Journal Article

Sex with stitches: The resumption of sexual activity during the post-circumcision wound healing period in Zambia

Objectives
This study uses observational data collected as part of Zambia’s male circumcision program to measure sexual behavior in the post-surgical healing period and to model its influence on HIV transmission for men and their partners.

Design/Methods
From August to October 2010, 248 men about to undergo male circumcision were recruited to participate. Interviews were conducted at baseline and six-weeks post-circumcision, the recommended period of sexual abstinence for complete wound healing. Logistic and Poisson regression models were used to assess risk factors for early resumption of sex. A static-network deterministic transmission model was constructed to assess the impact of the program given early resumption of sex.

Results
24% of circumcised men reported resuming sex prior to six-weeks postsurgery. Of men having sex, 46% had sex in the first three weeks, 82% reported at least one unprotected sex act, and 37% reported sex with two or more partners. The model estimates that of the 61 000 men circumcised in one year, early resumption of sex leads to 69 extra HIV infections (32 among men, 37 among women), but estimates a net effect of 230 fewer HIV infections in one year, predominantly among men.

Conclusions
Prevalence of risky sexual behavior during wound healing is high and more likely among those reporting risky sexual behaviors at baseline. Nonetheless, the net effect of the MC intervention is beneficial. The impact on women, however, is very sensitive to the prevalence of early resumption of sex.