AIDS Care, 2015 Vol. 27, No. 8, 986–989, http://dx.doi.org/10.1080/09540121.2015.1017797
Voluntary medical male circumcision for HIV prevention and early resumption of sexual activity: a literature review Veena Kamath and Rupali J. Limaye* Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA (Received 26 June 2014; accepted 26 January 2015) A number of programs have focused on scale-up and implementation research regarding voluntary medical male circumcision; however, there is limited research with regard to factors and strategies related to abstinence compliance and the effects of resuming sex during the wound healing period (42-day post-circumcision). We searched the literature for peer-reviewed articles examining early resumption of sex during this period. This review identifies factors that may predispose a client to engage in sex during the 42-day postoperative period, examines how early resumption of sex can inhibit wound healing and increase seroconversion, and reviews strategies that may increase adherence to abstinence during the wound healing period. We found that the most common factor that may predispose a client to engage in sex before the end of the postoperative period is marriage or cohabitation with a sexual partner. With regard to the effect of sex during the postoperative period on wound healing and seroconversion, we found that adverse events incurred were mild, and there was an increased risk of seroconversion. The only strategy studied to increase compliance to abstinence during the postoperative period utilized text messaging, and the trial results indicate that text messaging did not increase abstinence compliance. Keywords: male circumcision; early sex; abstinence; wound healing; HIV
Introduction By 2007, data from three randomized controlled trials confirmed that voluntary medical male circumcision (VMMC) reduces HIV acquisition among males from infected female partners by approximately 60% (Auvert et al., 2005; Bailey et al., 2007; Gray et al., 2007). These findings prompted the World Health Organization (WHO) and the Joint United Nations Program on HIV/ AIDS (UNAIDS) to recommend VMMC in areas with low circumcision and high HIV rates (WHO, 2007). Complete abstinence from sex with males or females, including anal sex, vaginal sex, oral sex, and masturbation for 42 days postoperatively is recommended because the unhealed wound may temporarily increase HIV transmission and acquisition by providing a portal of entry for the virus or through increased viral shedding (Hallett et al., 2008, 2011) and reducing population-level HIV transmission is dependent upon a number of fac‐ tors, including sexual abstinence 42 days postoperatively (Hewett et al., 2012). Studies indicate that most men are healed within six weeks (Kigozi et al., 2014; Rogers, Odoyo-June, Jaoko, & Bailey, 2013). Numerous programs have focused on VMMC implementation, but limited research exists related to factors and strategies related to abstinence compliance during the 42-day postoperative period, and the effects of early
*Corresponding author. Email: [email protected] © 2015 Taylor & Francis
resumption of sex on wound healing and seroconversion. This review identifies factors that may predispose a client to early resumption of sex (sex during the 42-day postoperative period), examines the effects of early resumption of sex on wound healing and seroconversion, and reviews abstinence adherence strategies post-circumcision.
Methods This review aimed to identify all peer-reviewed articles of early resumption of sexual activity post-circumcision (resumption of sex prior to the completion of the 42-day post-circumcision wound healing period). Inclusion criteria were early resumption of sex as the outcome and male circumcision status as the exposure. We searched EMBASE, PsycINFO, PubMed, and Scopus using the following terms: “male circumcision,” “safe medical circumcision,” “male,” “circumcision,” AND “early sex,” “resumption of sex,” “sexual intercourse,” and “sexual activity” and then included the additional terms: “wound healing,” “postoperative,” and “abstinence.” The initial search identified 60 papers. A review of abstracts identified 11 papers that reported on either factors influencing early resumption of sex, the effect of early resumption of sex, or factors utilized to increase abstinence compliance.
