240629 Association between high-risk HPV infection and feminine hygiene practices among rural Haitians

Tuesday, November 1, 2011: 10:50 AM

Jonathan Kish, MPH , Department of Epidemiology and Public Health, University of Miami, Miami, FL
Ian Bishop, BA , Miller School of Medicine, University of Miami, Miami, FL
Hannah Lipshultz, BA , Department of Epidemiology and Public Health, University of Miami, Miami
Maxi Raymondville, MD , Partners in Health/Zanmi Lasante, Boston, MA
Sarah Marsh, CM MPH , Women Health Program Director, Zanmi Lasante/Partners in Health, Boston, MA
Janelle Menard, PhD, MA, MPH , Division of Cancer Prevention and Control, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL
Erin Kobetz, PhD, MPH , Department of Epidemiology and Public Health, University of Miami, Leonard Miller School of Medicine, Miami, FL
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 debał 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.

Learning Areas:
Administer health education strategies, interventions and programs
Assessment of individual and community needs for health education
Epidemiology
Planning of health education strategies, interventions, and programs
Social and behavioral sciences

Learning Objectives:
Identify the risk from exposure to feminine hygiene products on HPV infection. Assess the distribution of high-risk HPV infection in a rural village in Haiti. Explain the importance of culture in the development of health outcomes.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the senior research associate and doctoral student responsible for the collection and analyses of the data and publication of peer-reviewed articles
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.