Early resumption of sexual activity following voluntary medical male circumcision in Botswana: A qualitative study

Ledikwe, Jenny H.; Ramabu, Nankie M.; Spees, Lisa P.; Barnhart, Scott; Ntsuape, Conrad; Semo, Bazghina-werq; Wirth, Kathleen E.

doi:10.1371/journal.pone.0186831

Cited by 8 publications

(6 citation statements)

References 28 publications

(43 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, a significant proportion of the women in this study did not have adequate knowledge of the six weeks of wound healing after VMMC. This is in agreement with findings from a study conducted in Botswana [37]. Such inadequate knowledge may facilitate early resumption of sex [37,38], thus creating an opportunity for increased risk of transmission of HIV infection.…”

Section: Discussionsupporting

confidence: 90%

Women’s support for voluntary medical male circumcision in fishing communities on the shores of Lake Victoria, Uganda

Byaruhanga

Mbona

Babirye

et al. 2022

BMC Health Serv Res

View full text Add to dashboard Cite

Background Women’s support can improve uptake of voluntary medical male circumcision (VMMC). We assessed the level of women’s support for VMMC and associated factors in fishing settlements on the shores of Lake Victoria in Uganda, to inform interventions aimed at increasing the uptake of safe male circumcision services in such high-risk populations. Methods We conducted a cross-sectional study, employing mixed methods of data collection, at Kasenyi and Kigungu landing sites in April 2018. We included women aged 18–49 years, who had stayed at the landing sites for ≥3 months. We obtained qualitative data using focus group discussions (FGDs), and interviewer-administered semi-structured questionnaires for quantitative data. The tool captured demographic characteristics, community factors including cultural norms and beliefs, women’s experiences, and health facility-related factors. The dependent variable was derived from the response to the question: "Would you encourage your partner/husband to go for VMMC?", and used as a proxy for support of VMMC. We used modified Poisson regression to identify factors associated with women’s support for VMMC. Qualitative data were analysed using thematic content analysis. Results We enrolled 313 women with a mean age of 28 (SD±6.8) years. Of the 313 women, 230 (73.5%) supported VMMC. Belief that VMMC increases penile hygiene (Adjusted prevalence ratio [aPR]=1.9; CI: 1.8–3.2), performing VMMC for religious reasons (aPR=1.9; CI: 1.8–2.9), preference for a circumcised man (aPR=1.3; CI: 1.2–1.5), belief that vaginal fluids facilitate wound healing (aPR=1.9; CI: 1.3–2.7), and knowledge about when a man can resume sex (4 weeks) after circumcision (aPR=2.1; CI: 1.8–3.3) were associated with women’s support for VMMC. FGDs revealed that women were not adequately involved in VMMC activities for decision making. Conclusion The support for VMMC was high among women in the fishing communities. However, women perceived they were not involved in decision-making for VMMC and had several misconceptions, including a belief that vaginal fluids facilitate wound healing. The Ministry of Health and VMMC implementing partners should devise strategies to increase sensitization and involvement of women in VMMC decision-making without slowing service uptake.

show abstract

Section: Discussionsupporting

confidence: 90%

Women’s support for voluntary medical male circumcision in fishing communities on the shores of Lake Victoria, Uganda

Byaruhanga

Mbona

Babirye

et al. 2022

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…21 In a prior qualitative study, we found a lack of awareness of the increased risk of HIV acquisition during the wound healing period among Batswana men. 34 In our current study, nearly half of men reported HIV prevention as the primary reason for undergoing VMMC. Future intervention studies aiming to promote post-VMMC abstinence should emphasis HIV prevention messaging during wound healing and incorporate qualitative findings about how norms and attitudes drive men’s health promoting HIV preventative behaviors.…”

Section: Discussionmentioning

confidence: 56%

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

et al. 2019

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…Our findings are similar to those of a study on AE patterns in Zimbabwe’s VMMC program, which found infections were more frequent in clients aged 10–14 years while bleeding was more frequent in clients aged ≥20 years [ 28 ]. More frequent bleeding in older clients could be related to increased vascularity of the penile skin, or to early resumption of sex following VMMC, which increases the risk of AEs [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Adverse event profile and associated factors following surgical voluntary medical male circumcision in two regions of Namibia, 2015–2018

et al. 2021

Self Cite

View full text Add to dashboard Cite

Introduction Monitoring clinical safety of voluntary medical male circumcision (VMMC) is critical to minimize risk as VMMC programs for HIV prevention are scaled. This cross-sectional analysis describes the adverse event (AE) profile of a large-scale, routine VMMC program and identifies factors associated with the development, severity, and timing of AEs to provide recommendations for program quality improvement. Materials and methods From 2015–2018 there were 28,990 circumcisions performed in International Training and Education Center for Health (I-TECH) supported regions of Namibia in collaboration with the Ministry of Health and Social Services. Two routine follow-up visits after VMMC were scheduled to identify clients with AEs. Summary statistics were used to describe characteristics of all VMMC clients and the subset who experienced an AE. We used chi-square tests to evaluate associations between AE timing, patient age, and other patient and AE characteristics. We used a logistic regression model to explore associations between patient characteristics and AE severity. Results Of the 498 clients with AEs (AE rate of 1.7%), 40 (8%) occurred ≤2 days, 262 (53%) occurred 3–7 days, 161 (32%) between day 8 and 14, and 35 (7%) were ≥15 days post-VMMC. Early AEs (on or before day 2) tended to be severe and categorized as bleeding, while infections were the most common AEs occurring later (p<0.001). Younger clients (aged 10–14 years) experienced more infections, whereas older clients experienced more bleeding (p<0.001). Conclusions Almost 40% of AEs occurred after the second follow-up visit, of which 179 (91%) were infections. Improvements in pre-surgical and post-surgical counselling and post-operative educational materials encouraging clients to seek care at any time, adoption of alternative follow-up methods, and the addition of a third follow-up visit may improve outcomes for patients. Enhancing post-surgical counselling and emphasizing wound care for younger VMMC clients and their caregivers could help mitigate elevated risk of infection.

show abstract

Early resumption of sexual activity following voluntary medical male circumcision in Botswana: A qualitative study

Cited by 8 publications

References 28 publications

Women’s support for voluntary medical male circumcision in fishing communities on the shores of Lake Victoria, Uganda

Women’s support for voluntary medical male circumcision in fishing communities on the shores of Lake Victoria, Uganda

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

Adverse event profile and associated factors following surgical voluntary medical male circumcision in two regions of Namibia, 2015–2018

Contact Info

Product

Resources

About