported in 47% of AGYW compared to symptoms of GTI in only 15%, supporting the notion that syndromic BV management offers substantial under-diagnosis for the effective management of implications to BV. Through multivariable logistic regression, we found 1.7 (0.7-3.8) odds of BV among VP users. Vaginal practices are highly prevalent among AGYW. An association between vaginal practices (VPs) and bacterial vaginosis (BV), a risk for HIV acquisition, has been previously reported. This study provides further evidence to this relationship and suggests that VPs are a likely determinant to BV; a plausible cause to increased HIV acquisition among AGYW. This information is important for the inferential management of the sexual and reproductive health of AGYW. The inconclusive findings call for a need to study and understand predisposing factors to HIV infection among AGYW for development of effective interventions.