| Abstract: | Cervical cancer is the primary cause of cancer deaths among Haitian
women; however, the social context of cervical cancer among Haitian
immigrant women has not been systematically examined. The ways in which
women assign meaning to this disease, understand its causality and situate it
within the broader context of gynecological health are poorly understood.
Further, Haitian immigrant women’s perceptions of disease risk, including
knowledge and understanding about Human Papillomavirus (HPV), the
primary etiologic factor in cervical cancer, have not been explored. Few
studies have assessed health behaviors, including culturally mediated
feminine hygiene practices, among Haitian immigrant women, which may
negatively impact gynecological health.
This exploratory study examines these dimensions of gynecological
health using ethnographic methods including participant observation,
observation, informal and semistructured interviewing and surveys.
Ethnographic data contextualize this disease in larger cultural and historical
contexts. In addition, these data informed the construction of a 92-item
survey, ensuring content validity of the personal questions women wereasked about feminine hygiene practices and the agents they use. This
survey, administered to 246 women in Little Haiti, Miami, represents an
application of medical anthropology to epidemiologic research. Each survey
respondent also was evaluated for cytology and sexually transmitted
infections (STIs), including HPV, using a self-sampling medical device.
Quantitative analysis of survey data indicates that prevalent STIs
(Chlamydia) are significantly associated with feminine hygiene practices;
however, HPV infection and cervical cancer are not associated with the
practices. The practices are likely underreported in the survey sample.
Qualitative analysis reveals that women’s constructions of gynecological
health are inseparable from cultural beliefs that emphasize feminine hygiene.
Beliefs guide behaviors, which include vaginal douching and intravaginal
washing, using plant-based therapies, imported commercial products and
chemical compounds. These practices serve the purpose of not only cleaning,
but also drying and tightening the vaginal environment for increased sexual
pleasure of male partners. Attempts to preserve relationships, and reduce
the chance that partners will take mistresses, occur through maintaining
intimate hygiene and, in some cases, by other ethnomedical means. |