Introduction and objectives: Research on vaginal practices for ‘dry sex’ in sub-Saharan Africa has established that many of these practices pose distinct health risks, particularly where HIV infection rates are high. Drawing on a study of vaginal practices in KwaZulu-Natal province conducted in 2005, this paper addresses an under-researched theme, namely, women’s own perceptions of the practices’ potential for harm and the manner in which such risk-assessment is shaped by local sexual politics. Women’s views on this subject are also contrasted with those of health workers. Methods: The study was conducted over 9 months in a rural and urban site in KwaZulu-Natal. Qualitative techniques were used, including: focus groups and in-depth-interviews with women and men, and key informant interviews with health workers, gender activists and traditional healers. Additional ethnographic material was gathered in the rural site. Results: Women regard vaginal practices as a way to increase their leverage of control in highly unequal love relationships, where they face uncertainty, betrayal and competition. These perceived social benefits (including the retention of partners’ sexual fidelity and protection from partner violence) thus tend to outweigh women’s assessment of harm associated with the practices, such as coital pain. Women also focus on dangers linked to the use of traditional medicines, drawing on a risk-assessment paradigm not necessarily shared by health workers, who express concern about long-term physiological damage and increased HIV risk. Since condom use is considered by many women to obstruct the efficacy of some intra-vaginal substances, vaginal practices may reinforce existing patterns of unprotected sex. Conclusions: Local norms of what constitutes “pleasurable sex”, unequal sexual partnerships, gendered poverty and economic dis-empowerment are key factors shaping women’s sense of risk associated with vaginal practices. These factors need to be considered in any development of public health messaging about harm-reduction.
Conflict of Interest: None disclosed
Financial Support/Funding: The Ford Foundation
Sydney Australia, April 2007
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