"Now that you are circumcised, you cannot have first sex with your wife": post circumcision sexual behaviours and beliefs among men in Wakiso district, Uganda.

Simon Peter Sebina Kibira,Ingvild Fossgard Sandøy,Lynn Muhimbuura Atuyambe,Marguerite Daniel,Fredrick Edward Makumbi

doi:10.7448/ias.20.1.21498

Simon Peter Sebina Kibira, Ingvild Fossgard Sandøy + Show 3 more

Open Access

https://doi.org/10.7448/ias.20.1.21498

Copy DOI

Abstract

Introduction: Safe male circumcision is an important biomedical intervention in the comprehensive HIV prevention programmes implemented in 14 sub-Saharan African countries with high HIV prevalence. To sustain its partial protective benefit, it is important that perceived reduced HIV risk does not lead to behavioural risk compensation among circumcised men and their sexual partners. This study explored beliefs that may influence post circumcision sexual behaviours among circumcised men in a programme setting.Methods: Forty-eight in-depth interviews were conducted with newly circumcised men in Wakiso district, central Uganda. Twenty-five men seeking circumcision services at public health facilities in the district were recruited from May to June 2015 and, interviewed at baseline and after 6 months. Participants’ beliefs and sexual behaviours were compared just after circumcision and at follow up to explore changes. Data were managed using atlas.ti7 and analysed following a thematic network analysis framework.Results: Four themes following safe male circumcision emerged from this study. Beliefs related to: (1) sexual cleansing, (2) healing, (3) post SMC sexual capabilities and (4) continued HIV transmission risk. Most men maintained or adopted safer sexual behaviour; being faithful to their partner after circumcision or using condoms with extramarital partners following the knowledge that there was continued HIV risk post circumcision. The most prevalent risky belief was regarding sexual cleansing post circumcision, and as a result of this belief, some men had one off condom-less sexual intercourse with a casual partner. Some resumed sex before the recommended period due to misunderstanding of what comprised healing.Conclusions: Although most men maintained or adopted safer sexual behaviour, there were instances of risky sexual behaviour resulting from beliefs regarding the first sexual intercourse after circumcision or misunderstandings of what comprised wound healing. If not addressed, these may attenuate the safe male circumcision benefits of risk reduction for HIV.

Highlights

Safe male circumcision is an important biomedical intervention in the comprehensive HIV prevention programmes implemented in 14 sub-Saharan African countries with high HIV prevalence
More sexual partners [2] were reported in the South African trial among the circumcised than the uncircumcised men
The findings show that some beliefs around circumcision could contribute to sexual risk behaviour

Summary

Introduction

Safe male circumcision is an important biomedical intervention in the comprehensive HIV prevention programmes implemented in 14 sub-Saharan African countries with high HIV prevalence. Conclusions: most men maintained or adopted safer sexual behaviour, there were instances of risky sexual behaviour resulting from beliefs regarding the first sexual intercourse after circumcision or misunderstandings of what comprised wound healing. If not addressed, these may attenuate the safe male circumcision benefits of risk reduction for HIV. In a programme setting in Kisumu, Kenya, Westercamp and colleagues observed no evidence of risk compensation [10] They instead found that both circumcised and uncircumcised men exposed to the SMC programme and information messages, respectively, adopted safer sexual behaviours. But contexts may be different [10]

Objectives

Methods

Results

Discussion

Conclusion