Transcript Rectal douching and lubricant use among global web-survey respondents Shauna Stahlman, Marjan Javanbakht, Jim Pickett, Marc-Andre LeBlanc, Pamina Gorbach.

Rectal douching and lubricant use among
global web-survey respondents
Shauna Stahlman, Marjan Javanbakht, Jim Pickett,
Marc-Andre LeBlanc, Pamina Gorbach
Background
 The acceptability of rectal microbicides formulated as
gels or lubricants (lubes) may be affected by other rectal
hygiene behaviors such as douching
 We examined lube use and sexual risk behaviors among
those who reported anal intercourse (AI), in order to
assess whether these practices differed by rectal
douching practice
Objectives
To determine:
 Are douchers more likely to use lube than nondouchers?
 Are douchers practicing more risky sexual behaviors
than non-douchers, and if so which behaviors?
 Are douchers at a higher risk for sexually transmitted
infections (STIs) than non-douchers?
Methods
 Anonymous web-based survey posted on IRMA’s website
 Distributed via listservs
 Respondents from August-October 2011
 >=18 yrs old
 AI in past 3 months
 Survey was available in English, Spanish, French,
Chinese, and Russian
Survey questions
 Demographics (age, gender, country)
 AI in past 3 months
 Douche in past 3 months
 Commercial/homemade product information
 Frequency of use and reasons for use
 Risk behaviors
 # and type of partners, drug use
 Frequency of condom and lube use for receptive AI
 STI history
Characteristics of survey respondents
 926 total responses
 Responses from 56 countries, majority from North
America (66%) or Europe (19%)
 82% male, 16% female and 2% transgender
 Mean age = 38 years (range 18-75)
 708 reported AI in the past 3 months and included in the
analysis
Sample characteristics, those reporting
AI (N=708)
Characteristic
Male
<30 years of age
USA
Canada
UK
Always used a condom during RAI
Lube use during RAI, past 3 months
Rectal douching, past 3 months
n
623
171
382
91
49
181
521
440
%
88
24
54
13
7
32
93
63
Characteristics of rectal douchers,
past 3 months (N=440)
Male
Always/almost always douched before RAI
Always/almost always douched after RAI
Always/almost always douched before AND
after RAI
Used a commercial product
Used a homemade product
n
414
280
47
44
%
94
75
35
21
128
324
35
74
Sexual risk behaviors and STI history by douching
status, among survey respondents reporting AI
6
5
5
4
3
2
Median
# sex
partners
2
1
0
Sex
partners**
*chi-square test, p<.01
**Wilcoxon rank-sum test, p<.01
Characteristics associated with report
of any rectal douching
Characteristic
Age
Number of sexual
partners
Lube use
Illicit drug use
Being HIV positive
Reported STI
Adjusted Odds
Ratio
1.06
1.02
95% Confidence
Interval
(1.03, 1.08)*
(1.00, 1.04)*
5.67
2.00
2.30
1.43
(2.31, 13.95)*
(1.29, 3.11)*
(1.33, 3.96)*
(0.77, 2.68)
*p<0.05
Conclusions
 Rectal douching was positively associated with lube use
regardless of age, number of sexual partners, illicit drug
use, STI history, and HIV status
 Rectal microbicides formulated as gels or lubes may be
an acceptable risk-reduction method for rectal douchers,
because lube use is already common practice
 Rectal douchers may be more likely than non-douchers
to benefit from lube-like microbicide intervention
 Future analyses will examine trends by region, gender,
partner type
How do you douche?
Or don't?
Visit www.rectalmicrobicides.org