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Prevalence and Types of Rectal Douches Used for Anal Intercourse Among Men Who Have Sex with Men in Brazil

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Prevalence and Types of Rectal Douches Used for Anal Intercourse Among Men Who Have Sex with Men in Brazil Open Access Research BMJ Open: first published as 10.1136/bmjopen-2016-011122 on 29 May 2017. Downloaded from Prevalence and types of rectal douches used for anal intercourse among men who have sex with men in Brazil Luiz Carlos Ribeiro Lamblet,1 Roberto José Carvalho da Silva2 To cite: Lamblet LCR, da ABSTRACT Strengths and limitations of this study Silva RJC. Prevalence and Introduction Rectal douching (RD) is practised among types of rectal douches used men who have sex with men (MSM), and various products for anal intercourse among ► Pioneering study in Brazil. and materials are used. There have been no studies in men who have sex with ► Basis for discussion of the issue in the country. Brazil on this practice and its risks in the transmission of men in Brazil. BMJ Open ► Unrepresentative sample of men who have sex with 2017;7:e011122. doi:10.1136/ sexually transmitted infections and HIV. men. bmjopen-2016-011122 Method Between June and August 2015, 401 MSM over the age of 18 were interviewed about their sexual ► Prepublication history and additional material are available. practices associated with RD over the last 3 months. RD group. Studies conducted between 2009 and To view these files please visit was associated with the reported sexual behaviour, and 2013 in Brazil in the MSM population show descriptive statistical analyses were conducted on the the journal online (http:// dx. doi. an HIV prevalence rate of 10.5%.7 8 One of org/ 10. 1136/ bmjopen- 2016- same. the main avenues of the spread of HIV among 011122). Results Among the respondents, 85.6% identified 9 themselves as men and 14.4% as transgender; 255 MSM is receptive anal intercourse (RAI). declared themselves to be white (63.6%) and 104 to be The proportion of cases among this group Received 13 January 2016 mixed (25.9%). From among those who had performed has tended to increase over the last 10 years, Revised 14 August 2016 7 Accepted 1 September 2016 anal sex within the last 3 months (n=369), 197 reported from 34.6% in 2004 to 43.2% in 2013. Social, having used RD (53.4%). The most commonly used biological, behavioural and epidemiological material was a shower hose (84.5%) and the main product studies are needed to understand social and used was water (93%). Of those interviewed, 94.5% never sexual practices among the MSM population received guidelines from health professionals on this and therefore trace new preventive strate- practice and its potential risks. Receptive anal intercourse 5 9–11 gies due to risks related to anal sex. This http://bmjopen.bmj.com/ and RD were found to be associated (p<0.001). study aims to determine the prevalence of Conclusions RD is a common practice among the MSM population. Health professionals must deepen their RD among MSM and to establish the main knowledge of this. We propose studies in Brazil on the substances and materials associated with this practice of RD that—from that knowledge strategies for practice. prevention and harm reduction—can be incorporated to the vulnerable populations. METHOD Study site The study was conducted after being autho- on October 2, 2021 by guest. Protected copyright. INTRODUCTION rised by Report n° 1 100 371 (Certificate of Rectal douching (RD) is commonly Presentation for Ethical Consideration). performed before anal intercourse among n° 45107215.7.0000.5375) by the ethics 1–3 men who have sex with men (MSM). and research committee of the Reference Several commercial and non-commercial and Training Centre (CRT/AIDS). The study devices, such as shower hoses, plastic bottles was conducted in three different clinics of the 4 and syringes, are used. Tap water and home- CRT/AIDS: the transgender clinic; the clinic made solutions are most commonly used in for monitoring patients with HIV/AIDS and RD. The primary reason for this practice is to the serological testing and counselling clinic. clean the rectal cavity and therefore increase 5 6 1Regional Council of Nursing, pleasure during sex. However, this practice Study population and inclusion criteria São Paulo, Brazil can alter anal tissues and is associated with The study included a population of MSM 2Reference and Training Center risky behaviour that may facilitate the trans- from CRT/AIDS regardless of serological (CRT/AIDS), São Paulo, Brazil mission of sexually transmitted infections HIV status and of 18 years of age or older. 1–4 6 Correspondence to (STIs) and the HIV. HIV prevalence in Respondents were included in the survey Dr Luiz Carlos Ribeiro Lamblet; Brazil is estimated to be 0.4% in the general after voluntarily agreeing to participate in the luizlamblet7@ gmail. com population and 0.6% in the 15–49 years age study during a visit to the above-mentioned Lamblet LCR, da Silva RJC. BMJ Open 2017;7:e011122. doi:10.1136/bmjopen-2016-011122 1 Open Access BMJ Open: first published as 10.1136/bmjopen-2016-011122 on 29 May 2017. Downloaded from Table 1 Gender identity, age, race/colour, education, necessary information about the aim of the study and monthly income, STI, drug abuse and anal sexual signed the Terms of Clarification and Freely Consenting intercourse among MSM (n=369) (TFCC). After receiving a copy of the TFCC, participants answered a digital questionnaire using a laptop. Partic- n=369 % ipants who had difficulty completing the questionnaire Gender identity digitally were assisted by a field researcher to use the Man 316 85.6 computer. Transgender 53 14.4 Data collection period Age (in years) Data were collected between 20 June and 20 August 2015. 