Early resumption of sex after voluntary medical male circumcision for HIV prevention within a programmatic delivery setting in Botswana

Abstract

To maximize the public health benefits of voluntary medical male circumcision (VMMC) in real-world settings, sexual abstinence is recommended for six weeks following VMMC to ensure complete wound healing. We determined the frequency and predictors of early resumption of sex among a cohort of HIV-negative, sexually active men 18–49 years who underwent VMMC within a public-sector clinic in Botswana. Multivariate robust Poisson regression methods were used to identify predictors of having any sexual intercourse in the last six weeks since undergoing VMMC. In total, 433/519 (83%) men had data available on sexual activity at six weeks post-VMMC. Median age was 27 years, 57% had a higher than secondary education, 72% were employed, and 9% were married. Overall, 122/433 (28%) men had sexual intercourse within the six weeks since VMMC, of whom 36% reported inconsistent condom use. Compared to men ≥34 years, men aged <30 years (adjusted risk ratio [aRR] = 1.71, 95% CI 0.95–3.08) and men 30–34 years had a two-fold higher likelihood of resuming sexual activity early in multivariate analyses (aRR = 2.31, 95% CI 1.26–4.25, Wald p = 0.018). Employed men were more likely to resume sexual activity early than unemployed men (aRR = 1.58, 95% CI 1.02–2.44, p = 0.039). Additional interventions are needed to encourage abstinence until complete wound healing.

Sexual function after voluntary medical male circumcision for human immunodeficiency virus prevention: Results from a programmatic delivery setting in Botswana

“…We previously assessed the frequency of adverse events at 7 days and early resumption of sexual intercourse amongst a cohort of adult men who underwent VMMC within a programmatic delivery setting in Botswana. 19,20 This current analysis examines the post-VMMC experience at 3 months, including sexual function and satisfaction with the procedure. Given the suboptimal uptake of VMMC in Botswana and the concerns of its potentially negative impact on sexual function identified in qualitative studies, 21,22 these new data could provide valuable evidence for VMMC demand-creation messaging in Botswana.…”