HIV This Week

Mbikusita-Lewanika M, Stephen H, Thomas J. The prevalence of the use of ‘dry sex’ traditional medicines, among Zambian women, and the profile of the users. Psychol Health Med. 2009;14(2):227-38.

Concern has been voiced about the ‘dry sex’ practice in Southern and Central Africa, and its possible role in HIV transmission. Despite this concern, there has been little information about the practice. Most of the available information has been anecdotal, speculative or inadequate mainly because of cultural reluctance to discuss or investigate personal sexual issues. This article provides information about the prevalence of the practice in Zambia and the profile of its practitioners. A cross-sectional study involving 812 Zambian women was undertaken in Lusaka , the capital city of Zambia. Quantitative and qualitative data was obtained through self-administered questionnaires, interviews, in-depth interviews and focus group discussions. The quantitative data were analysed using SPSS, and the qualitative data were used to complement and clarify the quantitative data. Awareness of the ‘dry sex’ practice was almost universal among Zambian women. About two-thirds had used ‘dry sex’ traditional medicines at some point in their lives, and about half were using them. Those who were most likely to have been using, or to have used ‘dry sex’ traditional medicines, were those who were older, married, with little or no formal education, mainstream Christians, from the lower socio-economic levels, homemakers, manual workers (p < 0.001), originally from the Eastern province of Zambia (p < 0.002) and those who had spent most of their formative years in rural areas (p < 0.006).The study showed that the knowledge and use of ‘dry sex’ traditional medicines is widespread among Zambian women, especially among those who were most likely to adhere to traditional views and beliefs about womanhood and marriage, and perhaps those likely to have a poor sense of self-worth or less confidence. In view of the concern about the possible role of ‘dry sex’ in HIV transmission, these findings would be useful in health education strategies.

Editors' note: This study of ‘dry sex practices’ or the use of traditional medicines to constrict the vagina or increase body heat, found significant associations with a number of factors but unfortunately the methodology and results of a regression analysis to tease out their interrelationships and identify confounding factors are not presented. However, an important finding was that only 7% of women who practised dry sex did so in anticipation of sexual activity, 16% used the medicines when they felt their bodies needed it, and 76% said they used them regularly anyway. Although qualitative data suggests that this may be related to concepts of womanhood, the possibility cannot be ignored that a vicious circle of chronic inflammation and resultant vaginal discharge induced by this practice may create the motivation for continuing self-medication.

Vaginal practices, such as intra-vaginal cleansing, drying and tightening, are suspected of placing women at higher risk of acquiring HIV and sexually transmitted infections. 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’. Scorgie and colleagues 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.

Editors' note: This detailed qualitative study reveals a complex array of motives for potentially harmful vaginal practices among women in Kwa Zulu Natal, a province with very high HIV incidence and prevalence among women. Products used include traditional medicines and a wide range of commercial preparations while procedures include cleansing, topical application, insertion, making incisions, and ingestion. Multiple, concurrent sexual partnerships in a context of poverty, labour migration, and unemployment set the stage for women’s mutual suspicion, jealousy, and competition over men as sources of income. Promoting notions of vaginal health to change these practices in order to reduce HIV risk will require that local women’s groups, advocates, and peer education initiatives address the socioeconomic and gender dynamics that underpin them.