Faculty of Population Health, Centre for Sexual Health and HIV Research, University College London, , London, UK.
Sex Transm Infect. 2014 Feb;90(1):33-5. doi: 10.1136/sextrans-2013-051154. Epub 2013 Aug 21.
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.
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.
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.
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.
虽然凝胶型直肠杀菌剂（RM）是第一批进入临床试验的药物，但在准备肛交时进行直肠冲洗是一种常见的做法；因此，作为冲洗剂配方的 RM 可能是凝胶的一种方便替代品。然而，人们对潜在使用者对冲洗剂配方 RM 或直肠冲洗实践的想法知之甚少，这些数据对于推进基于冲洗剂的 RM 非常重要。这项定性研究调查了男男性行为者和跨性别女性对冲洗剂、将其用作 RM 以及当前直肠冲洗实践的想法。
进行了 12 个焦点小组和 36 次深入访谈（N=140），以检查 RM 的总体可接受性，其中一个部分侧重于直肠冲洗。焦点小组和访谈进行了录音、逐字转录和编码；提取并分析了与直肠冲洗有关的文本。使用自我管理问卷收集社会人口统计学信息。
对冲洗剂配方 RM 的支持集中在联合性交前卫生和 HIV 保护的可能性上，并且人们认为，一种深入穿透的液体冲洗剂会比凝胶提供更大的 HIV 保护。缺点包括直肠干燥、不切实际和便携性问题，以及潜在的副作用。非商业性冲洗设备的使用很常见，使用的液体包括清洁剂、醋、漂白剂、柠檬汁和酒精。
虽然冲洗剂配方 RM 是可取的，并且被认为比凝胶配方 RM 更有效，但它也引发了关于实用性和副作用的问题。人们立即关注的是已经在使用的非商业性液体，这些液体可能会损害直肠上皮，从而增加 HIV 感染的风险。性交前直肠冲洗很常见，而且需要一种基于这种方法的 RM，但现在需要进行关于直肠冲洗实践的教育。
