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Getting Clear About Rectal Douching Among Men Who Have Sex With Men

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Abstract

Receptive anal sex is the primary means through which HIV is transmitted among men who have sex with men (MSM). Recently, researchers have begun investigating the role that rectal douching may play in amplifying risk for transmission. Yet, there is limited research on the frequency with which MSM douche, the products they use, and how this may vary across sociodemographic characteristics. A U.S. national sample of 4745 MSM completed an online survey that assessed their douching behavior, demographic characteristics, sexual behavior, and their anal sexual positioning (i.e., top, bottom, versatile). Nearly two-thirds (65.8%) had engaged in rectal douching in the last three months. Among those who douched, water was commonly reported (84.2%) and 20.1% reported using commercial enemas (e.g., Fleet), as well as water and soap (15.0%)—numbers exceed 100% as some participants reported more than one. Men who douched reported significantly more receptive and insertive condomless anal sex acts in the prior 3 months. One-in-ten men reported rectal bleeding after douching. Compared to HIV-negative participants who had not taken PrEP, participants had higher odds of reporting douching in the past 3 months if they were HIV-negative and currently on PrEP (AOR = 1.82), HIV-negative and previously used PrEP (AOR = 1.58), and HIV-positive (AOR = 1.83). Douching was common in this sample. Given that douching could amplify risk for HIV transmission, healthcare providers should discuss douching safety with their patients, with a focus on harm reduction (e.g., reduce risk of bleeding, as opposed to abstinence from douching).

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Change history

  • 09 October 2021

    In fourth sentence of the abstract of this article, the word “assessed” has been corrected from a previous version in which it was misspelled.

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Acknowledgements

Special thanks to additional members of the T5K study team: David Pantalone, Denis Nash, Sarit A. Golub, Viraj V. Patel, Gregorio Millett, Don Hoover, Sarah Kulkarni, Matthew Stief, Chloe Mirzayi, Javier Lopez-Rios, Alexa D’Angelo, Fatima Zohra, & Corey Morrison. Thank you to the program staff at NIH: Gerald Sharp, Sonia Lee, and Michael Stirratt. And thank you to the members of our Scientific Advisory Board: Michael Camacho, Demetre Daskalakis, Sabina Hirshfield, Jeremiah Johnson, Claude Mellins, and Milo Santos. While the NIH financially supported this research, the content is the responsibility of the authors and does not necessarily reflect official views of the NIH.

Funding

Together 5000 was funded by the National Institutes for Health (UH3 AI 133675—PI Grov). Other forms of support include the CUNY Institute for Implementation Science in Population Health, the Einstein, Rockefeller, CUNY Center for AIDS Research (ERC CFAR, P30 AI124414).

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Correspondence to Christian Grov.

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This study was approved by the City University of New York Institutional Review Board.

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Grov, C., Westmoreland, D., Carneiro, P.B. et al. Getting Clear About Rectal Douching Among Men Who Have Sex With Men. Arch Sex Behav 50, 2911–2920 (2021). https://doi.org/10.1007/s10508-021-01933-w

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