1. Shauna Stahlman, Marjan Javanbakht, Jim Pickett, Marc-Andre LeBlanc, Pamina Gorbach Rectal douching and lubricant use among global web-survey respondents

2. Background The acceptability of rectal microbicides formulated as gels or lubricants (lubes) may be affected by other rectal hygiene behaviors such as douching We examined lube use and sexual risk behaviors among those who reported anal intercourse (AI), in order to assess whether these practices differed by rectal douching practice

3. Objectives To determine: Are douchers more likely to use lube than non- douchers? Are douchers practicing more risky sexual behaviors than non-douchers, and if so which behaviors? Are douchers at a higher risk for sexually transmitted infections (STIs) than non-douchers?

4. Methods Anonymous web-based survey posted on IRMA’s website Distributed via listservs Respondents from August-October 2011 >=18 yrs old AI in past 3 months Survey was available in English, Spanish, French, Chinese, and Russian

5. Survey questions Demographics (age, gender, country) AI in past 3 months Douche in past 3 months Commercial/homemade product information Frequency of use and reasons for use Risk behaviors # and type of partners, drug use Frequency of condom and lube use for receptive AI STI history

6. Characteristics of survey respondents 926 total responses Responses from 56 countries, majority from North America (66%) or Europe (19%) 82% male, 16% female and 2% transgender Mean age = 38 years (range 18-75) 708 reported AI in the past 3 months and included in the analysis

7. Sample characteristics, those reporting AI (N=708) Characteristicn% Male62388 <30 years of age17124 USA38254 Canada9113 UK497 Always used a condom during RAI18132 Lube use during RAI, past 3 months52193 Rectal douching, past 3 months44063

8. Characteristics of rectal douchers, past 3 months (N=440) n% Male41494 Always/almost always douched before RAI28075 Always/almost always douched after RAI4735 Always/almost always douched before AND after RAI 4421 Used a commercial product12835 Used a homemade product32474

9. Sexual risk behaviors and STI history by douching status, among survey respondents reporting AI *chi-square test, p<.01**Wilcoxon rank-sum test, p<.01

10. Characteristics associated with report of any rectal douching CharacteristicAdjusted Odds Ratio 95% Confidence Interval Age1.06(1.03, 1.08)* Number of sexual partners 1.02(1.00, 1.04)* Lube use5.67(2.31, 13.95)* Illicit drug use2.00(1.29, 3.11)* Being HIV positive2.30(1.33, 3.96)* Reported STI1.43(0.77, 2.68) *p<0.05

11. Conclusions Rectal douching was positively associated with lube use regardless of age, number of sexual partners, illicit drug use, STI history, and HIV status Rectal microbicides formulated as gels or lubes may be an acceptable risk-reduction method for rectal douchers, because lube use is already common practice Rectal douchers may be more likely than non-douchers to benefit from lube-like microbicide intervention Future analyses will examine trends by region, gender, partner type

12. How do you douche? Or don't? Visit www.rectalmicrobicides.org