“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

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.

Patterns of sexual behaviors and related factors among prisoners in Iran: results from a national survey in 2015

“…In our study, having a higher level of education was a risk factor for unsafe sex. Inconsistent with our results, some studies with non-prisoners indicate that a low level of education is a significant risk factor for high-risk sexual behaviors (Kibira et al, 2017;Taffa, 1998). Hence, it appears that sexual behaviors among highly educated prisoners are different from those among the general population.…”

Association between medical male circumcision and HIV risk compensation among heterosexual men: a systematic review and meta-analysis

“…60 Findings from this meta-analysis are largely consistent with previous qualitative research on the same topic, with most men reporting that they adopt protective sexual behaviours (increase condom use or reduce the number of sexual partners) or maintained protective sexual behaviours after circumcision. [61][62][63][64][65] However, some studies reported that circumcised men increased higherrisk sexual behaviours after circumcision because they falsely believed that MMC could offer complete protection from HIV infection, 16,66,67 and one study from Zambia reported that about 30-40% of women incorrectly believed MMC fully protects men from getting HIV. 68 In addition, some studies found that men were more likely to report higher-risk sexual behaviours after MMC or report false belief regarding the protective effect provided by circumcision if they had low levels of education, were married, had alcoholism, or had misconceptions regarding antiretroviral therapy; religious beliefs might also affect risk behaviour after MMC.…”

A review of public health, social and ethical implications of voluntary medical male circumcision programs for HIV prevention in sub-Saharan Africa

“…Added to this, smaller, qualitative, and survey-based studies provide greater context for how changes in behavior and attitudes post-medical male circumcision may affect risk behaviors [ 63 ]. For example, one study reported men engaging in unprotected sex too soon after VMMC due to cultural beliefs concerning sexual cleansing and/or misunderstandings related to what it meant to be fully healed [ 43 ]. Worryingly, a cross-sectional survey study conducted in Botswana, Namibia, and Swaziland found that 13% of young men and 10% of young women incorrectly believed that circumcision provides men with 100% protection from HIV [ 64 ].…”