Abstract
Unprotected sexual intercourse after undergoing voluntary medical male circumcision but prior to complete wound healing can lead to major adverse events including HIV acquisition. To better understand perceptions related to early resumption of sex prior to wound healing, 27 focus group discussions were conducted among 238 adult men, women, and community leaders in Botswana. Median age among all participants was 31 years of whom 60% were male and 51% were either employed and receiving salary or self-employed. Only 12% reported being currently married. Pain, not risk of HIV acquisition, was perceived as the main adverse consequence of early resumption of sex. In fact, no participant mentioned that early resumption of sex could lead to an increase in HIV risk. Demonstrating masculinity and virility, fear of losing female partners, and misperception about post-operative wound healing also played key roles in the decision to resume sex prior to complete wound healing. Findings from this study highlight a potentially widespread lack of awareness of the increased risk of HIV acquisition during the wound healing period. Strengthening post-operative counseling and identifying strategies to discourage the early resumption of sex will be increasingly important as older men and HIV-positive men seek voluntary medical male circumcision services.
Highlights
The World Health Organization (WHO) and the joint United Nations program on HIV/AIDS (UNAIDS) recommended voluntary medical male circumcision (VMMC) as an add-on strategy for HIV prevention in 2007 [1]. This recommendation was prompted by evidence from three randomized clinical trials demonstrating that VMMC reduces the risk of acquiring HIV infection by 51% to 60% among heterosexual men [2,3,4]
The study was conducted by the International Training and Education Center for Health (I-TECH), which is a collaboration between the University of Washington and University of California, San Francisco
Strategies to promote post-procedure abstinence shared by participants included educating women about the wound healing process, linking VMMC with female partners’ post-partum period, and encouraging infant male circumcision
Summary
The World Health Organization (WHO) and the joint United Nations program on HIV/AIDS (UNAIDS) recommended voluntary medical male circumcision (VMMC) as an add-on strategy for HIV prevention in 2007 [1] This recommendation was prompted by evidence from three randomized clinical trials demonstrating that VMMC reduces the risk of acquiring HIV infection by 51% to 60% among heterosexual men [2,3,4]. The intervention was unsuccessful at improving post-procedure abstinence, the authors were able to identify risk factors for early resumption of sexual activity They highlighted the need for in-depth qualitative studies to better understand the reasons for early resumption of sex [16], as have other studies [22]. We sought to better understand early resumption of sex following VMMC in Botswana
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