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Lu T, Mao X, Peng E, Gao Y, Chu Z, Dong W, Zhang W, Jiang YJ, Xu J. Association between rectal douching and HIV acquisition: the mediating role of condom use and rectal bleeding in a national online sample of Chinese men who have sex with men. Sex Transm Infect 2021; 97:69-74. [PMID: 32371429 PMCID: PMC7841489 DOI: 10.1136/sextrans-2019-054415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/30/2020] [Accepted: 04/14/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Previous studies have demonstrated that rectal douching (RD) is associated with HIV acquisition among men who have sex with men (MSM). However, the precise mechanism underlying the association between RD and HIV remains unclear. METHODS We recruited participants over WeChat from October 2017 to October 2018. Respondents received mailed HIV self-testing kits, uploaded images of HIV self-test results and completed an online electronic questionnaire simultaneously. The questionnaire assessed sociodemographic characteristics, RD practices and sexual risk behaviours. HIV status was measured as the result of the HIV self-testing. The Baron and Kenny statistical method was used to assess the association between RD and HIV, controlling for condomless anal intercourse (CAI) and rectal bleeding. RESULTS Of 1365 participants, 39.93% (545/1365) reported RD in the past 6 months, 60.07% had multiple male sexual partners and 43.08% had CAI in the past 6 months. The prevalence of HIV, based on self-testing, was 3.37% (46/1365). Multivariable logistic analysis showed RD was significantly associated with bottom sexual role (adjusted OR (aOR) 14.0; 95% CI 9.8 to 20.2), having multiple male sexual partners (aOR 1.8; 95% CI 1.4 to 2.2), CAI (aOR 1.3; 95% CI 1.0 to 1.6), rectal bleeding (aOR 2.0; 95% CI 1.6 to 2.6) and HIV infection (aOR 1.9; 95% CI 1.0 to 3.4). Baron and Kenny analysis found both CAI (aOR 2.2; 95% CI 1.2 to 4.1) and rectal bleeding (aOR 1.9; 95% CI 1.0 to 3.4) play a mediating role in the association between RD and HIV. CONCLUSIONS Our study results confirmed the relationship between RD and HIV, and found CAI and rectal bleeding mediated HIV infection in Chinese MSM who douched. Strategies should be encouraged to strengthen health education and reduce high-risk sexual behaviour in order to reduce the risk of HIV in MSM who use enemas. Rectal microbicides may represent an efficient means of providing HIV prophylaxis among MSM.
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Affiliation(s)
- Tianyi Lu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiang Mao
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Erlei Peng
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yangyang Gao
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhenxing Chu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Willa Dong
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Wenran Zhang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yong-Jun Jiang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Junjie Xu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
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Li P, Yuan T, Fitzpatrick T, Smith K, Zhao J, Wu G, Ouyang L, Wang Y, Zhang K, Zhou Y, Li M, Chen D, Li L, Cai W, Cai Y, Zou H. Association between rectal douching and HIV and other sexually transmitted infections among men who have sex with men: a systematic review and meta-analysis. Sex Transm Infect 2019; 95:428-436. [PMID: 31073094 DOI: 10.1136/sextrans-2019-053964] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/13/2019] [Accepted: 04/18/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are disproportionately affected by HIV and other STIs worldwide. Rectal douching, which is commonly used by MSM in preparation for anal sex, may increase the risk of HIV and other STIs by injuring the rectal mucosa. Results from individual studies reporting associations between rectal douching and HIV and other STIs among MSM are inconsistent. We performed a systematic review and meta-analysis to estimate the association between rectal douching and HIV and other STIs among MSM. METHODS We searched PubMed, Embase, Scopus and Web of Science for studies published from January 1970 to November 2018. Studies that reported ORs and 95% CIs of associations between rectal douching and infection with HIV/STIs, or reported enough data to calculate these estimates, were included. We assessed risk of bias using the Newcastle-Ottawa Scale. ORs were pooled using a random effects model. RESULTS Twenty-eight eligible studies were identified in our review, of which 24 (20 398 participants) were included in the meta-analysis. Rectal douching was associated with increased odds of infection with HIV (OR 2.80, 95% CI 2.32 to 3.39), and any STI other than HIV (including hepatitis B virus (HBV), hepatitis C virus (HCV), chlamydia, gonorrhoea, syphilis and human papillomavirus) (OR 2.46, 95% CI 1.95 to 3.11) among MSM. For specific STIs, douching was associated with increased odds of viral hepatitis (HBV, HCV) (OR 3.29, 95% CI 2.79 to 3.87), and chlamydia or gonorrhoea (OR 3.25, 95% CI 2.02 to 5.23). These associations remained significant in studies that adjusted for potential confounders. CONCLUSION Rectal douching may put MSM at increased risk for infection with HIV and other STIs. Longitudinal studies are needed to clarify this association, and health education materials should inform men of the potential for increased risk of infection with rectal douching.
