Early resumption of sexual activity following voluntary medical male circumcision in Botswana: A qualitative study

PLoS One. 2017 Nov 14;12(11):e0186831. doi: 10.1371/journal.pone.0186831. eCollection 2017.


Unprotected sexual intercourse after undergoing voluntary medical male circumcision but prior to complete wound healing can lead to major adverse events including HIV acquisition. To better understand perceptions related to early resumption of sex prior to wound healing, 27 focus group discussions were conducted among 238 adult men, women, and community leaders in Botswana. Median age among all participants was 31 years of whom 60% were male and 51% were either employed and receiving salary or self-employed. Only 12% reported being currently married. Pain, not risk of HIV acquisition, was perceived as the main adverse consequence of early resumption of sex. In fact, no participant mentioned that early resumption of sex could lead to an increase in HIV risk. Demonstrating masculinity and virility, fear of losing female partners, and misperception about post-operative wound healing also played key roles in the decision to resume sex prior to complete wound healing. Findings from this study highlight a potentially widespread lack of awareness of the increased risk of HIV acquisition during the wound healing period. Strengthening post-operative counseling and identifying strategies to discourage the early resumption of sex will be increasingly important as older men and HIV-positive men seek voluntary medical male circumcision services.

MeSH terms

  • Awareness
  • Botswana
  • Circumcision, Male* / adverse effects
  • Elective Surgical Procedures* / adverse effects
  • Focus Groups
  • HIV Infections / transmission
  • Humans
  • Male
  • Middle Aged
  • Qualitative Research
  • Risk Factors
  • Sexual Behavior*
  • Young Adult

Grant support

This work was supported by the President’s Emergency Plan for AIDS Relief (PEPFAR), through funding to the University of Washington and I-TECH from the US Department of Health and Human Services, Health Resources and Services Administration (HRSA) Global HIV/AIDS Bureau under Cooperative Agreement No. U91HA06801.