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Rectal douching and implications for rectal microbicides among populations vulnerable to HIV in South America: a qualitative study
  1. Jerome T Galea1,
  2. Janni J Kinsler2,
  3. John Imrie1,3,4,
  4. César R Nureña5,
  5. Jorge Sánchez6,
  6. William E Cunningham7
  1. 1Faculty of Population Health, Centre for Sexual Health and HIV Research, University College London, London, UK
  2. 2Department of Community Health Sciences, School of Public Health, University of California, Los Angeles, California, USA
  3. 3Health4Men, Anova Health Institute, Johannesburg, South Africa
  4. 4Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa
  5. 5Escuela de Antropología, Universidad Nacional Mayor de San Marcos, Lima, Peru
  6. 6Asociación Civil Impacta Salud y Educación, Lima, Peru
  7. 7Department of Medicine, Division of General Internal Medicine and Health Services Research, School of Medicine, University of California, Los Angeles, California, USA
  1. Correspondence to Jerome T Galea, Calle Unión 259, Barranco, Lima—4, Peru; jerome.galea.09{at}


Objective While gel-formulated rectal microbicides (RM) are the first to enter clinical trials, rectal douching in preparation for anal intercourse is a common practice; thus RMs formulated as douches may be a convenient alternative to gels. Nonetheless, little is known about potential users’ thoughts regarding douche-formulated RMs or rectal douching practices, data that is needed to inform the advancement of douche-based RMs. This qualitative study examined thoughts regarding douches, their use as an RM and current douching practices among men who have sex with men and transgender women.

Methods 12 focus groups and 36 in-depth interviews were conducted (N=140) to examine the overall acceptability of RM, of which one component focused on rectal douching. Focus groups and interviews were recorded, transcribed verbatim and coded; text relating to rectal douching was extracted and analysed. Sociodemographic information was collected using a self-administered questionnaire.

Results Support for a douche-formulated RM centred on the possibility of combined precoital hygiene and HIV protection, and it was believed that a deeply penetrating liquid douche would confer greater HIV protection than a gel. Drawbacks included rectal dryness, impracticality and portability issues, and potential side effects. Non-commercial douching apparatus use was common and liquids used included detergents, vinegar, bleach, lemon juice and alcohol.

Conclusions A douche-formulated RM, while desirable and perceived as more effective than a gel-formulated RM, also generated questions regarding practicality and side effects. Of immediate concern were the non-commercial liquids already being used that likely damage rectal epithelia, potentially increasing HIV infection risk. Precoital rectal douching is common and an RM formulated as such is desirable, but education on rectal douching practices is needed now.

  • HIV

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