Resumption Of Sexual Activity After Voluntary Medical Male Circumcision: Data From A Population Based Cohort In Rakai, Uganda, 2013 To 2020

IntroductionVoluntary medical male circumcision (VMMC) reduces the risk of heterosexual acquisition of HIV by 50%-60%. The Uganda Ministry of Health recommends abstinence for 42 days after VMMC to allow complete wound healing. However, some men resume sex early before the recommended period. We estimated trends in prevalence and risk factors of early sex resumption (ESR) among VMMC clients in Rakai, Uganda, from 2013-2020. MethodsData from the Rakai Community Cohort Study, a cross-sectional study were analyzed. Data included consenting men aged 15-49 years in who self-reported having received VMMC in one of four successive surveys, (June 2013 to January 2015), (February 2015 to September 2016), (October 2016 to May 2018), and (June 2018 to October 2020). ESR prevalence and associated risk factors using modified Poisson regression to estimate adjusted prevalence ratios (aPR) were estimated. ResultsOverall, 1,832 men participated in the study. ESR decreased from 45.1% in 2013 to 14.9% in 2020 (p<0.001). Across the three surveys, ESR prevalence was consistently higher among married than never married men, aPR=1.83, 95% CI: [1.30,2.57]; aPR=2.46, 95% CI: [1.50,4.06]; aPR=2.22, 95% CI: [1.22,4.03]. ESR prevalence was higher among men who reported more than one sexual partner than men with one partner, aPR=1.59, 95% CI: [1.16,2.20]. In the fourth survey (2018-2020), ESR prevalence was significantly higher among men with primary education than men with post-primary, aPR=2.38, 95% CI: [1.31, 4.30] while ESR prevalence was lower among men aged at least 45 men with no sexual relationship in the past 12 months but self-reported to have resumed sex activities, aPR= 0, 95% CI: [1.86-07, 2.69-06] and aPR=0, 95% CI: [3.61e-07, 2.12e-06], respectively. Overall, men who reported primary school as their highest level of education reported ESR more often than those with post-primary education aPR=2.38, 95% CI: [1.31, 4.30]. Occupation and known HIV status were not associated with ESR. ConclusionsSelf-reported ESR after VMMC declined between 2013 and 2020. Targeted efforts for counseling focusing on married men, men who had multiple sex partners, and men with lower levels of education can help decrease post-VMMC ESR.