Association between high-risk HPV infection and feminine hygiene practices among rural Haitians

BACKGROUND: PAHO estimates the incidence of cervical cancer in Haiti at 93/100,000, the highest in the western hemisphere. This excess burden of disease is largely attributable to a lack of access to Pap smear screening. Our research examines whether intravaginal cleansing, or twalet deba¸ mediates the risk of persistent high risk HPV (HR-HPV) infection, a necessary cause of disease. METHODS: Community health workers (CHWs) in Thomonde, Haiti recruited women, administered a demographic and health history questionnaire, and instructed women on how to perform cervical self-sampling. Samples were analyzed for HR-HPV infection; multivariate logistic regression models were fitted to a dichotomous outcome of infection status (positive vs. negative). RESULTS: 373 women completed the self-sampling and questionnaire. 341 samples were viable for genetic analysis, 13.5% tested positive for HR-HPV infection; 2.9% of women never used feminine hygiene products. Among all participants: 77.6% report ever using savon (Haitian soap), 51.2% Palma Christi (herb) 51% Permeganat (potassium permanganate), and 40.3% Pwa Kongo (herb). Increased odds of HPV infection were associated with HIV positivity (OR = 3.44[0.79-15.0]) and Pwa Kongo (OR = 3.514, [1.11-12.0]). Using Palma Christi (OR = 0.19 [0.06-0.64]) decreased infection risk significantly. CONCLUSIONS: These data are the first to quantify the association between intravaginal cleansing and HR-HPV infection. Out of 11 routinely used products Pwa Kongo was a positive (increased risk) mediator between exposure and persistent HR-HPV infection. CHWs should be educated on the risks of using this herb, and educate women on using culturally acceptable alternatives that showed a null association.