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Rectal douching among Peruvian men who have sex with men, and acceptability of a douche-formulated rectal microbicide to prevent HIV infection
  1. Janni J Kinsler1,
  2. Jerome T Galea2,
  3. Javier R Lama3,
  4. Patricia Segura3,
  5. Jesús Peinado3,
  6. Martin Casapia4,
  7. Abner Ortiz5,
  8. Carsten Nadjat-Haiem6,
  9. Silvia M Montano7,
  10. Jorge Sanchez3
  1. 1Department of Community Health Sciences, School of Public Health, University of California, Los Angeles, California, USA
  2. 2Program in Global Health, David Geffen School of Medicine, University of California, Los Angeles, California, USA
  3. 3Asociación Civil Impacta Salud y Educación, Lima, Peru
  4. 4Asociación Civil Selva Amazónica, Iquitos, Peru
  5. 5Asociación Civil Cayetano Heredia, Pucallpa, Peru
  6. 6Department of Anesthesiology, University of California, Los Angeles, Los Angeles, California, USA
  7. 7Department of Bacteriology, US Naval Medical Research Unit No.6, Lima, Peru
  1. Correspondence to Dr Janni Jacqueline Kinsler, UCLA School of Public Health, Department of Community Health Sciences, 650 Young Drive South, Los Angeles, CA 90095, USA; janni.kinsler{at}

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Rectal douching has attracted recent interest as a possible rectal microbicide (RM) formulation since many men who have sex with men (MSM) practice the behaviour prior to receptive anal intercourse (RAI).1 Acceptability research on rectal douches used by MSM found that if douches were available as an RM, MSM would be highly likely to use them when condoms were not used.2 This study reports on the practice of rectal douching, and the acceptability of a hypothetical RM formulated as a rectal douche among Peruvian MSM, a population with an estimated HIV prevalence of 12.2% compared with 0.61% in the general population.3

This retrospective study was based on data collected from a convenience sample of 824 MSM reporting RAI from three Peruvian cities (Lima, the Pacific coast capital, and the Amazonian cities of Iquitos and Pucallpa) participating in the 2008 HIV Sentinel Surveillance using computerised-assisted self interviewing. The study was approved by the Peruvian National AIDS and STD Control Program, the Institutional Review Boards of the Asociación Civil Impacta Salud y Educación in Lima, and the US Naval Medical Research Unit No 6, Lima, Peru. Of the total sample, 27% reported a history of rectal douching and 80% reported they would use an RM formulated as a rectal douche to protect against HIV if available. Willingness to use a future RM formulated as a douche was more common among individuals with a history of rectal douching compared with those without (OR=2.16; 95% CI=1.23 to 3.79), and less common among individuals from Pucallpa and Iquitos compared with those from Lima (OR=0.50; 95% CI=0.29 to 0.86; and OR=0.39; 95% CI=0.22 to 0.67).

The positive association between a history of rectal douching and willingness to use an RM formulated as a rectal douche signals that an RM formulated as a rectal douche may be acceptable to Peruvian MSM, especially those who practice rectal douching. Individuals from the cities of Pucallpa and Iquitos were less likely to be willing to use an RM formulated as a rectal douche than individuals from Lima. A possible explanation for this finding may be that MSM in Lima (population 10 million) have more exposure to douching as a preparation for RAI, compared with the much smaller, relatively remote jungle city of Pucallpa (population 301 000), where MSM may have less exposure to this practice. Cultural differences between participants from the three cities may also be a potential explanation for our findings. More in-depth research is needed to better understand these differences. RM research is advancing rapidly, and knowledge of how they may be used by various populations globally must be generated now while products are under development.


The authors would like to thank César R. Nureña for his assistance with review of the manuscript. This work was partially funded by the US HIV Research Program, Walter Reed Army Institute of Research, Work Unit No 62787A S17 H B0002. The views expressed in this article are those of the author, and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the US Government. Dr Silvia M Montano is an employee of the US Government. This work was prepared as part of her official duties. Title 17 USC. § 105 provides that ‘Copyright protection under this title is not available for any work of the US Government’. Title 17 USC. § 101 defines a US Government work as a work prepared by a military service member or employee of the US Government as part of that person's official duties.



  • Funding This study was supported by the Asociacion Civil Impacta Salud Y Educacion Core Funds AND US HIV Research Program, Walter Reed Army Institute of Research.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Institutional Review Board of the Asociación Civil Impacta Salud y Educación in Lima, AND the US Naval Medical Research Unit No 6.

  • Provenance and peer review Not commissioned; externally peer reviewed.