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Affiliation(s)
- Peiyang Li
- School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Tanwei Yuan
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, Guangdong, China
| | | | - Kumi Smith
- School of Public Health, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Jin Zhao
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Guohui Wu
- Institute for AIDS/STD Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Lin Ouyang
- Institute for AIDS/STD Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Ying Wang
- School of Public Health, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Kechun Zhang
- Shenzhen Longhua District Center for Disease Control and Prevention, Shenzhen, China
| | - Yiguo Zhou
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Meijuan Li
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Dahui Chen
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Linghua Li
- Center for Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou, Guangdong, China
| | - Weiping Cai
- Center for Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou, Guangdong, China
| | - Yong Cai
- School of Public Health, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, Guangdong, China .,Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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Calabrese SK, Rosenberger JG, Schick VR, Novak DS, Reece M. An event-level comparison of risk-related sexual practices between black and other-race men who have sex with men: condoms, semen, lubricant, and rectal douching. AIDS Patient Care STDS 2013; 27:77-84. [PMID: 23373663 DOI: 10.1089/apc.2012.0355] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Black men who have sex with men (MSM) living in the U.S. are disproportionately affected by HIV/AIDS. An online survey of sexual behavior was completed by Black, White, Hispanic/Latino, Asian/Pacific Islander, and other-race MSM (n=11,766) ages 18-87 years. Complete condom use, semen exposure, pre-coital rectal douching (enema use), and lubricant use at last male-partnered sexual event were compared by race, controlling for relevant sociodemographic variables and stratifying by sexual position (receptive, insertive, or both). Across sexual positions, 55-62% of Black MSM reported condom use, 5-8% reported semen exposure, 18-53% reported douching, and 33-43% reported lubricant use. Reported behavioral profiles were not significantly different from other races, except that Black MSM reported greater condom use than White MSM in the insertive position. Although findings argue against disproportionate rates of risk behavior accounting for racial disparities in HIV prevalence, they nonetheless highlight a need for continued behavioral intervention.
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Affiliation(s)
- Sarah K. Calabrese
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
| | - Joshua G. Rosenberger
- Department of Global and Community Health, George Mason University, Fairfax, Virginia
| | - Vanessa R. Schick
- Center for Sexual Health Promotion, Indiana University, Bloomington, Indiana
| | - David S. Novak
- OLB Research Institute, Online Buddies, Inc., Cambridge, Massachusetts
| | - Michael Reece
- Center for Sexual Health Promotion, Indiana University, Bloomington, Indiana
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Reback CJ, Larkins S, Shoptaw S. Methamphetamine abuse as a barrier to HIV medication adherence among gay and bisexual men. AIDS Care 2004; 15:775-85. [PMID: 14617499 DOI: 10.1080/09540120310001618621] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Medication adherence among persons with HIV infection is important not only because of the effect of non-adherence on an individual's health but also because non-adherence can lead to medication-resistant viral strains. However, adherence to HIV medications is difficult due to complex dosing regimens and side effects. This paper is a qualitative analysis of HIV medication adherence among gay and bisexual methamphetamine-abusing men enrolled in an outpatient drug treatment research project. As part of an open-ended, semi-structured interview, 23 HIV-infected men discussed the effects of their methamphetamine use on their medication adherence. Substance-use barriers to adherence were coded into two main themes: (1) planned non-adherence and (2) unplanned non-adherence. Planned non-adherence was a strategy for coping with demanding HIV medication schedules, or was linked to sexual behaviours while using methamphetamine or to fears of interaction effects from mixing methamphetamine with HIV medications. Participants did not define their medication regimen adjustments as non-adherence but as a way to achieve a sense of control over their lives. Unplanned non-adherence was linked to methamphetamine-related disruptions in food and sleep schedules. Findings are helpful in designing culturally specific HIV medication adherence interventions for this population.
