AIDS and Behavior

, Volume 20, Issue 11, pp 2555–2564 | Cite as

Rectal Douching Prevalence and Practices Among Peruvian Men Who have Sex with Men and Transwomen: Implications for Rectal Microbicides

  • Jerome T. GaleaEmail author
  • Janni J. Kinsler
  • Sarah McLean
  • Gino Calvo
  • Hugo Sánchez
  • Segundo R. Leon
  • Brandon Brown
Original Paper


Peruvian men who have sex with men (MSM) and transwomen (TW) could benefit from a rectal microbicide (RM) formulated as a rectal douche to prevent HIV infection. However, little is known about rectal douching practices among Peruvian MSM and TW, information necessary to inform RM douche development and future uptake. Using a self-administered interview, we examined the prevalence of and factors associated with rectal douching among a convenience sample of 415 Peruvian MSM and 68 TW. In the previous 6 months, 18 % of participants reported rectal douching using pre-filled commercial kits or plastic bottles or enema bags filled with water, water/soap or saltwater. Multivariate logistic analysis found that “equally insertive and receptive” or “exclusively/mainly receptive” sex roles were associated with douche use. Rectal douching among Peruvian MSM and TW is similar to reports from other studies and supports the potential uptake of a douche-formulated RM in these populations.


MSM Transwomen HIV Rectal douche Enema Microbicide 


Los hombres que tienen sexo con otros hombres (HSH) y las mujeres transgénero (MT) peruanos podrían beneficiarse con microbicidas rectales (MR) formulados como una ducha rectal para prevenir la infección por VIH. Sin embargo, se conoce poco sobre las prácticas de duchas rectales entre HSH y MT en Perú, información necesaria para orientar el desarrollo de MR y su futura aceptación. Utilizando una entrevista auto-administrada, examinamos la prevalencia y los factores asociados con el uso de duchas rectales en una muestra por conveniencia de 415 HSH y 68 MT peruanos. En los seis meses recientes, 18% de los participantes reportaron haber usado duchas rectales comerciales pre-llenados o botellas de plástico o bolsas para enema llenas con agua, agua con jabón, o agua salada. El análisis multivariado encontró que los roles sexuales "igualmente insertivos o receptivos" o "exclusivamente/principalmente receptivos" estaban asociados con el uso de duchas rectales. El uso de duchas rectales entre HSH y MT es similar a lo reportado en otros estudios y da respaldo a la posible aceptación por parte de estas poblaciones de los MR formulados.



We are grateful to the men and women who participated in this study as well as the staff at the community center Epicentro in Lima, Peru where the study was conducted. This work was supported in part by a research grant from the Merck Investigator-Initiated Studies Program of Merck & Co., Inc., NIH grant T32 MH080634 and the NIH Health Disparities Research Loan Repayment Program. The opinions expressed in this paper are those of the authors and do not necessarily represent those of Merck & Co., Inc. We also thank the International Rectal Microbicides Advocates (IRMA) who provided access to the global rectal douching survey and allowed its modification for use in the present study.


