Understanding motives for intravaginal practices amongst Tanzanian and Ugandan women at high risk of HIV infection: The embodiment of social and cultural norms and well-being
Outcomes: Human Immunodeficiency Virus, Sexual and Reproductive Health
View SourceKey Social Norms Take-aways This study explores how intravaginal cleansing and insertion practices among women in Tanzania and Uganda are influenced by social and cultural norms related to gender, sexuality, and morality. While the study does not use formal social norms measurement tools, it explicitly investigates how these practices are shaped by community expectations, traditional teachings, and ideals of womanhood. Norms around cleanliness, sexual respectability, fertility, and physical desirability guide women’s motivations for engaging in vaginal practices. These norms are transmitted through female relatives, peers, and reinforced by male partner expectations. Women undertake these practices to meet cultural standards of being “clean” or “virginal,” while also addressing concerns about health, relationships, and economic survival. The findings highlight the importance of addressing gendered normative pressures in efforts to reduce harm and promote safer sexual health practices.
Objectives To explore the motivations behind intravaginal cleansing and the insertion of substances among women at high risk of acquiring HIV in Tanzania and Uganda, and to understand how these practices reflect broader social and cultural norms as well as individual well-being.
Methods The qualitative study was nested within an observational cohort of women working in bars, guesthouses, and other food and recreational facilities or self-identified as engaging in sex work. Data collection included 176 in-depth, semi-structured interviews with women in both countries and 8 focus group discussions in Tanzania with traditional healers, male bar patrons, and female participants. Data were analyzed using framework analysis with the support of NVivo software.
Results Intravaginal cleansing was nearly universal among study participants, with 96 percent reporting the practice in Tanzania and 100 percent in Uganda. The insertion of substances was reported by 10 percent of participants in Tanzania and 46 percent in Uganda. Practices were driven by overlapping motivations, including hygiene (removal of bodily fluids such as semen and menstrual blood), morality (maintaining a “virgin-like” vaginal state), enhancing sexual pleasure, improving fertility, securing romantic or sexual relationships, and economic survival. Women often kept these practices secret, even from intimate partners, and relied on advice from older women, traditional healers, and peers.
Conclusions Intravaginal cleansing and insertion practices reflect a complex interplay between gendered cultural norms and women’s agency. Effective interventions should move beyond individual behavior change to also address the broader social, economic, and cultural forces that shape these practices. Engaging traditional healers, peer educators, and community leaders may support sustainable and culturally acceptable harm reduction approaches.
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