Transcript Use of Lemon/Lime Juice Douching by Women To Prevent

KEEP CLICKING
TO REVEAL
MORE
INFORMATION
Use of Lemon/Lime Juice Douching by
Women To Prevent Infections and
Pregnancy in Jos, Nigeria
Godwin E. Imade1*, Atiene S. Sagay1, Viola A.
Onwuliri1, Daniel Z. Egah1, Malcolm Potts2, Roger V. Short3
1Faculty
of Medical Sciences, University of Jos, Jos, Nigeria
2University of California, Berkeley, USA
3University of Melbourne, Melbourne, Australia
*[email protected]
12th Prorities in Reproductive
Health and HIV Conference 18-20
Oct 2005, Stellenbosch, South
Africa
1
Introduction


Women account for 50% of the 42 million
people living with HIV World Wide and for
57% of the 25 million infected in subSaharan Africa (UNAIDS 2004).
The increasing rate of HIV infection in
women in Africa is fuelled by poor socioeconomic circumstances and gender
inequity.
Older men have sex with younger women
Women can not insist on the use of
condom
Cultural practices tend to favour the male2
Nigeria: National HIV Prevalence trend
Population: 130 Million
7
6
5.4
5.8
5.0
4.5
5
3.8
4
% 3
2
1.8
1
0
1991
1993
1996
1999
2001
2003
3
Nigeria: HIV Prevalence Survey
2003
Sokoto
Katsina
Jigawa
Zamfara
Yobe
Borno
Kano
Kebbi
Kaduna
Bauchi
Gombe
Niger
Adamawa
Plateau
Kwara
FCT
Nasarawa
Oyo
Taraba
Osun
Kogi
Ekiti
Key
Benue
Ondo
Ogun
Lagos
Prevalence
Edo
Delta
Bayelsa
Ebonyi
Imo
Rivers
Abia
Akwa
Ibom
Cross
River
≥ 10%
7.5 – 9.9%
5 – 7.4%
2.5 – 4.9%
< 2.5%
4
HIV Prevalence in Jos, Nigeria

8-10% in Pregnant women*

25-30% in STI patients

54% among Female Sex Workers and as
high as 60% in some parts of Nigeria
*Sagay AS, Kapiga S, Imade GE, Sankalé JL, Idoko JA, Kanki P.
HIV Infection Among Pregnant Women In Nigeria
International Journal of Gynaecology and Obstetrics 2005, 90 (1): 61-67
5
Some Local and Traditional Agents Women Use For
Douching To Prevent Sexually Transmitted Infections and
Pregnancy

Lemon and lime
juices

Soft drinks

Others
6
Objectives of Study
To describe the use of lemon/lime
juice for douching by female sex
workers (FSWs) and family planning
clients (FPCs) in Jos, Nigeria.

To determine the mode and rationale
for the use of lemon/lime juice for
sex.

7
STUDY SITE: JOS, NIGERIA
8
Study Subjects and Methods




Study Subjects: 300 Sexually Active
Women.
 200
Female Sex Workers
 100
Family Planning Clients
A Questionnaire Survey
Period of Interview of study subjects: June
2004
Data collation and analysis were done with
File Maker Pro and SPSS Computer Soft
wares
9
RESULTS
Table 1: Mean ages and users of
lemon/lime
Mean Age
(Years)
Lemon/lime
Users
FCW
N=200
FPC
N=100
26±5.5
33.1±7.1
163 (81.5%)
4 (4%)
10
Table 2. The mode, preference and rationale for use of lemon/lime juice
by sexually active women (FSWs & FPCs) in Jos, Nigeria
Predictor
n=167
A. Do you use lemon or lime
Lime
Lemon
Mixture
Blank
N(%)
95% Confidence
Interval (%)
105(62.8)
30(18.0)
18(10.8)
14(8.4)
55-70
12-25
7-16
5-14
44(26.3)
75(44.9)
6(3.6)
22(13.2)
20(12.7)
20-34
37-53
1-8
8-19
7-18
44(26.3)
44(26.3)
8(4.8)
13(7.8)
1(0.6)
54(34.1)
20-34
20-34
2-9
4-13
0-3
25-40
B. In what concentration do you
use lemon/lime juice for sex?
Neat (undiluted)
Diluted in water
Diluted in other Fluids
Others
Blank
C. How do you know it
(lemon/lime) works?
1. It prevents pregnancy
2. It prevents infection
3. It increases sexual pleasure
Both 1 and 2
Both 2 and 3
Other reasons
11
Results Continued

19 % (32/167) of the women found the
juice painful.

Duration of use of lemon/lime ranged
from <1 to 10 years

They did not know their HIV status.

86% would like to recommend it to
others

71% were willing to take part in a study
to evaluate its safety and efficacy.
12
Discussion


Lemon/lime juice is widely used in Jos for douching by
women at high risk of acquiring HIV with a belief that it
prevents pregnancy and STIs including HIV.
The crucial question! Does lemon/lime juice really work?
– Literature revealed that women over the years have used
lemon/lime juice to prevent pregnancy. E.g. Turkish Women
(Norman Himes 1963)
– Recent in-vitro studies have shown that lemon/lime juice
immobilises spermatozoa and kills HIV. (Clarke, McCoombe &
Short, 2005, Short, McCoombe,Maslin, Niam & Crowe 2004)
Effects due to Low PH 2-2.6 : Citric acid

19% of women experienced pain. Was the pain due to
lemon/lime juice or as a result of pre-existing vaginal
lesions?
– A lesson from the case of Nonoxynol-9
13
Conclusion




Lemon/Lime juice is a natural product which is already
being used by sexually active women in Nigeria with a
belief that it prevents pregnancy and sexually
transmitted infections including HIV.
A well designed study to evaluate its safety and efficacy
among women volunteers is very urgent to determine
whether its use should be promoted or discouraged.
The vulnerable women in sub-Saharan Africa and other
developing countries are in desperate need of a cheap,
safe, effective and readily available microbicide they
can control and use to protect themselves from STIs
including HIV and pregnancy.
How soon will this come?
14
Jos Lemon/Lime Study Group
Godwin Imade
Roger Short,
Malcolm Potts
University of Melbourne, Australia
University of California, Berkley,
USA
Solomon Sagay
Viola Onwuliri
Faculty of Medical Sciences, University of Jos, Nigeria
Daniel Egah
15
Acknowledgement


Mary Magdalene Project, Australian AIDS
Fund Inc. Melbourne (www.aids.net.au)
Courtesy: Prof. Roger Short and Brain Haill
for providing funds to cover my travel
expenses.
The Organisers of 12th Priorities in
Reproductive Health and HIV Conference,
18-21 Oct 2005, Stellenbosch, South Africa
for Bursary award to cover my registration
and lodging fees
16
17