Perceptions of Risk and Sexual Behavior Change following Adult Male Circumcision in Urban Swaziland

Male circumcision has been shown to reduce the risk of heterosexual transmission of HIV infection in men by up to 60% in three randomized controlled trials. However, little is known about sexual behavior change of men who have been circumcised and whether the protective effect of circumcision leads to riskier sexual behavior among circumcised men.

The target population for this study was men aged over 18 years in three urban areas in Swaziland who have undergone circumcision in the previous 12 months. This study used in-depth interviews to explore men's perceptions of sexual behavior following voluntary medical circumcision. The use of open-ended questions allowed participants to express personal narratives about their sexual behavior following circumcision, while maintaining the highest level of confidentiality and privacy. These men were purposively recruited and asked about their perceptions of sexual risk, sexual behavior, and resumption of sexual activity post-circumcision.

Although behavioral disinhibition was investigated, results show that men report greater sexual responsibility and sexual satisfaction following the procedure, though results on resumption of sexual activity following circumcision are inconsistent. Results also indicate that HIV counseling and testing may act as a barrier to men seeking circumcision.

Male circumcision is becoming more accessible to many young men throughout Swaziland and several other southern African countries with high HIV prevalence, though HIV stigma is still high in certain areas. Both HIV counseling and testing providers and male circumcision implementers need to work closely to communicate more consistent messaging about circumcision and HIV counseling and testing.