Bacterial vaginosis among women at high risk for HIV in East Africa: the role of behaviour, host immunity, genetics

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Around 25 million people are infected with the human immunodeficiency virus (HIV) in sub-Saharan Africa - roughly two-thirds of the worldwide total. The greatest burden is shouldered by 13.3 million African women, who make up 60% of the epidemic in this region. A risk factor for HIV, bacterial vaginosis (BV) is a highly prevalent, reproductive tract infection affecting women. We do not understand the causes of BV or how to control it long-term. By further investigating behaviour, genetics, and immunological responses to BV, as well as the bacteria that are associated with BV, we hope to further understand the role of these factors in BV and develop a framework that would help researchers to design interventions to respond to this infection. Though research has shown that some types of behaviour are risk factors for BV, notably intravaginal cleansing and sexual behaviour (e.g. new sex partners, frequency of sexual intercourse without condoms), it seems that behaviour does not completely explain the following questions: why some populations have consistently higher prevalence of BV than others; why some women have recurrent BV and others do not; and why some women have symptoms and others do not. We hope to find answers to these questions that will guide future research on BV with the aim of reducing reproductive health burden and HIV transmission.