South American survey finds rectal microbicide formulated as a douche acceptable

Published: September 18, 2013

 A qualitative study of 140 men who have sex with men (MSM) and transgender women (TGW) in three cities in Peru and Ecuador has found that most thought that a rectal microbicide formulated as a douche, rather than as a gel or lubricant, might offer additional safety or efficacy.

However, it also found that participants doubted the practicality of such a formulation for use in sex away from home. The researchers also comment that interviewees who regard douching as hazardous would be unlikely to change their minds and adopt a microbicide douche. 
The researchers also discovered in the course of their research that some participants were already using a variety of homemade douching preparations before anal sex, some of them potentially hazardous or downright toxic. They comment that regardless of the desirability of a rectal microbicide douche, "education on rectal douching practices is needed now".
This study follows on from several other studies of rectal douching in MSM and TGW. A study in the USA (Carballo-Diéguez) found that 53% of HIV-negative MSM there douched in preparation for anal sex. A global survey (Stahlman) by International Rectal Microbicide Advocates (IRMA), presented at the Microbicides 2012 Conference in Sydney last year, found that 63% of the people who answered the survey (mainly MSM) douched rectally before receiving anal sex, with only 25% using commercial enema products and most using shower hoses and homemade kits made from bottles. Douching was more common in people with HIV, and people who douched averaged five partners a month compared with two among those who did not douche, suggesting that a rectal douche focused on people at high risk of HIV might be effective.
A previous study from three cities in Peru (Kinsler) found that only 27% of MSM/TGW douched rectally before receptive anal sex but that 80% said they would use a microbicide douche if it had efficacy against HIV infection. Participants who already douched were more than twice as likely to say they would use a rectal microbicide douche and those from the capital, Lima, were twice as likely to say they would use a microbicide douche as those from the other two cities, which were the smaller and more remote jungle cities of Iquitos and Pucallpa.
The current survey interviewed 104 participants in focus groups and 36 in indepth interviews, with approximately equal numbers coming from Lima and Iquitos in Peru and Guayaquil in Ecuador. Participants were in the main mixed-race, aged under 30 (only 10-12% were 30 or older in Iquitos and Guayaquil, 38% in Lima), had at least high-school education and were employed.
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