Resumen
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. (Extraído del documento)