Abstract
HIV/STI disparities are highest among Black sexual minority men (BSMM) and Black transwomen (BTW) in the Deep South. Exploring the prevalence and correlates of rectal douching and enema use could provide insights into risk factors and HIV/STI prevention opportunities among these groups. This study explored the prevalence and correlates of rectal douching and enema using Poisson regression models among 375 BSMM and BTW in Jackson, MS, and Atlanta GA. Approximately 95% reported their gender as male/man; 5.6% self-identified as transwomen. Most reported being single (73.1%) and were unemployed (56.0%); 36.1% were previously diagnosed with HIV. In multivariable models, BSMM and BTW who reported that their typical sexual position during anal sex was “bottom” (aPR = 2.39, 95% CI = 1.48, 3.84) or “versatile” (aPR = 2.46, 95% CI = 1.44, 4.17) had a higher prevalence of rectal douching and enema use than those who reported “top.” Deeper understanding of the contexts of rectal douching, enema use, and sexual positioning practices is needed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Achterbergh, R. C. A., van der Helm, J., van den Boom, W., Heijman, T., Stolte, I. G., van Rooijen, M., & de Vries, H. (2017). Is rectal douching and sharing douching equipment associated with anorectal chlamydia and gonorrhoea? A cross-sectional study among men who have sex with men. Sexually Transmitted Infections,93(6), 431–437. https://doi.org/10.1136/sextrans-2016-052777.
Baggaley, R. F., Owen, B. N., Silhol, R., Anton, P., McGowan, I., van der Straten, A., & Boily, M.-C. (2018). Per act HIV transmission risk through anal intercourse: An updated systematic review and meta-analysis. Presented at the HIV Research for Prevention meeting, Mardi, Spain. Retrieved November 21, 2018 from http://www.natap.org/2018/HIVR4P/BaggaleyEtAlPosterR4P_2018.pdf
Carballo-Diéguez, A., Balán, I. C., Brown, W., Giguere, R., Dolezal, C., Leu, C.-S., & Cranston, R. D. (2017). High levels of adherence to a rectal microbicide gel and to oral pre-exposure prophylaxis (PrEP) achieved in MTN-017 among men who have sex with men (MSM) and transgender women. PLoS ONE,12(7), e0181607. https://doi.org/10.1371/journal.pone.0181607.
Carballo-Dieguez, A., Giguere, R., Lentz, C., Dolezal, C., Fuchs, E. J., & Hendrix, C. W. (2019). Rectal douching practices associated with anal intercourse: Implications for the development of a behaviorally congruent HIV-prevention rectal microbicide douche. AIDS and Behavior, 23, 1484–1493. https://doi.org/10.1007/s10461-018-2336-6.
Carballo-Diéguez, A., Lentz, C., Giguere, R., Fuchs, E. J., & Hendrix, C. W. (2018). Rectal douching associated with receptive anal intercourse: A literature review. AIDS and Behavior,22(4), 1288–1294. https://doi.org/10.1007/s10461-017-1959-3.
Centers for Disease Control and Prevention. (2016). HIV surveillance report, 2015 (Vol. 27). http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html
Centers for Disease Control and Prevention. (2017). Sexually Transmitted Disease Surveillance, 2016. Retrieved October 5, 2017, from https://www.cdc.gov/std/stats16/CDC_2016_STDS_Report-for508WebSep21_2017_1644.pdf
Centers for Disease Control and Prevention. (2018a). Gonorrhea—2017Sexually Transmitted Diseases Surveillance. Retrieved October 16, 2018, from https://www.cdc.gov/std/stats17/gonorrhea.htm
Centers for Disease Control and Prevention. (2018b). Transgender People | Gender | HIV by Group | HIV/AIDS | CDC. Retrieved March 7, 2019, from https://www.cdc.gov/hiv/group/gender/transgender/index.html
Chmiel, J. S., Detels, R., Kaslow, R. A., Raden, M. V., Kingsley, L. A., & Brookmeyer, R.(1987). Factors associated with prevalent human immunodeficiency virus infection in the Multicenter AIDS Cohort Study. American Journal of Epidemiology, 126(4), 568–575.
Dangerfield, D. T., II, Smith, L. R., Williams, J., Unger, J., & Bluthenthal, R. (2017). Sexual positioning among men who have sex with men: A narrative review. Archives of Sexual Behavior,46(4), 869–884. https://doi.org/10.1007/s10508-016-0738-y.
Easterbrook, P. J., Chmiel, J. S., Hoover, D. R., Saah, A. J., Kaslow, R. A., Kingsley, L. A., & Detels, R. (1993). Racial and ethnic differences in human immunodeficiency virus Type 1 (HIV-1) seroprevalence among homosexual and bisexual men. American Journal of Epidemiology,138(6), 415–429. https://doi.org/10.1093/oxfordjournals.aje.a116874.
Galea, J. T., Kinsler, J. J., McLean, S., Calvo, G., Sánchez, H., Leon, S. R., & Brown, B. (2016). Rectal douching prevalence and practices among Peruvian men who have sex with men and transwomen: Implications for rectal microbicides. AIDS and Behavior,20(11), 2555–2564. https://doi.org/10.1007/s10461-015-1221-9.
Gee, R. (2006). Primary care health issues among men who have sex with men. Journal of the American Academy of Nurse Practitioners,18(4), 144–153. https://doi.org/10.1111/j.1745-7599.2006.00117.x.