  1. 1.
    Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99.PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    McCormack S, Dunn D. Pragmatic open-label randomised trial of preexposure prophylaxis: the proud study [abstract 22LB]. Abstract presented at: Conference on Retroviruses and Opportunistic Infections (CROI); February 23–26, 2015; Seattle, Washington.Google Scholar
  3. 3.
    Grant RM, Anderson PL, McMahan VM, et al. Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study. Lancet Infect Dis. 2014;14(9):820–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Molina JM, Capitant C, Charreau I, Spire B et al. On demand PrEP With Oral TDF-FTC in MSM: results of the ANRS Ipergay trial [abstract 23LB]. Abstract presented at: Conference on Retroviruses and Opportunistic Infections (CROI); February 23–26, 2015; Seattle, Washington.Google Scholar
  5. 5.
    Krakower DS, Mayer KH. Pre-exposure prophylaxis to prevent HIV infection: current status, future opportunities and challenges. Drugs. 2015;75(3):243–51.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Peinado J, Lama JR, Galea JT, et al. Acceptability of oral versus rectal HIV preexposure prophylaxis among men who have sex with men and transgender women in Peru. J Int Assoc Provid AIDS Care. 2013;12(4):278–83.PubMedCrossRefGoogle Scholar
  7. 7.
    Gomez GB, Borquez A, Caceres CF, et al. The potential impact of pre-exposure prophylaxis for HIV prevention among men who have sex with men and transwomen in Lima, Peru: a mathematical modelling study. PLoS Med. 2012;9(10):e1001323.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Beyrer C, Sullivan P, Millett G, Sanchez J, et al. The increase in global HIV epidemics MSM. AIDS. 2013;27(17):2665–78.PubMedCrossRefGoogle Scholar
  9. 9.
    Galea JT, Kinsler JJ, Imrie J, et al. Preparing for rectal microbicides: sociocultural factors affecting product uptake among potential South American users. Am J Public Health. 2014;104(6):e113–20.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    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;1(16):18476.Google Scholar
  11. 11.
    Pines HA, Gorbach PM, Weiss RE, et al. Acceptability of potential rectal microbicide delivery systems for HIV prevention: a randomized crossover trial. AIDS Behav. 2013;17(3):1002–15.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Carballo-Diéguez A, Exner T, Dolezal C, Pickard R, Lin P, Mayer KH. Rectal microbicide acceptability: results of a volume escalation trial. Sex Transm Dis. 2007;34(4):224–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Kinsler JJ, Cunningham WE, Nureña CR, et al. Using conjoint analysis to measure the acceptability of rectal microbicides among men who have sex with men in four South American cities. AIDS Behav. 2012;16(6):1436–47.PubMedCrossRefGoogle Scholar
  14. 14.
    Microbicide Trials Network. MTN-017: phase II safety and acceptability study of tenofovir gel reformulated for rectal use. Accessed 5 June 2015.
  15. 15.
    Javanbakht M, Murphy R, Gorbach P, LeBlanc MA, Pickett J. Preference and practices relating to lubricant use during anal intercourse: implications for rectal microbicides. Sex Health. 2010;7(2):193–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Kinsler JJ, Galea JT, Peinado J, Segura P, Montano SM, Sánchez J. Lubricant use among men who have sex with men reporting receptive anal intercourse in Peru: implications for rectal microbicides as an HIV prevention strategy. Int J STD AIDS. 2010;21(8):567–72.PubMedCrossRefGoogle Scholar
  17. 17.
    Carballo-Diéguez A, Bauermeister JA, Ventuneac A, Dolezal C, Balan I, Remien RH. 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
  18. 18.
    Carballo-Diéguez A, Bauermeister J, Ventuneac A, Dolezal C, Mayer K. Why rectal douches may be acceptable rectal-microbicide delivery vehicles for men who have sex with men. Sex Trans Dis. 2010;37(4):228–33.Google Scholar
  19. 19.
    Galea JT, Kinsler JJ, Imrie J, Nureña CR, Sanchez J, Cunningham WE. 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
  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.
    Javanbakht M, Stahlman S, Pickett J, LeBlanc MA, Gorbach PM. Prevalence and types of rectal douches used for anal intercourse: results from an international survey. BMC Infect Dis. 2014;14:95.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Beyrer C, Baral SD, van Griensven F, et al. Global epidemiology of HIV infection in men who have sex with men. Lancet. 2012;380(9839):367–77.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Baral SD, Poteat T, Stromdahl S, Wirtz AL, Guadamuz TE, Beyrer C. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13(3):214–22.PubMedCrossRefGoogle Scholar
  24. 24.
    Beyrer C, Baral SD, Walker D, Wirtz AL, Johns B, Sifakis F. The expanding epidemics of HIV type 1 among men who have sex with men in low- and middle-income countries: diversity and consistency. Epidemiol Rev. 2010;32(1):137–51.PubMedCrossRefGoogle Scholar
  25. 25.
    MINSA [Peruvian Ministry of Health]. Informe nacional sobre los progresos realizados en el país [National report on progress made in the country]. Accessed 5 June 2015.
  26. 26.
    UNAIDS Peru country report 2013. Accessed 5 June 2013.
  27. 27.
    Kinsler JJ, Galea JT, Lama JR, 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
  28. 28.
    Brown B, Davtyan M, Leon SR, et al. A prospective cohort study characterising the role of anogenital warts in HIV acquisition among men who have sex with men: a study protocol. BMJ Open. 2014;4(9):e005687.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Schilder A, Orchard TR, Buchner CS, Strathdee SA, Hogg RS. Insert discourse: rectal douching among young HIV-positive and HIV-negative men who have sex with men in Vancouver. Can Sex Cult. 2010;14(4):327–43.CrossRefGoogle Scholar
  30. 30.
    Anton P, Herold BC. HIV transmission: time for translational studies to bridge the gap. Sci Transl Med. 2011;3(77):77ps11.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Schmelzer M, Schiller LR, Meyer R, Rugari SM, Case P. Safety and effectiveness of large-volume enema solutions. Appl Nurs Res. 2004;17(4):265–74.PubMedGoogle Scholar
  32. 32.
    de Vries HJ, van der Bij AK, Fennema JS, et al. Lymphogranuloma venereum proctitis in men who have sex with men is associated with anal enema use and high-risk behavior. Sex Trans Dis. 2008;35(2):203–8.CrossRefGoogle Scholar
  33. 33.
    Schreeder MT, Thompson SE, Hadler SC, 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
  34. 34.
    Ndimbie OK, Kingsley LA, Nedjar S, Rinaldo CR. Hepatitis C virus infection in a male homosexual cohort: risk factor analysis. Genitourin Med. 1996;72(3):213–6.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Heiligenberg M, Rijnders B, van der Loeff MFs, et al. High prevalence of sexually transmitted infections in HIV-infected men during routine outpatient visits in The Netherlands. Sex Trans Dis. 2012;39(1):8–15.CrossRefGoogle Scholar
  36. 36.
    Richel O, De Vries HJ, Dijkgraaf MG, Van Noesel CJ, Prins JM. Risk factors for the presence of anal intraepithelial neoplasia in HIV+ men who have sex with men. PLoS One. 2013;8(12):e84030.PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Galea JT, Kinsler JJ, Galan DB, et al. Factors associated with visible anogenital warts among HIV-uninfected Peruvian men who have sex with men and transwomen: a cross-sectional study. Sex Trans Dis. 2015;42(4):202–7.CrossRefGoogle Scholar
  38. 38.
    Development of rectal enema as microbicide (DREAM). Accessed 5 June 2015.

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Jerome T. Galea
    • 1
    • 2
    Email author
  • Janni J. Kinsler
    • 3
  • Sarah McLean
    • 4
  • Gino Calvo
    • 2
  • Hugo Sánchez
    • 2
  • Segundo R. Leon
    • 1
    • 5
  • Brandon Brown
    • 6
  1. 1.Socios En SaludLimaPeru
  2. 2.Epicentro SaludLimaPeru
  3. 3.Department of Community Health Sciences, School of Public HealthUniversity of CaliforniaLos AngelesUSA
  4. 4.The Fenway Institute, Fenway HealthBostonUSA
  5. 5.Laboratory of Sexual HealthUniversidad Peruana Cayetano Heredia School of Public HealthLimaPeru
  6. 6.Center for Healthy Communities, School of MedicineUniversity of CaliforniaRiversideUSA

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