Why rectal douches may be acceptable rectal-microbicide delivery vehicles for men who have sex with men.
BACKGROUND
To explore age of onset of rectal douching among men who have sex with men (MSM) and reasons leading to and maintaining douching behavior; and to consider whether rectal douches containing microbicidal agents might be acceptable for men at HIV risk.


METHODS
In stage 1, we used qualitative methods to explore douching behavior in a sample of 20 MSM. Subsequently, we developed a structured questionnaire that was administered in stage 2 to 105 MSM.


RESULTS
More than half of participants who completed stage 1 douched during the trial despite having been advised not to do so. Of the 105 human immunodeficiency virus uninfected participants in stage 2, 51% reported using rectal douches in the prior 6 months; 47% douched before and 25% after anal intercourse. Most participants reported douching frequently or always. On average, men reported douching about 2 hours before or 1 hour following intercourse. Average age of onset was late 20s. Most men who douched wanted to be clean or were encouraged to douche by their partners. Some men thought douching after sex could prevent sexually transmitted infections.


CONCLUSIONS
Rectal douching appears to be a popular behavior among men who have receptive anal intercourse. It is necessary to identify harmless douches. If human immunodeficiency virus or sexually transmitted infections preventive douches can be developed, rectal douching before or following sexual intercourse could become an important additional prevention tool. To reshape an existing behavior to which some men strongly adhere, like douching, by suggesting use of 1 type of douche over another may be more successful than trying to convince MSM to engage in behaviors they never practiced before or those they resist (e.g., condom use).
Carballo-Diéguez
Alex
A
Department of Infectious Diseases Division, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY 10032, USA. ac72@columbia.edu
Bauermeister
José
J
Ventuneac
Ana
A
Dolezal
Curtis
C
Mayer
Kenneth
K
D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D001900:Boston; D003902:Detergents; D016503:Drug Delivery Systems; D004848:Epithelium / Q000187:drug effects* / Q000276:immunology; D015658:HIV Infections / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011092:Polyethylene Glycols; D012007:Rectum / Q000187:drug effects / Q000276:immunology; D012307:Risk Factors; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data*; D012747:Sexual Partners / Q000523:psychology; D011795:Surveys and Questionnaires; D007507:Therapeutic Irrigation / Q000379:methods; D013997:Time Factors
D000890:Anti-Infective Agents; D003902:Detergents; D011092:Polyethylene Glycols