Rectal Use of Nonoxynol-9 Among Men Who Have Sex With Men
Nonoxynol-9 (N-9), a detergent ingredient previously thought to have microbicidal properties, is found in sexual lubricants, condoms, gels and other spermicidal products. Scientists have recently stated safety and efficacy concerns about N-9 for human sexual use, supported by studies that found N-9 was not protective against urogenital gonorrhea or chlamydia infection and causes rectal mucosa disruption in humans, which may increase risk for HIV infection during anal intercourse.
CDC, WHO and other agencies have issued several public health statements since 2000 indicating that N-9 is not protective against HIV and STD infection and may enhance transmission when used under certain conditions. The authors of the current study assessed recent rectal use of N-9 by men who have sex with men, awareness that N-9 may not be protective against HIV, intent to use N-9 in the future, and factors associated with intentions to use N-9.
Participants were recruited during Fall 2001 at multiple street locations and through community-based agencies in various sections of San Francisco and Oakland, Calif. Recruited men (n=1,528) were 18 years or older, lived or worked in the San Francisco Bay Area, and reported having sex with a man in the previous 12 months or self-identified as gay or bisexual. Men who were eligible and willing to participate (n=1,037) were scheduled for an interview at the Health Department or various community locations. Fifty-five percent (n=573) of eligible and initially willing participants completed the survey.
Participants were asked if they had heard of N-9. Men who responded affirmatively were asked questions about their perceptions and recent rectal use of N-9, motivations to use N-9 rectally because they thought it might be protective against HIV, intent to use N-9 rectally in the future, and having heard recently that N-9 may not be protective against HIV infection. Demographic and sexual behavior variables were also measured.
Sixty-one percent (n=349) of participants had heard of N-9. Latinos and men of unknown HIV serostatus were less likely to have heard of N-9; men who were HIV-positive or had higher educational attainment were more likely to have heard of N-9. Fifty-five percent of the 349 men aware of N-9 had heard in the previous year that it may not be protective against HIV.
The most commonly reported sources of information that N-9 may not be protective were newspapers (54 percent) and health agencies (50 percent), followed by magazines (37 percent) and friends (35 percent). Relatively few men reported that they received warnings about N-9 from the Internet (19 percent), product labels (17 percent), sexual partners (16 percent) or TV (15 percent).
Of men aware of N-9, 83 percent used it at some point, of which 67 percent knowingly used N-9 during anal intercourse in the previous year. Among men who knowingly used N-9 during anal intercourse in the past year, 41 percent did so without a condom because they believed or hoped it was protective.
"All MSM need to know about the dangers of using N-9 rectally," the authors wrote. "HIV care providers and prevention specialists should actively support public health warnings and disseminate information to reduce rectal use of N-9. Health officials should develop targeted educational campaigns to reduce consumer demand for N-9 products and increase demand for N-9-free lubricants and condoms among MSM. Culturally-sensitive campaigns in Spanish and English are needed. Agencies and communities should work together to remove N-9 from products, venues and websites that predominately serve MSM." In addition, the authors recommended, "Manufacturers should consider providing warning labels specific to rectal use on N-9 products as some have already done. Research is needed to better understand and intervene on unknowing use of N-9. Lastly, enhanced research is needed of other candidate HIV and STD mircobicides, including studies to ensure the safety and efficacy of products used for rectal application."