Barcelona 2013
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| Abstract #555 - E-Posters English | ||||
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Session: 50.1: E-Posters English (Poster) on Sunday in Chaired by Authors: Presenting Author: Prof Deven Hamilton - Battelle, United States |
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| Additional Authors: Dr. Jordi Casabona, Sra Cristina Sanclemente, Dra. Anna Esteve, Dra. Victoria Gonzalez, Grupo HIVITS TS, | ||||
| Aim: Male circumcision (MC) has been demonstrated to substantially reduce female to male transmission of HIV. Many countries are proactively seeking innovative solutions for scaling up MC including using adult MC devices that may side-step the need for the full surgical procedure. Devices, especially those that can be used by broader cadres of health care workers, offer hope for more rapid scale-up of adult MC in resource-limited settings. One such device is the PrePexTM Device which uses a plastic ring with a rubber O-ring to necrotize the foreskin. A three phase clinical trial of a non-surgical circumcision device was carried out in Zimbabwe and completed in 2012. Phase II of that trial was a comparative phase to assess its performance compared directly to surgical MCs. In addition to clinical outcomes, men?s feeling and expectations about sexual practices as well as their behavior were measured. Because MC is only about 60% protective, it is also important that men continue to engage in safe sex practices. Determining what opinions men have regarding effects of MC on sexual relations, is also useful for directing post-circumcision counseling messages and in developing evidence-based communications and educational campaigns to address misconceptions men may have. | ||||
| Method / Issue: The Comparative Study Phase of the clinical trial was a randomized, open label, trial comparing the performance of a non-surgical MC device to surgical MC in healthy adult men and was conducted among 242 men. After recruitment, men were randomized to either device or surgical MC in a 2:1 ratio; two device to one surgical MC. The Comparative Study phase examined numerous clinical and psychosocial outcomes in addition to their sexual behavior and their pre- and post-circumcision attitudes towards the impact on their sexual behavior post-procedure. Men were surveyed at MC, and 2-weeks and 90-days post MC. | ||||
| Results / Comments: Men in both groups were significantly less confident over time in their ability to abstain from sex (p < .05). By 90 days 11% of surgery group and 8% of device group men reported they disagreed that they were able to control themselves to not engage in sex for the recommended six weeks. Behavioral data indicated that 36 (15%) of the men returned to sexual activity in less than the recommended 42 day abstinence period. Prior to undergoing their surgical circumcision men generally believed that circumcision would have a positive impact on their sexual relations. There was a significant increase in agreement among men in both groups that post circumcision they would ?last longer during sexual relations? and ?erections would last longer? (p < .01 and p < .001 respectively). This effect differed by group with the surgical group reporting a significantly greater positive change over time. | ||||
| Discussion: Men report positive outcomes with both surgical and device MC including increased sexual satisfaction. The long recovery time and difficulty abstaining for the entire duration of the healing process may present a new risk for HIV transmission and will need to be evaluated further. | ||||
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