AIDS Care Results The relevant articles were grouped into four categories: factors influencing early resumption of sex, the effect of early resumption of sex on wound healing and adverse events, the effect of early resumption of sex on seroconversion, and strategies to increase abstinence compliance during the postoperative period. Factors influencing early resumption of sex Two studies conducted in Kenya examined factors that influenced early resumption of sex. Herman-Roloff, Bailey, and Agot (2012) prospectively assessed time to sexual activity in Nyanza (n = 1344). Participants who engaged in early sexual activity (
Voluntary medical male circumcision for HIV prevention and early resumption of sexual activity: a literature review Veena Kamath and Rupali J. Limaye* Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA (Received 26 June 2014; accepted 26 January 2015) A number of programs have focused on scale-up and implementation research regarding voluntary medical male circumcision; however, there is limited research with regard to factors and strategies related to abstinence compliance and the effects of resuming sex during the wound healing period (42-day post-circumcision). We searched the literature for peer-reviewed articles examining early resumption of sex during this period. This review identifies factors that may predispose a client to engage in sex during the 42-day postoperative period, examines how early resumption of sex can inhibit wound healing and increase seroconversion, and reviews strategies that may increase adherence to abstinence during the wound healing period. We found that the most common factor that may predispose a client to engage in sex before the end of the postoperative period is marriage or cohabitation with a sexual partner. With regard to the effect of sex during the postoperative period on wound healing and seroconversion, we found that adverse events incurred were mild, and there was an increased risk of seroconversion. The only strategy studied to increase compliance to abstinence during the postoperative period utilized text messaging, and the trial results indicate that text messaging did not increase abstinence compliance. Keywords: male circumcision; early sex; abstinence; wound healing; HIV
Introduction By 2007, data from three randomized controlled trials confirmed that voluntary medical male circumcision (VMMC) reduces HIV acquisition among males from infected female partners by approximately 60% (Auvert et al., 2005; Bailey et al., 2007; Gray et al., 2007). These findings prompted the World Health Organization (WHO) and the Joint United Nations Program on HIV/ AIDS (UNAIDS) to recommend VMMC in areas with low circumcision and high HIV rates (WHO, 2007). Complete abstinence from sex with males or females, including anal sex, vaginal sex, oral sex, and masturbation for 42 days postoperatively is recommended because the unhealed wound may temporarily increase HIV transmission and acquisition by providing a portal of entry for the virus or through increased viral shedding (Hallett et al., 2008, 2011) and reducing population-level HIV transmission is dependent upon a number of fac‐ tors, including sexual abstinence 42 days postoperatively (Hewett et al., 2012). Studies indicate that most men are healed within six weeks (Kigozi et al., 2014; Rogers, Odoyo-June, Jaoko, & Bailey, 2013). Numerous programs have focused on VMMC implementation, but limited research exists related to factors and strategies related to abstinence compliance during the 42-day postoperative period, and the effects of early
*Corresponding author. Email: [email protected] © 2015 Taylor & Francis
resumption of sex on wound healing and seroconversion. This review identifies factors that may predispose a client to early resumption of sex (sex during the 42-day postoperative period), examines the effects of early resumption of sex on wound healing and seroconversion, and reviews abstinence adherence strategies post-circumcision.
Methods This review aimed to identify all peer-reviewed articles of early resumption of sexual activity post-circumcision (resumption of sex prior to the completion of the 42-day post-circumcision wound healing period). Inclusion criteria were early resumption of sex as the outcome and male circumcision status as the exposure. We searched EMBASE, PsycINFO, PubMed, and Scopus using the following terms: “male circumcision,” “safe medical circumcision,” “male,” “circumcision,” AND “early sex,” “resumption of sex,” “sexual intercourse,” and “sexual activity” and then included the additional terms: “wound healing,” “postoperative,” and “abstinence.” The initial search identified 60 papers. A review of abstracts identified 11 papers that reported on either factors influencing early resumption of sex, the effect of early resumption of sex, or factors utilized to increase abstinence compliance.
AIDS Care Results The relevant articles were grouped into four categories: factors influencing early resumption of sex, the effect of early resumption of sex on wound healing and adverse events, the effect of early resumption of sex on seroconversion, and strategies to increase abstinence compliance during the postoperative period. Factors influencing early resumption of sex Two studies conducted in Kenya examined factors that influenced early resumption of sex. Herman-Roloff, Bailey, and Agot (2012) prospectively assessed time to sexual activity in Nyanza (n = 1344). Participants who engaged in early sexual activity (
