Abstract
BackgroundUptake of voluntary medical male circumcision (VMMC) remains modest in Botswana in spite of the government’s commitment and service provision availability. Data on sexual function post-VMMC in programmatic settings could help guide messaging tailored to Botswana.ObjectivesAt 3-month post-VMMC, we evaluated changes in sexual function and satisfaction with the VMMC procedure amongst a cohort of HIV-negative, sexually active men aged 18–49 years who underwent VMMC in a public-sector clinic in Botswana.MethodsWe assessed whether each of the following domains of sexual function had improved, stayed the same or worsened since VMMC: sexual desire, ability to use condoms, ease of vaginal penetration, ease of ejaculation, ability to achieve and maintain an erection and hygiene or cleanliness.ResultsData on sexual function were available for 378 men at 3-month post-VMMC. Median age was 27 years – 54% had a higher than secondary education, 72% were employed and 27% were married. Nearly all (96%) the men reported improvement in at least one domain of sexual function, while 19% reported improvement in all six domains. One-fourth (91/378, 24%) of the men reported that at least one domain of sexual function worsened post-VMMC. The most frequently reported domain that worsened was sexual desire (11%); in all other domains, < 10% of the men reported worsening. Men who reported any worsening sexual function were 2.3-fold as likely to be less than ‘very satisfied’ with the VMMC procedure (risk ratio 2.36, 95% confidence interval [CI] 1.66–3.34, p < 0.001).ConclusionEmphasising improved sexual function experienced after VMMC in demand-creation efforts could potentially increase VMMC uptake in Botswana.
Highlights
More than 18.6 million men have been circumcised through voluntary medical male circumcision (VMMC) programmes in 14 priority African countries to date, averting an estimated 230,000 new human immunodeficiency virus (HIV) infections by 2017.4,5,6,7,8 Achieving the global target of 27 million more VMMC procedures by 2021, translating to 90% of males aged 10–29 years being circumcised in priority countries, will depend in part on the continued acceptability of VMMC amongst target populations.[3]
Similar to prior studies that evaluated sexual function preand post-circumcision amongst African men,[15,18] we found that the majority of the men reported improvement in some domains of sexual function after undergoing VMMC in Botswana
Demand-creation messaging for VMMC in Botswana has primarily focussed on HIV prevention
Summary
Continued promotion of voluntary medical male circumcision (VMMC) programmes in countries with high human immunodeficiency virus (HIV) burden and low male circumcision rates is needed to decrease population-level HIV incidences.[1,2,3] More than 18.6 million men have been circumcised through VMMC programmes in 14 priority African countries to date, averting an estimated 230,000 new HIV infections by 2017.4,5,6,7,8 Achieving the global target of 27 million more VMMC procedures by 2021, translating to 90% of males aged 10–29 years being circumcised in priority countries, will depend in part on the continued acceptability of VMMC amongst target populations.[3] Uptake of VMMC began slowly in Botswana[9] and has remained modest in spite of government commitment, donor support and availability of service provision of VMMC since 2009. Data on sexual function post-VMMC in programmatic settings could help guide messaging tailored to Botswana
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