1. HIV CENTER for Clinical and Behavioral Studies MAIN POINTS ACKNOWLEDGMENTS This research was supported by a NIMH grant (R01-69333; PI, Alex Carballo-Diéguez, Ph.D) and a NIMH center grant (P30-MH43520; PI: Anke A. Ehrhardt, Ph.D.). Dr. Bauermeister is supported by a NIMH training grant (T32-MH19139 Behavioral Sciences Research in HIV Infection; PI: Anke A. Ehrhardt, Ph.D.) RECTAL DOUCHES OR ENEMAS: IMPLICATIONS FOR RECTAL MICROBICIDES Alex Carballo-Diéguez, Ph.D., José A. Bauermeister, Ph.D., and Ana Ventuneac, M.A. HIV Center for Clinical and Behavioral Studies New York State Psychiatric Institute and Columbia University New York, NY, USA HIV CENTER for Clinical and Behavioral Studies It is clear that  2/3 of MSM who have unprotected receptive anal intercourse (URAI) douche prior to intercourse.  Number of douching occasions is associated with HIV-positive status, after controlling for number of URAI occasions and having at least one serodiscordant partner.  Given that douching is widely practiced and unlikely to be abandoned, there is a need to identify and popularize a harmless douche that could be used as a delivery vehicle for a rectal microbicide. METHODS  Population: Men in New York City, US, who seek other men for intentional unprotected receptive anal intercourse (URAI) were recruited exclusively over the Internet. Subsequently, they were interviewed in person at the research office.  Methods: We used CASI that included questions on sexual behavior and rectal douches or enema use.  Sample: N = 105 Two-thirds of our sample were racial/ethnic minorities. Participants had a mean age of 33 years, some college education (M = 14.77), and an average income of $27,000. Twenty-seven men (26%) reported being HIV-positive. RESULTS Douching Prevalence:  Two-thirds of respondents (64%) used rectal douches in preparation for sex.  A quarter of respondents used rectal douches after sex.  HIV-positive men (96%) were more likely to report douching before sex than HIV-negative men (53%). Being HIV-positive was associated with  Greater number of douching occasions in the past 6 months (OR = 3.00)  Greater number of URAI occasions in the past 2 months (OR = 4.48)  Having at least 1 serodiscordant partner in the past 2 months (OR = 2.33 ) CONCLUSIONS INTRODUCTION  Rectal douching prior to intercourse may have damaging effects on the rectal mucosa. This could confound or even cancel out the potentially protective effects of a rectal microbicide.  We sought to describe the prevalence of rectal douching among those men most likely to benefit from a future rectal microbicide: men who have intentional condomless anal sex with other men in risky circumstances (“barebacking”).  Douching behavior is highly popular among men at highest risk for HIV transmission. More research is needed on harmless douches.  MSM need further education about what types of enemas could potentiate HIV transmission and which may be harmless.  Given the popularity of rectal douching, if an effective microbicide could be delivered via a rectal enema, it might have high acceptability among men who engage in URAI. Drop your card here to receive the full report.