18–29 175 47.4 30–39 129 35.0 Research tools 40–49 51 13.8 The questionnaire addressed epidemiological issues (sex, age, race, origin and residence), sexual orienta- 50–59 12 3.3 tion and sexual practices (frequency and partners) and 60–66 2 0.5 the use of commercial and non-commercial products Colour/race declared when performing RD (types of products used, frequency White 236 64.0 of these practices and risk behaviours). The questions Mixed 95 25.8 addressed practices during the last 3 months and the last month before the interview, for better time reliability. Black 24 6.5 After being adjusted, the questionnaire was formatted in Other 14 3.8 the free application Google Docs and tested in a pre-test. Formal education Middle school finished/unfinished 29 7.9 Pre-test High school finished/unfinished 86 23.3 The researchers used five questionnaires to test under- standing of the content and to carry out adjustments to Under graduate student (complete/ 254 68.8 the instrument. These questionnaires were not included incomplete)/graduated in the study. Total monthly income BRL 0–2000 175 47.4 Sample design and sample size BRL 2001–4000 117 31.7 The methodology used to calculate the sample came from a convenience sample, considering a CI of 95% BRL over 4000 77 20.9 and a maximum sampling error of 5% and an estimated http://bmjopen.bmj.com/ STI over the last 12 months prevalence of RD use of 50%. For these calculations, the No 234 63.4 minimum sample should include 391 participants. The 12 Yes 134 36.3 present study had 401 participants. I don't know 1 0.3 Statistical treatment of the sample Drug use during intercourse—last Respondents were classified into two groups: those who 12 months use and those who do not use RD. Initially, the descriptive Yes 186 50.4 analysis of these two groups was conducted considering No 183 49.6 social and demographic variables. The following analysis on October 2, 2021 by guest. Protected copyright. Anal intercourse was performed considering the variables for those in the Insertive anal intercourse only 79 21.4 group who performed RD. The categorical variables were tested with the χ2 test or Fisher’s exact test. The OR and RAI only 86 23.3 the respective CIs were estimated. The tests used were RAI and insertive 204 55.3 bi-flow rates and the level of significance was p<0.05. MSM, men who have sex with men; RAI, receptive anal intercourse; STI, sexually transmitted infection. RESULTS Of the research participants, 369 (92%) had anal inter- clinics to receive treatment or guidelines or to be tested course in the past 3 months (table 1). Among these, 86 for STI/HIV. reported to have performed RAI and 50.9% responded having had RAI and insertive intercourse. Among MSM Participant recruitment for the study who had had anal intercourse within the last 3 months, Participants were recruited by researchers trained in 314 resided in the State of São Paulo (85.1%), 85.6% advance. After agreeing to participate in the study, partic- identified themselves as men and 14.4% as transgender. ipants were taken into a room specifically set aside for Among these, 236 declared themselves to be white (64%) this study at each of the clinics. There, they received all and 104 declared themselves to be mixed (25.8%). 2 Lamblet LCR, da Silva RJC. BMJ Open 2017;7:e011122. doi:10.1136/bmjopen-2016-011122 Open Access BMJ Open: first published as 10.1136/bmjopen-2016-011122 on 29 May 2017. Downloaded from Table 2 Rectal douching (RD) use in the last 3 months: Table 3 Reasons for the practice of rectal douching solutions, products and equipment (RD) and difficulties associated with RD before and after % receptive anal intercourse in the last 3 months (n=197)* n % RD (n=369) Yes 197 53.4 Reason—RD always BEFORE No 172 46.6 Cleaning/hygiene 84 42.6 Home-made products (n=181)* Mor e pleasurable anal intercourse 34 17.2 Water + soap 33 18.2 It is a preference of the partner 6 3.0 Water only 181 100.0 Constipation 1 0.5 Commercial products and solutions (n=52) Reason—RD sometimes or never BEFORE Fosfoenema 19 36.54 Unnecessary 69 35.0 In-M 7 13.46 Do not like it 53 26.9 Minilax 3 5.77 Unplanned sexual encounter 46 23.4 I don't remember 5 9.62 Did not have time 43 21.8 Intimate liquid soap 3 5.77 Have no information on RD 6 3.0 Glycerin suppository 2 3.85 Think it is unhealthy 1 0.5 Disposable Kit purchased at pharmacy 13 25.00 Reason—RD always AFTER or store Cleaning/hygiene 21 10.7 Home-made equipment used (n=232)* Partner did not use condom 7 3.6 Shower hose, bidet or sink 199 85.78 Pr evious RD was not adequate 1 0.5 Plastic water pump 22 9.48 Reason—RD sometimes or never AFTER Plastic bottle 11 4.74 Unnecessary 153 77.7 *Multiple choice.
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