Dry sex practices and HIV infection in the Dominican Republic and Haiti.

“Dry sex” has been documented in a number of sub-Saharan African countries. These practices involve the introduction of intravaginal douching and/or astringent preparations before sexual intercourse. In Zambia, 86% of women across a range of socioeconomic and ethnic groups reported use of such techniques, and a study in Zimbabwe found 93% of women had practised dry sex. Focus groups in central Zaire identified extensive use of washing and wiping procedures as well as 30 diVerent substances, including leaves, powders, and small stones, that were inserted to produce a desired drying and/or tightening eVect. Researchers in Zimbabwe found that herbal preparations were most frequently utilised (by 21% of women), although douching with water and soap (19%), wiping inside the vagina with newspaper, cloth, or tissues (17%), douching with Dettol or Betadine (15%), and inserting cotton wool (14%) were also commonly mentioned. Pervasive dry sex practices have similarly been described in several other African countries including Malawi, Botswana (Edward Green, personal communication, May 1999), and South Africa. 8 The most commonly stated reason for engaging in such behaviour is for pleasure, particularly for the male partner. 7–10 Some studies suggest an association between these often mucosally abrasive practices and increased risk of infection by HIV 11–17 and other sexually transmitted infections, 5 7 15 although the evidence is not entirely conclusive. Other than a US study which found 16% of African-American and 4% of white American women in the Seattle area reporting dry sex related behaviours, the existence of such practices in the western hemisphere—for example, Haiti and Costa Rica, has been mentioned only briefly in the epidemiological literature. 4 9 During the course of a USAID/Family Health International sponsored HIV/STD prevention project in the Dominican Republic in February–March 1999, the author conducted 20 interviews and five focus groups with adults from diverse socioeconomic backgrounds (n=69). The majority of Dominican men, particularly those from the lower economic social classes including those of more African descent, described a preference for “tight” and/or “dry” sex, entailing intravaginal introduction of alum or other astringent and/or douching substances before intercourse. Along with Haiti, the other nation comprising the Caribbean island of Hispaniola, this may be one of the few areas in the western hemisphere where dry sex techniques are pervasively utilised. Similar practices have been reported by women, including sex workers, of African descent in Guyana and Surinam (Edward Green, personal communication, July 1999). In the interviews and focus groups, a number of Dominican women also disclosed practising dry sex, although this is not normally a publicly discussed practice. In addition to alum (alumbre), an inexpensive substance widely sold in pharmacies, public markets, and elsewhere, women reported using boric acid and a variety of commercial bactericides. Typically, mothers and other older female family members discretely convey these techniques to adolescent girls. Use of dry sex substances is reported to be especially prevalent among female sex workers in the Dominican Republic (Antonio de Moya, Luis Moreno, personal communications, March 1999). Both women and men explained to the author that an overly “wet” (aguá/aguada) wife/female partner runs the real risk of being abandoned by her mate. Many men described a preference for the greater “friction” of dry and tight intercourse, complaining that with a “loose” or “too wet” woman “you just can’t feel anything.” Furthermore, some men expressed the notion that a partner’s “wetness” would indicate that she is “promiscuous.” Data from focus groups conducted by the author with Haitian immigrants residing in the “Bienvenido” sugar plantation located outside the capital, Santo Domingo, suggest that dry sex is almost universally practised by men and women in this shanty town area, which is consistent with reports that these practices are very common in Haiti (Marie Bloch RN, Max Blanchet, personal communications, March, October 1999). In focus group research conducted in the semirural Leogane area of Haiti in 1993 by Judith Brown (n=90), the majority of participants in all 10 group interviews (five with women and five with men) agreed that a woman should ideally have a “dry” or “tight” vagina (personal communication, November 1999). They described a “bad,” undesirable vagina as being too loose or wet, employing a wealth of metaphors to describe this: “feels like soft dough,” “corn meal mush,” “ . . .no muscle,” “like walking in mud,” “nothing inside . . .,” etc (Judith Brown, personal communication, November 1999). Furthermore, the Haitian women described a number of substances inserted into the vagina to remedy looseness or wetness, mentioning both traditional herbs or plants as well as Sex Transm Inf 1999;75:445–446 445