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

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          Abstract

          Background

          Uptake 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.

          Objectives

          At 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.

          Methods

          We 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.

          Results

          Data 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).

          Conclusion

          Emphasising improved sexual function experienced after VMMC in demand-creation efforts could potentially increase VMMC uptake in Botswana.

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          Most cited references28

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          Combination HIV Prevention and HIV Incidence in Uganda

          BACKGROUND To assess the impact of combination HIV prevention (CHP) on HIV incidence, we analyzed the association between HIV incidence and scale-up of antiretroviral therapy (ART) and medical male circumcision in Rakai, Uganda. Changes in population-level viral load suppression and sexual behaviors were also examined. METHODS Between 1999 and 2016, data were collected through 12 surveys from 30 communities in the Rakai Community Cohort Study, an open population-based cohort of persons aged 15-49 years. We assessed HIV incidence trends based on observed seroconversion data, self-reported ART and male circumcision coverage, viral load suppression, and sexual behaviors. RESULTS In total, 33,937 study participants contributed 103,011 person-visits (HIV prevalence ~13%). Follow-up of 17,870 HIV-negative persons contributed 94,427 person-years with 931 seroconversions. ART was introduced in 2004; by 2016 coverage was 69% (72% in women vs. 61% in men, p<0.001). HIV viral load suppression among all HIV-positive persons increased from 42% in 2009 to 75% by 2016 (p<0.001). Male circumcision coverage increased from 15% in 1999 to 59% by 2016 (p<0.001). Persons 15-19 years reporting n 71 ever having sex increased from 30% to 55% (p<0.0001). HIV incidence declined by 42% in 2016 relative to the pre-CHP period prior to 2010 (1.17/100 py to 0.66/100 py; adjIRR:0.58: 95%CI: 0.45-0.76); declines were greater in men (adjIRR=0.46; 95%CI: 0.29-0.73) than women (adjIRR=0.68, 95%CI: 0.50-0.94). CONCLUSIONS In this longitudinal study, HIV incidence significantly declined with CHP scale-up, providing empiric evidence that HIV control interventions can have substantial population-level impact. However, additional efforts are needed to overcome gender disparities and achieve HIV elimination.
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            Adult male circumcision: effects on sexual function and sexual satisfaction in Kisumu, Kenya.

            Male circumcision is being promoted for HIV prevention in high-risk heterosexual populations. However, there is a concern that circumcision may impair sexual function. To assess adult male circumcision's effect on men's sexual function and pleasure. Participants in a controlled trial of circumcision to reduce HIV incidence in Kisumu, Kenya were uncircumcised, HIV negative, sexually active men, aged 18-24 years, with a hemoglobin >or=9.0 mmol/L. Exclusion criteria included foreskin covering less than half the glans, a condition that might unduly increase surgical risks, or a medical indication for circumcision. Participants were randomized 1:1 to either immediate circumcision or delayed circumcision after 2 years (control group). Detailed evaluations occurred at 1, 3, 6, 12, 18, and 24 months. (i) Sexual function between circumcised and uncircumcised men; and (ii) sexual satisfaction and pleasure over time following circumcision. Between February 2002 and September 2005, 2,784 participants were randomized, including the 100 excluded from this analysis because they crossed over, were not circumcised within 30 days of randomization, did not complete baseline interviews, or were outside the age range. For the circumcision and control groups, respectively, rates of any reported sexual dysfunction decreased from 23.6% and 25.9% at baseline to 6.2% and 5.8% at month 24. Changes over time were not associated with circumcision status. Compared to before they were circumcised, 64.0% of circumcised men reported their penis was "much more sensitive," and 54.5% rated their ease of reaching orgasm as "much more" at month 24. Adult male circumcision was not associated with sexual dysfunction. Circumcised men reported increased penile sensitivity and enhanced ease of reaching orgasm. These data indicate that integration of male circumcision into programs to reduce HIV risk is unlikely to adversely effect male sexual function.
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              Estimation of prevalence rate ratios for cross sectional data: an example in occupational epidemiology.

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                Author and article information

                Journal
                South Afr J HIV Med
                South Afr J HIV Med
                HIVMED
                Southern African Journal of HIV Medicine
                AOSIS
                1608-9693
                2078-6751
                20 April 2020
                2020
                : 21
                : 1
                : 1042
                Affiliations
                [1 ]Department of Global Health, University of Washington, Seattle, United States
                [2 ]Botswana International Training and Education Center for Health (I-TECH), Gaborone, Botswana
                [3 ]Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
                [4 ]Department of HIV/AIDS Prevention and Care, Botswana Ministry of Health and Wellness, Gaborone, Botswana
                [5 ]NJK Consulting, Seattle, Washington, United States
                [6 ]Amgen Asia Holdings Ltd, Hong Kong, Japan
                [7 ]Department of Health Policy and Management, University of North Carolina, Chapel Hill, United States,
                [8 ]Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, United States
                [9 ]FHI 360, Washington, Washington, United States
                Author notes
                Corresponding author: Jillian Pintye, jpintye@ 123456uw.edu
                Author information
                https://orcid.org/0000-0003-1255-7191
                https://orcid.org/0000-0002-7468-851X
                https://orcid.org/0000-0003-1568-6124
                https://orcid.org/0000-0001-8203-2724
                https://orcid.org/0000-0002-5680-9330
                https://orcid.org/0000-0003-4573-414X
                https://orcid.org/0000-0001-8318-2230
                https://orcid.org/0000-0001-8658-2993
                Article
                HIVMED-21-1042
                10.4102/sajhivmed.v21i1.1042
                7203194
                5267c766-545b-439a-b6b9-5f91765ba6b0
                © 2020. The Authors

                Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.

                History
                : 01 November 2019
                : 28 November 2019
                Categories
                Original Research

                botswana,voluntary medical male circumcision,human immunodeficiency virus (hiv) prevention,men,implementation science,program delivery

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