Advertisement

AIDS and Behavior

, Volume 22, Issue 2, pp 379–387 | Cite as

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

  • H. Rhodes Hambrick
  • Su Hyun Park
  • William C. Goedel
  • Jace G. Morganstein
  • Noah T. Kreski
  • Ofole Mgbako
  • Dustin T. DuncanEmail author
Original Paper

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.

Keywords

Rectal douching Enema Rectal microbicides HIV prevention Men who have sex with men 

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.

Notes

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.

Compliance with Ethical Standards

Conflicts of interest

The authors have no conflicts interests.

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.

Informed Consent

Informed consent was obtained prior to participants’ beginning the survey.

References

  1. 1.
    World Health Organization. HIV/AIDS. [Web] http://www.who.int/gho/hiv/en/. Accessed 17 Nov 2016.
  2. 2.
    Põder A, Haldre M. HIV in Europe. Clin Dermatol. 2014;32(2):282–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Marcus U, et al. Age biases in a large HIV and sexual behavior-related internet survey among MSM. BMC Public Health. 2013;13:826–37.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    European Centre for Disease Prevention and Control. HIV and STI prevention among men who have sex with men. Stockholm: European Centre for Disease Prevention and Control; 2016.Google Scholar
  5. 5.
    McCormack SM, et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet. 2016;387(10013):53–60.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Grant RM, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363:2587–99.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Molina JM, et al. On-demand pre-exposure prophylaxis in men at high risk for HIV-1 infection. N Engl J Med. 2015;373:2237–46.PubMedCrossRefGoogle Scholar
  8. 8.
    Molina J-M. PrEP roll-out in france, in World AIDS Conference. 2016: Durban, South Africa.Google Scholar
  9. 9.
    Reyniers T, et al. Pre-exposure prophylaxis (PrEP) for men who have sex with men in Europe: Review of evidence for a much needed prevention tool. Sex Transm Infect. 2016;93:363–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Hendrix CW. Development of rectal enema as microbicide (DREAM). Baltimore: Johns Hopkins University; 2014.Google Scholar
  11. 11.
    Collins C. Rectal Microbicides Fact Sheet. 2016.Google Scholar
  12. 12.
    Leyva FJ, et al. Isoosmolar enemas demonstrate preferential gastrointestinal distribution, safety, and acceptability compared with hyperosmolar and hypoosmolar enemas as a potential delivery vehicle for rectal microbicides. AIDS Res Hum Retroviruses. 2013;29(11):1487–95.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Hall EW, et al. Pre-exposure prophylaxis modality preferences among men who have sex with men and use social media in the United States. J Med Internet Res. 2016;18(5):e111.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Marra E, Hankins CA. Perceptions among Dutch men who have sex with men and their willingness to use rectal microbicides and oral pre-exposure prophylaxis to reduce HIV risk: a preliminary study. AIDS Care. 2015;27(12):1493–500.PubMedCrossRefGoogle Scholar
  15. 15.
    McGowan I, et al. A phase 1 randomized, double blind, placebo controlled rectal safety and acceptability study of tenofovir 1% gel (MTN-007). PLoS ONE. 2013;8(4):e60147.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    McGowan I, et al. Project gel: a randomized rectal microbicide safety and acceptability study in young men and transgender women. PLoS ONE. 2016;11(6):e0158310.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Mitchell JW, et al. Anal douche practices and willingness to use a rectal microbicide enema for HIV prevention and associated factors among an internet sample of HIV-negative and HIV-discordant male couples in the US. AIDS Behav. 2016;20:2578–87.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Calabrese SK, et al. An event-level comparison of risk-related sexual practices between black and other-race men who have sex with men: condoms, semen, lubricant, and rectal douching. AIDS Patient Care STD. 2013;27(2):77–84.CrossRefGoogle Scholar
  19. 19.
    Galea JT, et al. Rectal douching prevalence and practices among Peruvian men who have sex with men and transwomen: implications for rectal microbicides. AIDS Behav. 2016;20(11):2555–64.PubMedCrossRefGoogle Scholar
  20. 20.
    Noor SW, Rosser BR. Enema use among men who have sex with men: a behavioral epidemiologic study with implications for HIV/STI prevention. Arch Sex Behav. 2014;43(4):755–69.PubMedCrossRefGoogle Scholar
  21. 21.
    Carballo-Diéguez A, et al. The use of rectal douches among HIV-uninfected and infected men who have unprotected receptive anal intercourse: implications for rectal microbicides. AIDS Behav. 2008;12(6):860–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Chmiel JS, et al. Factors associated with prevalent human immunodeficiency virus infection in the Multicenter AIDS Cohort Study. Am J Epidemiol. 1987;126:568–75.PubMedCrossRefGoogle Scholar
  23. 23.
    Moss AR, et al. Risk factors for AIDS and HIV seropositivity in homosexual men. Am J Epidemiol. 1987;125:1035–47.PubMedCrossRefGoogle Scholar
  24. 24.
    Winkelstein W Jr, et al. Sexual practices and risk of infection by the human immunodeficiency virus. The San Francisco Men’s Health Study. JAMA. 1987;257(3):321–5.PubMedCrossRefGoogle Scholar
