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Correlates of Rectal Douching Practices Among Men Who Have Sex With Men in Kenya

Saleska, Jessica Londeree, MPH*; Turner, Abigail Norris, PhD; Syvertsen, Jennifer, PhD, MPH; Nakhumwa, Jesse, MBA-MIS§; Soo, Leonard, MPH; Ohaga, Spala, PhD§; Agot, Kawango, PhD, MPH§

doi: 10.1097/OLQ.0000000000000890

Background Among men who have sex with men (MSM), rectal douching (RD) has been associated with increased prevalence of human immunodeficiency virus and other sexually transmitted infections. Substances commonly used for RD, especially water-based solutions, could disrupt the rectal epithelium and increase susceptibility to infection. The few existing reports on RD among MSM are primarily in middle- and high-income settings, and to date, no study has focused on RD among MSM in Africa.

Methods We conducted a secondary data analysis of programmatic data from key population service centers in western Kenya. Data were extracted from records of clients who identified as MSM and accessed services between January 1, 2014, and September 1, 2016. We compared demographic and behavioral characteristics of men who did and did not practice RD. Logistic regression assessed associations with RD.

Results Of the 202 MSM in this analysis, 63% engaged in RD. All who engaged in RD used water-based substances. Those who engaged in receptive anal intercourse in the last 3 months were more likely to report RD (odds ratio, 3.19; 95% confidence interval, 1.67–6.07). Among MSM who engaged in sex work, those who practiced RD reported more regular clients per week (2.8 clients vs. 1.3 clients, P = 0.01). Rectal douching practices did not vary by other sexual risk practices.

Conclusions Rectal douching is common in this population of Kenyan MSM, especially among those who have recently engaged in receptive anal intercourse, suggesting that a rectal douche that delivers microbicides could be a potential intervention to reduce human immunodeficiency virus/sexually transmitted infection within this population.

A study of programmatic data on men who have sex with men in Kisumu, Kenya, found that those who practice rectal douching were more likely to engage in recent receptive anal intercourse.

From the *Division of Epidemiology, College of Public Health,

Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Ohio State University, Columbus, OH;

Department of Anthropology, University of California at Riverside, Riverside, CA;

§Impact Research and Development Organization, Kisumu; and

Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention (CDC), Nairobi, Kenya

Conflict of Interest: None declared.

Sources of Funding: This publication was made possible by support from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention (CDC) under the terms of the cooperative agreement 5U2GPS002777.

Correspondence: Jessica Londeree Saleska, MPH, Cunz Hall, 1841 Neil Ave, Columbus, OH 43210. E-mail:

Received for publication March 20, 2018, and accepted June 26, 2018.

© Copyright 2018 American Sexually Transmitted Diseases Association