Original Research

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

Jillian C. Pintye, Kathleen Wirth, Conrad Ntsuape, Nora J. Kleinman, Lisa Spees, Bazghina-werq Semo, Shreshth Mawandia, Jenny Ledikwe
Southern African Journal of HIV Medicine | Vol 21, No 1 | a1042 | DOI: https://doi.org/10.4102/sajhivmed.v21i1.1042 | © 2020 Jillian C. Pintye, Kathleen E. Wirth, Conrad Ntsuape, Nora J. Kleinman, Lisa Spees, Bazghina-werq Semo, Shreshth Mawandia, Jenny Ledikwe | This work is licensed under CC Attribution 4.0
Submitted: 01 November 2019 | Published: 20 April 2020

About the author(s)

Jillian C. Pintye, Department of Global Health, University of Washington, Seattle, United States
Kathleen Wirth, Botswana International Training and Education Center for Health (I-TECH), Gaborone, Botswana; and, Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
Conrad Ntsuape, Department of HIV/AIDS Prevention and Care, Botswana Ministry of Health and Wellness, Gaborone, Botswana
Nora J. Kleinman, Department of Global Health, University of Washington, Seattle, United States; and, Botswana International Training and Education Center for Health (I-TECH), Gaborone, Botswana; and, NJK Consulting, Seattle, Washington, United States; and, Amgen Asia Holdings Ltd, Hong Kong, United States
Lisa Spees, Department of Health Policy and Management, University of North Carolina, Chapel Hill, United States; and, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, United States
Bazghina-werq Semo, Department of Global Health, University of Washington, Seattle, United States; and, Botswana International Training and Education Center for Health (I-TECH), Gaborone, Botswana; and, FHI 360, Washington, Washington, United States
Shreshth Mawandia, Department of Global Health, University of Washington, Seattle, United States; and, Botswana International Training and Education Center for Health (I-TECH), Gaborone, Botswana
Jenny Ledikwe, Department of Global Health, University of Washington, Seattle, United States; and, Botswana International Training and Education Center for Health (I-TECH), Gaborone, 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.


Keywords

Botswana; voluntary medical male circumcision; human immunodeficiency virus (HIV) prevention; men; implementation science; program delivery

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