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PrEP You Don't Swallow: The Future of Anal HIV Prevention

HIV prevention only works when people at risk for contracting the disease use it.

It’s why Truvada as PrEP has become increasingly popular. Research has shown that many people, particularly gay and bisexual men, just don’t use condoms every time.

But whether it be cost-related or due to personal choice, not everyone wants to use PrEP as a daily pill either. With adherence to a once-daily pill being a concern for some, scientists have begun developing a long-lasting, injectable PrEP and even PrEP implants, although these are still years away from being available.

And now new research shows how PrEP may be attractive in another form – a PrEP enema.

Brandon Brown, an assistant professor at the University of California Riverside School of Medicine, and colleagues, reported in a paper published last week in the journal AIDS Behavior that about 18 percent of 415 men who have sex with men, and 68 transgender women, had douched before a sexual experience in the previous six months.

Related HIV Equal News: What Anal Microbicides could mean for HIV Prevention

While cleanliness when bottoming makes sense in theory, douches actually can increase your risk for HIV, even when done with plain tap water. The water damages the lining of the rectum, making you more susceptible to HIV and other sexually transmitted infections.

“A douche-based rectal microbicide that is safe and effective could play an important role by providing another HIV prevention option for these highly vulnerable groups,” Brown said in a news release. “In view of the expanding global HIV epidemic in MSM and TW, there is an urgent and immediate need for novel HIV prevention options, such as the douche-based rectal microbicides we propose, that can be readily incorporated into existing sexual practices.”

In their study among Peruvian men and transgender women, funded by Merck and the National Institutes of Health, Brown and colleagues make the case for developing a douche that would use rectal microbicides to protect against HIV.

“We found that men who douched prior to sex did it primarily for hygiene and pleasure,” Brown said. “We should capitalize on these reasons to increase this practice and eventually include a rectal microbicide for HIV prevention.”

Such microbicides already are in development and even have begun human clinical trials.

“Based on the findings from this study and previous studies on rectal microbicides, we need to learn more about the sexual practices and beliefs among diverse MSM and TW,” Brown said. “In the absence of the availability of oral antiretroviral pre-exposure prophylaxis or PrEP in Peru and globally, we need to explore additional venues for HIV prevention. Rectal microbicides are one possible cost-effective tool to prevent HIV.”