Feminine hygiene practices and the risk for HPV infection and cervical dysplasia among Haitian women in Miami, Florida

A2 Haitian women in South Florida experience an increased risk of cervical carcinoma. This disparity likely ensues from the interplay of multiple factors, including underutilization of Pap smear screening and a high prevalence of Human Papilloma Virus (HPV) infection. Preliminary data suggests that Haitian women, particularly those residing in Little Haiti, the predominately Haitian area in Miami, Florida, have higher rates of infection than other racial/ethnic minorities and immigrant population sub-groups in the Miami metropolitan area. The excess rate of infection may, in part, ensue from a cultural practice known as twalet deba. Simply put, twalet deba is a feminine hygiene practice performed regularly to clean the vagina and external genitalia, as well as, to induce tightening and drying of the vagina for enhanced sexual pleasure of male partners. This practice often involves the use of herbs/ leaves and commercial products, manufactured outside the United States and sold in area markets (known as botanicas in Haitian Creole), which include, among other ingredients: boric acid, potassium permanganate, and sulfuric acid. Such products and their herbal counterparts may contribute to the excess incidence of HPV among Haitian women, and also to the etiology of invasive cervical carcinoma within this population sub-group by :(1) causing sub-clinical and clinical changes in the cervical mucosa that increase susceptibility to infection; (2) creating prolonged inflammation of the cervix that acts synergistically with HPV to induce cervical carcinogenesis; and/or, (3) damaging the DNA of cervical mucosal cells such that when exposed to HPV infection they become mutagenic. Our research integrates the methods of community-based participatory research (CBPR) with laboratory-based science to test in-vitro hypotheses about differences in rates of HPV infection and cervical dysplasia among Haitian women who regularly practice twalet deba versus those who do not. Community Health Workers (CHWs), who are indigenous to Little Haiti and fluent in English and Haitian Creole, canvass door-to-door in the area to identify 350 women who meet study eligibility criteria (e.g., Haitian descent, 18 years of age and older, no history of cervical cancer or surgical hysterectomy). Women who agree to participate receive instruction on how to use the Fournier self-sampler, a self-administered cervical sampling device with similar efficacy to the Pap smear, and complete a short interview which assesses, among other things, use of twalet deba. The cervical specimens, collected using the Fournier device, are then evaluated by a certified pathologist for cytologic changes, and are also tested for HPV using polymerase chain reaction (PCR). Preliminary findings indicate that Haitian women who report practicing twalet deba experience an increased risk of HPV infection and cervical dysplasia, even after controlling for other known risk factors for HPV infection, such as age, number of lifetime male partners, use of oral contraceptives, and co-infection with Chlamydia trachomatis. Future research must examine differences in risk for infection and dysplasia between categories of users (e.g., type of product and frequency of use), as well as, identify which commonly used products provide a safe, culturally-acceptable alternative for this practice.