Advertisement

AIDS and Behavior

, Volume 16, Issue 5, pp 1173–1181 | Cite as

Factors Associated with the Early Resumption of Sexual Activity Following Medical Male Circumcision in Nyanza Province, Kenya

  • Amy Herman-RoloffEmail author
  • Robert C. Bailey
  • Kawango Agot
Original Paper

Abstract

Research has established that voluntary medical male circumcision (VMMC) reduces HIV acquisition in heterosexual men by approximately 60%; however, engaging in sexual activity before the wound is healed may attenuate this protective effect. This prospective study included VMMC clients who were circumcised in Kenya between November, 2008 and March, 2010, aged ≥18 years, and randomly selected for an interview and genital examination 28–45 days post-VMMC (N = 1,344). At the time of the interview, 91.3% participants were healed. Overall, 30.7% reported engaging in early sexual activity, usually 3–4 weeks post-VMMC. In a multivariable analysis, being married or cohabitating was the strongest predictor of engaging in early sexual activity. Strategies to reduce engaging in sexual activity during the recommended 42-day abstinence period following VMMC should be explored including re-energizing the effort to include female partners in counseling, mass education campaigns, and targeted text messaging programs for VMMC clients.

Keywords

HIV Voluntary medical male circumcision Sexual intercourse Wound healing Kenya 

Notes

Acknowledgments

Support for this study was provided by a grant to FHI from the Bill & Melinda Gates Foundation to support the Male Circumcision Consortium (MCC), a partnership between FHI, University of Illinois at Chicago working closely with the Nyanza Reproductive Health Society (NRHS), and Engender Health. The views expressed in this publication do not necessarily reflect those of the Bill & Melinda Gates Foundation or the MCC partners. We thank the Government of Kenya and the participants in the study without whom this work would not be possible. We also thank Nixon Otieno, Nelli Westercamp, Deborah Rosenberg, Mark Dworkin, Tim Johnson, Joan Kennelly, the late Jekoniah Ndinya-Achola, and NRHS staff and study research assistants for their commitment to the study and helpful feedback on this manuscript.

References

  1. 1.
    UNAIDS. Voluntary medical male circumcision: global trends and determinants of prevalence, safety, and acceptability. Geneva: World Health Organization; 2007.Google Scholar
  2. 2.
    Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A. Randomized, controlled intervention trial of voluntary medical male circumcision for reduction of HIV infection risk: the ANRS 1265 trial. PLoS Med. 2005;2(11):e298.PubMedCrossRefGoogle Scholar
  3. 3.
    Bailey RC, Moses S, Parker CB, et al. Voluntary medical male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomized controlled trial. Lancet. 2007;369(9562):643–56.PubMedCrossRefGoogle Scholar
  4. 4.
    Gray RH, Kigozi G, Serwadda D, et al. Voluntary medical male circumcision for HIV prevention in men in Rakai, Uganda: a randomized trial. Lancet. 2007;369(9562):657–66.PubMedCrossRefGoogle Scholar
  5. 5.
    Weiss HA, Halperin D, Bailey RC, Hayes RJ, Schmid G, Hankins CA. Voluntary medical male circumcision for HIV prevention: from evidence to action? AIDS. 2008;22:567–74.PubMedCrossRefGoogle Scholar
  6. 6.
    World Health Organization. New data on voluntary medical male circumcision and HIV prevention: policy and programme implications. 2007. http://data.unaids.org/pub/Report/2007/VMMC_recommendations_en.pdf. Accessed 24 March 2011.
  7. 7.
    UNAIDS/WHO/SACEMA Expert Group on Modelling the Impact and Cost of Voluntary Medical Male Circumcision for HIV Prevention. Voluntary medical male circumcision for HIV prevention in high HIV prevalence settings: what can mathematical modelling contribute to informed decision making? PLoS Med. 2009;6(9):e1000109. doi: 10.1371/journal.pmed.1000109.
  8. 8.
    de Bruyn G, Martinson NA, Gray GE. Voluntary medical male circumcision for HIV prevention: developments from Sub-Saharan Africa. Expert Rev Anti Infect Ther. 2010;8(1):23–31.PubMedCrossRefGoogle Scholar
  9. 9.
    Weiss H, Hankins C, Dickson K. Voluntary medical male circumcision and risk of HIV infection in women: a systematic review and meta-analysis. Lancet Infect Dis. 2009;9:669–77.PubMedCrossRefGoogle Scholar
  10. 10.
    Mehta SD, Gray RH, Auvert B, et al. Does sex in the early period after circumcision increase HIV-seroconversion risk? Pooled analysis of adult voluntary medical male circumcision clinical trials. AIDS. 2009;23(12):1557–64.PubMedCrossRefGoogle Scholar
  11. 11.
    Wawer MJ, Makumbi F, Kigozi G, et al. Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial. Lancet. 2009;374(9685):229–37.PubMedCrossRefGoogle Scholar
  12. 12.
    Kenya National Bureau of Statistics and ICF Macro. Kenya Demographic and Health Survey 2008–09. Calverton: KNBS and ICF Macro. 2010.Google Scholar
  13. 13.
    National AIDS and STI Control Programme, Ministry of Health, Kenya. Guidelines for Safe, Voluntary Medical Voluntary medical male circumcision in Kenya. 2008.Google Scholar
  14. 14.
    Brachman PS. Surveillance and the primary care physician. J Postgrad Med. 1977;62(2):86–91.Google Scholar
  15. 15.
    Vogt RL, LaRue D, Klaucke DN, Jillson DA. Comparison of an Active and passive surveillance system of primary care providers for hepatitis, measles, rubella, and salmonellosis in vermont. Am J Public Health. 1983;73(7):795–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Wood JL, Adams VJ. Epidemiological approaches to safety investigations. Vet Microbiol. 2006;117(1):66–70.PubMedCrossRefGoogle Scholar
  17. 17.
    Lissouba P, Taljaard D, Rech D, et al. A model for the roll-out of comprehensive adult voluntary medical male circumcision services in African low-income settings of high HIV incidence: the ANRS 12126 bophelo pele project. PLoS Med. 2010;7(7):e1000309. doi:10.1371/journal.pmed.1000309.

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Amy Herman-Roloff
    • 1
    • 2
    Email author
  • Robert C. Bailey
    • 1
    • 2
  • Kawango Agot
    • 3
  1. 1.Division of Epidemiology and BiostatisticsSchool of Public Health, University of Illinois at ChicagoChicagoUSA
  2. 2.Nyanza Reproductive Health SocietyKisumuKenya
  3. 3.Impact Research and Development OrganizationKisumuKenya

Personalised recommendations