Hess, K. L., Hu, X., Lansky, A., Mermin, J., & Hall, H. I. (2017). Lifetime risk of a diagnosis of HIV infection in the United States. Annals of Epidemiology,27(4), 238–243. https://doi.org/10.1016/j.annepidem.2017.02.003.
Hickson, D. A., Truong, N. L., Smith-Bankhead, N., Sturdevant, N., Duncan, D. T., Schnorr, J., & Mena, L. A. (2015). Rationale, design and methods of the ecological study of sexual behaviors and HIV/STI among African American men who have sex with men in the Southeastern United States (The MARI Study). PLoS ONE,10(12), e0143823. https://doi.org/10.1371/journal.pone.0143823.
Javanbakht, M., Stahlman, S., Pickett, J., LeBlanc, M.-A., & Gorbach, P. M. (2014). Prevalence and types of rectal douches used for anal intercourse: Results from an international survey. BMC Infectious Diseases,14(1), 95. https://doi.org/10.1186/1471-2334-14-95.
Jin, F., Jansson, J., Law, M., Prestage, G. P., Zablotska, I., Imrie, J. C. G., & Wilson, D. P. (2010). Per-contact probability of HIV transmission in homosexual men in Sydney in the era of HAART. AIDS, 24(6), 907–913. https://doi.org/10.1097/QAD.0b013e3283372d90.
Leyva, F. J., Bakshi, R. P., Fuchs, E. J., Li, L., Caffo, B. S., Goldsmith, A. J., & Hendrix, C. W. (2013). Isoosmolar enemas demonstrate preferential gastrointestinal distribution, safety, and acceptability compared with hyperosmolar and hypoosmolar enemas as a potential delivery vehicle for rectal microbicides. AIDS Research and Human Retroviruses,29(11), 1487–1495. https://doi.org/10.1089/aid.2013.0189.
Maisel, K., Chattopadhyay, S., Moench, T., Hendrix, C., Cone, R., Ensign, L. M., & Hanes, J. (2015). Enema ion compositions for enhancing colorectal drug delivery. Journal of Controlled Release,209, 280–287. https://doi.org/10.1016/j.jconrel.2015.04.040.
Mitchell, J. W., Sophus, A. I., Lee, J.-Y., & Petroll, A. E. (2016). 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 and Behavior,20(11), 2578–2587. https://doi.org/10.1007/s10461-015-1250-4.
Moss, A. R., Osmond, D., Bacchetti, P., Chermann, J.-C., Barre-Sinoussi, F., & Carlson, J. (1987). Risk factors for AIDS and HIV seropositivity in homosexual men. American Journal of Epidemiology,125(6), 1035–1047. https://doi.org/10.1093/oxfordjournals.aje.a114619.
Patton, M. E., Kidd, S., Llata, E., Stenger, M., Braxton, J., Asbel, L., & Weinstock, H. (2014). Extragenital gonorrhea and chlamydia testing and infection among men who have sex with men—STD surveillance network, United States, 2010–2012. Clinical Infectious Diseases,58(11), 1564–1570. https://doi.org/10.1093/cid/ciu184.
Schilder, A. J., Orchard, T. R., Buchner, C. S., Strathdee, S. A., & Hogg, R. S. (2010). Insert discourse: rectal douching among young HIV-positive and HIV-negative men who have sex with men in Vancouver, Canada. Sexuality & Culture,14(4), 327–343. https://doi.org/10.1007/s12119-010-9077-7.
Schmelzer, M., Schiller, L. R., Meyer, R., Rugari, S. M., & Case, P. (2004). Safety and effectiveness of large-volume enema solutions. Applied Nursing Research,17(4), 265–274. https://doi.org/10.1016/j.apnr.2004.09.010.
Sutton, M. Y., Lanier, Y. A., Willis, L. A., Castellanos, T., Dominguez, K., Fitzpatrick, L., & Miller, K. S. (2013). Strengthening the network of mentored, underrepresented minority scientists and leaders to reduce HIV-related health disparities. American Journal of Public Health,103(12), 2207–2214. https://doi.org/10.2105/AJPH.2013.301345.
Wilton, L., Herbst, J. H., Coury-Doniger, P., Painter, T. M., English, G., Alvarez, M. E., & Carey, J. W. (2009). Efficacy of an HIV/STI prevention intervention for black men who have sex with men: Findings from the Many Men, Many Voices (3MV) Project. AIDS and Behavior,13(3), 532–544. https://doi.org/10.1007/s10461-009-9529-y.
Wylie, S. A., Corliss, H. L., Boulanger, V., Prokop, L. A., & Austin, S. B. (2010). Socially assigned gender nonconformity: A brief measure for use in surveillance and investigation of health disparities. Sex Roles,63(3–4), 264–276. https://doi.org/10.1007/s11199-010-9798-y.
Acknowledgements
The authors gratefully thank The MARI Study participants for their time and participation in the study.
Funding
This study was funded by the Centers for Disease Control and Prevention as part of the Minority HIV/AIDS Research Initiative (Cooperative Agreement: U01PS003315). This work was also supported, in part, by the National Institutes of Health (Grant #: R21MH083620 and K01MH118943).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that they have no conflict of interest.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in this study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Dangerfield, D.T., Johnson, D., Hamlin-Palmer, S. et al. Prevalence and Correlates of Rectal Douching and Enema Use Among Black Sexual Minority Men and Black Transwomen in the Deep South. Arch Sex Behav 49, 1915–1922 (2020). https://doi.org/10.1007/s10508-019-01605-w
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10508-019-01605-w