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Affiliation(s)
- C J Reback
- Friends Research Institute, Los Angeles, CA 90025, USA.
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Abstract
Individuals who use illicit stimulants, primarily cocaine and methamphetamine, engage in substantial amounts of HIV-related sexual risk behaviors when under the influence. This paper presents the idea that reductions in stimulant use consequent to drug treatment makes stimulant drug treatment an important HIV prevention tool for this high-risk population. Data are presented to describe many of the HIV-related sexual risks reported by out-of-treatment methamphetamine users and by cocaine and methamphetamine abusers at treatment entry and six months post treatment entry. Overall, our findings demonstrate that following initiation of a treatment episode, stimulant abusers demonstrate significant and relevant reductions in HIV-related sexual behaviors, primarily by reducing the number of sexual partners. Reasons for why stimulant treatment corresponds to HIV transmission risk reductions and suggestions for implementing prevention messages in treatment settings are offered.
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Affiliation(s)
- S Shoptaw
- Matrix Center, Friends Research Institute, Inc., Los Angeles, CA 90025, USA
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Flowers P, Sheeran P, Beail N, Smith JA. The role of psychosocial factors in hiv risk-reduction among gay and bisexual men: A quantitative review. Psychol Health 1997. [DOI: 10.1080/08870449708407400] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sowell RL, Seals BF, Cooper JA. HIV transmission knowledge and risk behaviors of persons with HIV infection. AIDS Patient Care STDS 1996; 10:111-5. [PMID: 11361687 DOI: 10.1089/apc.1996.10.111] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R L Sowell
- College of Nursing, University of South Carolina, Columbia, USA
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Joesoef MR, Sumampouw H, Linnan M, Schmid S, Idajadi A, St Louis ME. Douching and sexually transmitted diseases in pregnant women in Surabaya, Indonesia. Am J Obstet Gynecol 1996; 174:115-9. [PMID: 8571993 DOI: 10.1016/s0002-9378(96)70382-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Our purpose was to investigate the association between douching (douching agents and timing) and sexually transmitted disease. STUDY DESIGN A cross-sectional survey of sexually transmitted diseases and habits of vaginal douching was performed on 599 pregnant women who visited a prenatal clinic in Surabaya, Indonesia. RESULTS Of the 599 pregnant women, 115 (19.2%) had at least one sexually transmitted disease (gonorrhea, chlamydia, syphilis, trichomoniasis, or herpes simplex virus-2). Most women had douched with water (19%) or water and soap (63%) at least once in the preceding month. Approximately 10% of the women had douched in the preceding month with a commercial agent (2%) or betel leaf (8%). Douching with water alone after sex was not associated with sexually transmitted disease. Douching with water and soap or with a betel leaf or commercial agent after sex was associated with sexually transmitted disease; adjusted odds ratios were 2.6 (95% confidence interval 1.0 to 7.1) and 2.7 (95% confidence interval 0.5 to 14.5), respectively. The association was enhanced if the women douched before sex or both before and after sex; adjusted odds ratio were 2.7 (95% confidence interval 1.0 to 7.3) for douching with water and soap and 5.2 (95% confidence interval 1.6 to 16.7) for douching with betel leaf or a commercial agent. Compared with women who never douched, women who always douched with betel leaf or a commercial agent had a substantially increased risk for sexually transmitted disease (adjusted odds ratio 9.4, 95% confidence interval 1.8 to 50.3). CONCLUSIONS We found a significant association between sexually transmitted disease and douching habits (douching with betel leaf, commercial agents, or water and soap). However, further prospective investigations are needed to evaluate the temporal relationship between douching and sexually transmitted disease.
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Affiliation(s)
- M R Joesoef
- Division of Sexually-Transmitted Disease/Human Immunodeficiency Virus Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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