  25. 25.
    Koziol DE, et al. A comparison of risk factors for human immunodeficiency virus and hepatitis B virus infections in homosexual men. Ann Epidemiol. 1993;3(4):434–41.PubMedCrossRefGoogle Scholar
  26. 26.
    Schreeder MT, et al. Hepatitis B in homosexual men: prevalence of infection and factors related to transmission. J Infect Dis. 1982;146(1):7–15.PubMedCrossRefGoogle Scholar
  27. 27.
    de Vries HJ, et al. Lymphogranuloma venereum proctitis in men who have sex with men is associated with anal enema use and high-risk behavior. Sex Transm Dis. 2008;35:203–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Macdonald N, et al. Risk factors for rectal lymphogranuloma venereum in gay men: results of a multicentre case-control study in the U.K. Sex Transm Infect. 2014;90(4):262–8.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Ndimbie OK, et al. Hepatitis C virus infection in a male homosexual cohort: risk factor analysis. Genitoruin Med. 1996;72(3):213–6.Google Scholar
  30. 30.
    Kinsler JJ, et al. Rectal douching among Peruvian men who have sex with men, and acceptability of a douche-formulated rectal microbicide to prevent HIV infection. Sex Transm Infect. 2013;89(1):62.PubMedCrossRefGoogle Scholar
  31. 31.
    Galea JT, et al. Rectal douching and implications for rectal microbicides among populations vulnerable to HIV in South America: a qualitative study. Sex Transm Infect. 2014;90(1):33–5.PubMedCrossRefGoogle Scholar
  32. 32.
    Newman PA, Roungprakhon S, Tepjan S. A social ecology of rectal microbicide acceptability among young men who have sex with men and transgender women in Thailand. J Int AIDS Soc. 2013;16(1):18476.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Carballo-Diéguez A, et al. Preference for gel over suppository as delivery vehicle for a rectal microbicide: results of a randomised, crossover acceptability trial among men who have sex with men. Sex Transm Infect. 2008;84(6):483–7.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Achterbergh R, et al. Is rectal douching and sharing douching equipment associated with anorectal chlamydia and gonorrhoea? A cross-sectional study among men who have sex with men. Sex Transm Infect. 2017;. doi: 10.1136/sextrans-2016-052777.PubMedGoogle Scholar
  35. 35.
    Goedel WC, Duncan DT. Geosocial-network app usage patterns of gay, bisexual, and other men who have sex with men: survey among users of Grindr, a mobile dating app. JMIR Public Health Surveill. 2015;1(1):e4.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Landovitz RJ, et al. Epidemiology, sexual risk behavior, and HIV prevention practices of men who have sex with men using GRINDR in Los Angeles. California. J Urban Health. 2013;90(4):729–39.PubMedCrossRefGoogle Scholar
  37. 37.
    Duncan DT, et al. Poor sleep health and its association with mental health, substance use and condomless anal intercourse among gay, bisexual, and other men who have sex with men. Sleep Health. 2016;2(4):316–21.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Harkness J. Questionnaire translation, in cross-cultural survey methods. In: Harkness J, Van de Vijer F, Moher P, editors. Cross-Cultural Survey Methods. Hoboken: Wiley; 2003. p. 35–6.Google Scholar
  39. 39.
    Phillips G, et al. Use of geosocial networking (GSN) mobile phone applications to find men for sex by men who have sex with men (MSM) in Washington. DC. AIDS Behav. 2014;18(9):1630–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Zou H, Fan S. Characteristics of men who have sex with men who use smartphone geosocial networking applications and implications for HIV interventions: a systematic review and meta-analysis. Arch Sex Behav. 2016;46(4):885–94.PubMedCrossRefGoogle Scholar
  41. 41.
    Javanbakht M, et al. Prevalence and types of rectal douches used for anal intercourse: results from an inernational survey. BMC Infect Dis. 2014;14:95.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Anton PA, et al. RMP-02/MTN-006: a phase 1 rectal safety, acceptability, pharmacokinetic, and pharmacodynamic study of tenofovir 1% gel compared with oral tenofovir disoproxil fumarate. AIDS Res Hum Retroviruses. 2012;28(11):1412–21.PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Begay O, et al. Identification of personal lubricants that can cause rectal epithelial cell damage and enhance HIV type 1 replication in vitro. AIDS Res Hum Retroviruses. 2011;27(9):1019–24.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Rebe KB, et al. Sexual lubricants in South Africa may potentially disrupt mucosal surfaces and increase HIV transmission among men who have sex with men. AS Afr Med J. 2013;104(1):49–51.CrossRefGoogle Scholar
  45. 45.
    Guthmann JP, Fonteneau L, Lévy-Bruhl D. Assessment of vaccination coverage in France: Current sources and data. Saint-Maurice: French Institute for Public Health Surveillance; 2012.Google Scholar
  46. 46.
    Diez Roux AV. Neighborhoods and health: where are we and where do we go from here? Rev Epidemiol Sante Publique. 2007;55:13–21.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of Population Health, Spatial Epidemiology LabNew York University School of MedicineNew YorkUSA
  2. 2.New York University Internal Medicine Residency ProgramNew York University School of MedicineNew YorkUSA

Personalised recommendations