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Rectal Douching Among Men Who Have Sex with Men in Paris: Implications for HIV/STI Risk Behaviors and Rectal Microbicide Development

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Abstract

Rectal douching is a common but potentially risky practice among MSM; MSM who douche may be ideal candidates for rectal microbicides as HIV prevention. Herein we explored rectal douching and its association with condomless receptive anal intercourse (CRAI), group sex, rates of HIV and other STIs, and likelihood to use rectal microbicide gels. We recruited a sample of 580 MSM from a geosocial-networking smartphone application in Paris, France in 2016. Regression models estimated adjusted risk ratios (aRRs) for associations between rectal douche use and (1) engagement in CRAI, (2) group sex, (3) self-reported HIV and STI diagnoses, and (4) likelihood to use rectal microbicide gels for HIV prevention. 54.3% of respondents used a rectal douche or enema in the preceding 3 months. Douching was significantly associated with CRAI (aRR: 1.77), participation in group sex (aRR: 1.42), HIV infection (aRR: 3.40), STI diagnosis (aRR: 1.73), and likelihood to use rectal microbicide gels (aRR: 1.78). Rectal douching is common among MSM, particularly those who practice CRAI, and rectal microbicide gels may be an acceptable mode of HIV prevention for MSM who use rectal douches.

Resumen

Los hombres que tienen sexo con otros hombres (MSM – por sus siglas en inglés, men who have sex with men) suelen usar duchas rectales antes de sexo anal, pero este práctica es potencialmente arriesgado; MSM quienes usan duchas rectales pueden ser candidatos ideales para microbicidas rectales como manera de prevención del VIH. En esta investigación exploramos el uso de duchas rectales entre MSM y su asociación con sexo anal receptivo sin condones (CRAI – por sus siglas en inglés, condomless receptive anal intercourse), el sexo en grupo, tasas del VIH y otras infecciones de transmisión sexual, y la probabilidad de usar geles microbicidas rectales. Recultamos una muestra de 580 MSM de usuarios de una aplicación de red social en París, Francia en el 2016. Modelos de regresión estimaron índices de riesgo ajustados (aRR – por sus siglas en inglés, adjusted risk ratio) para asociaciones entre el uso de duchas rectales y (1) practicando CRAI, (2) el sexo en grupo, (3) tasas del VIH y de otras infecciones de transmisión sexual autoinformadas, y (4) probabilidad de usar una microbicida rectal en gel para la prevención del VIH. 54,3% de nuestra muestra había usado una ducha o enema rectal durante las 3 meses anteriores. El uso de duchas rectales tenía una asociación con CRAI (aRR: 1.77), participación en sexo en grupo (aRR: 1.42), infección con el VIH (aRR: 3.40) y con otras enfermedades de transmisión sexual (aRR: 1.73), y probabilidad de usar una microbicida rectal en gel (aRR: 1.78). El uso de duchas rectales es común entre MSM, especialmente ellos quienes practican CRAI, y las microbicidas rectales en gel pueden ser una modalidad de prevención del VIH para MSM quienes usan duchas rectales.

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Acknowledgements

We thank the translators and participants of this study who contributed to the project.

Funding

Dr. Dustin Duncan was funded in part by National Institutes of Health Grants R01MH112406, R21MH110190, and R03DA039748 and the Centers for Disease Control and Prevention grant U01PS005122. This work was supported by Dr. Dustin Duncan’s New York University School of Medicine Start-Up Research Fund.

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Authors and Affiliations

  1. Department of Population Health, Spatial Epidemiology Lab, New York University School of Medicine, 227 East 30th Street, 6th Floor, Room 621, New York, NY, 10016, USA

    H. Rhodes Hambrick, Su Hyun Park, William C. Goedel, Jace G. Morganstein, Noah T. Kreski, Ofole Mgbako & Dustin T. Duncan

  2. New York University Internal Medicine Residency Program, New York University School of Medicine, New York, NY, USA

    Ofole Mgbako

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  1. H. Rhodes Hambrick
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  2. Su Hyun Park
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Correspondence to Dustin T. Duncan.

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Research Involving Human Participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of our institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Hambrick, H.R., Park, S.H., Goedel, W.C. et al. Rectal Douching Among Men Who Have Sex with Men in Paris: Implications for HIV/STI Risk Behaviors and Rectal Microbicide Development. AIDS Behav 22, 379–387 (2018). https://doi.org/10.1007/s10461-017-1873-8

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