Does sex in the early period after circumcision increase HIV-seroconversion risk? Pooled analysis of adult male circumcision clinical trials

Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA.
AIDS (London, England) (Impact Factor: 5.55). 07/2009; 23(12):1557-64. DOI: 10.1097/QAD.0b013e32832afe95
Source: PubMed


To evaluate whether sexual intercourse soon after adult male circumcision affected HIV risk.
Combined analysis of data from African trials of men who were randomized to and underwent circumcision.
We examined two associations: early sex (intercourse <42 days after circumcision) and HIV acquisition at 3 months for the Orange Farm and Kisumu trials and at 6 months for the Rakai and Kisumu trials and incomplete wound healing at 1 month and seroconversion at 3 and 6 months for the Kisumu trial and at 6 months for the Rakai trial.
Early sex was reported by 3.9% of participants in Kisumu, 5.4% in Rakai, and 22.5% in Orange Farm. HIV seroprevalence was 0.0% at 3 months and 1.9% at 6 months among 18-24-year-olds reporting early sex and 0.2% at 3 months and 0.6% at 6 months among those who did not report early sex. In pooled analyses, men reporting early sex did not have higher HIV infection risk at 3 or 6 months. In Kisumu, 16 (1.3%) men had incomplete wound healing at the 30-day visit. One (6.3%) of these seroconverted at 3 months compared with 2 (0.2%) of 1246 men with complete wound healing (P = 0.075). No association was observed between incomplete wound healing and seroconversion for Rakai participants.
Most men delayed intercourse after circumcision. Early sex after circumcision was not associated with HIV risk, although the study power was limited. Nevertheless, men should delay intercourse to limit the potential for increased HIV risk until complete wound healing.

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    • "When circumcision is delayed beyond the onset of sexual activity, the impact of a period of abstinence must be considered. Analysis of data from three RCTs found that relatively few men engaged in sexual intercourse within 42 days of circumcision [158]. It has been suggested, not unreasonably, that this period of complete abstinence (from both intercourse and masturbation) is "often daunting and serves as a disincentive for men to undertake the procedure" [159], and the recommended post-surgical abstinence period was found to be a significant barrier to MC uptake in Kenya [111]. "
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