"Now that you are circumcised, you cannot have first sex with your wife": post circumcision sexual behaviours and beliefs among men in Wakiso district, Uganda
"Now that you are circumcised, you cannot have first sex with your wife": post circumcision sexual behaviours and beliefs among men in Wakiso district, Uganda
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DOI：
10.7448/ias.20.1.21498
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发表时间：
2017-06-05
影响因子：
6
通讯作者：
Daniel, Marguerite
中科院分区：
文献类型：
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作者：
Kibira, Simon Peter Sebina;Atuyambe, Lynn Muhimbuura;Daniel, Marguerite
导言：安全的男性包皮环切术是在14个艾滋病毒感染率较高的撒哈拉以南非洲国家实施的全面艾滋病毒预防方案中的一项重要生物医学干预措施。为了维持其部分保护效益，重要的是，人们认为艾滋病毒风险的降低不会导致接受包皮环切术的男性及其性伴侣获得行为风险补偿。这项研究探索了可能影响受包皮环切术男性在方案背景下的性行为的信念。方法：对乌干达中部瓦基索地区新接受割礼的男性进行了48次深入访谈。2015年5月至6月，该地区的公共卫生机构招募了25名寻求包皮环切服务的男子，并在基线和6个月后进行了面谈。参与者的信仰和性行为在包皮环切术后和随访时进行了比较，以探索变化。使用地图集管理数据。结果：本研究提出了安全男性包皮环切术后的四个主题。信仰与：(1)性清洗，(2)愈合，(3)SMC后的性能力和(4)持续的艾滋病毒传播风险。大多数男子维持或采取更安全的性行为；在知道割礼后仍有艾滋病毒风险后，忠于其伴侣，或与婚外伴侣一起使用避孕套。最普遍的危险信念是关于包皮环切术后的性清洗，作为这种信念的结果，一些男性只有一次不使用避孕套-与临时伴侣发生性行为。一些人由于对什么是愈合的误解而在推荐期之前恢复了性行为。结论：尽管大多数男性保持或采取了更安全的性行为，但也有一些危险的性行为是由于对包皮环切术后的第一次性行为的信念或对什么是伤口愈合的误解造成的。如果不加以解决，这些问题可能会削弱男性包皮环切术降低艾滋病毒风险的安全益处。
Introduction: Safe male circumcision is an important biomedical intervention in the comprehensive HIV prevention programmes implemented in 14 sub-Saharan African countries with high HIV prevalence. To sustain its partial protective benefit, it is important that perceived reduced HIV risk does not lead to behavioural risk compensation among circumcised men and their sexual partners. This study explored beliefs that may influence post circumcision sexual behaviours among circumcised men in a programme setting.Methods: Forty-eight in-depth interviews were conducted with newly circumcised men in Wakiso district, central Uganda. Twenty-five men seeking circumcision services at public health facilities in the district were recruited from May to June 2015 and, interviewed at baseline and after 6 months. Participants' beliefs and sexual behaviours were compared just after circumcision and at follow up to explore changes. Data were managed using atlas. ti7 and analysed following a thematic network analysis framework.Results: Four themes following safe male circumcision emerged from this study. Beliefs related to: (1) sexual cleansing, (2) healing, (3) post SMC sexual capabilities and (4) continued HIV transmission risk. Most men maintained or adopted safer sexual behaviour; being faithful to their partner after circumcision or using condoms with extramarital partners following the knowledge that there was continued HIV risk post circumcision. The most prevalent risky belief was regarding sexual cleansing post circumcision, and as a result of this belief, some men had one off condom-less sexual intercourse with a casual partner. Some resumed sex before the recommended period due to misunderstanding of what comprised healing.Conclusions: Although most men maintained or adopted safer sexual behaviour, there were instances of risky sexual behaviour resulting from beliefs regarding the first sexual intercourse after circumcision or misunderstandings of what comprised wound healing. If not addressed, these may attenuate the safe male circumcision benefits of risk reduction for HIV.