Rectal douches could be a viable option to deliver HIV-protective drugs to men who practice receptive anal intercourse with other men, according to study results published in AIDS and Behavior.

Although pre-exposure prophylaxis (PrEP) effectively prevents HIV infection, both oral and long-acting PrEP are systemic, and out of concern about long-term side effects some individuals at risk for HIV infection do not want to be exposed to systemic drugs. Since many individuals who engage in receptive anal intercourse use cleansing rectal douches, rectal douches present the possibility for delivery of topical rectal microbicide and a reliable vehicle to deliver an HIV-protective drug. Further, a topical administration of a protective drug may result in higher drug concentrations in colonic tissue compared with oral administration. As a result, development of a “behaviorally-congruent” rectal microbicide douche is underway, the characteristics, mode of use, and adaptability of which will closely mimic real-world experiences of potential users. Therefore, this study aimed to obtain additional data on behavioral aspects of rectal douching associated with anal intercourse that could contribute to the development of a behaviorally congruent rectal microbicide douche.

Between October and November 2017, an online survey was conducted through Grindr, a social media app popular among men who have sex with men. A message was sent to all active users in the United States. A total of 4751 individuals who were born male, aged ³18 years, and had engaged in anal intercourse met the inclusion criteria for this study. Most responders were white; average age was 36.63 years and 10% were HIV-positive.

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Results showed that microbicide douches could become an important HIV-prevention tool. Of participants who responded to the question on frequency of receptive anal intercourse in the prior 3 months, 78% answered in the affirmative. Of individuals who had engaged in receptive anal intercourse, 80% reported douching prior to intercourse in the past 3 months and 27% reported douching afterwards. Of the participants who answered both questions, 25% reported they had douched both before and after intercourse, while 18% douched neither before nor afterwards. These results confirmed douching popularity. Of the 80% of participants who douched beforehand, 82% douched within 1 hour and with a mean of 2.9 consecutive applications. Of the 27% of participants who reported douching afterwards, 83% douched within 1 hour with a mean of 1.7 consecutive applications. Of the multidose users, 78% applied doses within 2 minutes and 76% retained liquid for longer than 1 minute. In addition, 89% of individuals in the study reported using tap water in an enema bottle (50%) or rubber bulb (43%), and douched to enhance pleasure (24%), for cleanliness (97%), or to avoid smelling bad (65%). Further, 98% of individuals who douched indicated that they would “definitely” or “probably” use a douche with anti-HIV properties (70% and 28%, respectively). Of the 18% individuals who had not douched, the most common reason was not feeling inclined to do so. Since HIV infection can occur during PrEP use, the douche will create minimal risk for selection of resistant HIV.

Overall, the study authors concluded that, “An ideal product will protect within a user’s typical number of applications, within 1 h[our], and be dissolvable in tap water.”

Reference

Carballo-Dieguez A, Giguere R, Lentz C, Dolezal C, Fuchs EJ, Hendrix CW. Rectal douching practices associated with anal intercourse: implications for the development of a behaviorally congruent HIV-prevention rectal microbicide douche [published online November 10, 2018]. AIDS and Behavior. doi:10.1007/s10461-018-2336-6