“I Feel Like More of a Man”: A Mixed Methods Study of Masculinity, Sexual Performance, and Circumcision for HIV Prevention

Ethnographic studies from numerous societies have documented the central role of male circumcision in conferring masculinity and preparing boys for adult male sexuality. Despite this link between masculinity, sexuality, and circumcision, there has been no research on these dynamics among men who have received a circumcision for HIV prevention. We employed a mixed methods approach with data collected from recently circumcised men in the Dominican Republic (DR) to explore this link. We analyzed survey data collected 6-12 months post-circumcision (N = 293) and in-depth interviews with a sub-sample of those men (n = 30). We found that 42% of men felt more masculine post-circumcision. In multivariate analysis, feeling more masculine was associated with greater concern about being perceived as masculine (OR = 1.70, 95% CI: 1.25-2.32), feeling more potent erections post-circumcision (OR = 2.25, 95% CI: 1.26-4.03), and reporting increased ability to satisfy their partner post-circumcision (OR = 2.30, 95% CI: 1.11-4.77). In qualitative interviews, these factors were all related to masculine norms of sexually satisfying one's partner and men's experiences of circumcision were shaped by social norms of masculinity. This study highlights that circumcision is not simply a biomedical intervention and that circumcision programs need to incorporate considerations of masculine norms and male sexuality into their programming

Acceptability of Male Circumcision for the Prevention of HIV/AIDS in the Dominican Republic

Male circumcision (MC) is an effective strategy to prevent HIV infection in heterosexual men. To our knowledge, there are no studies of the acceptability of this procedure in the Dominican Republic (DR). The main objective of this study was to assess the acceptability of MC to prevent HIV transmission among men ages 18 to 50 years in the Altagracia Province in the Dominican Republic. Because differences in culture and beliefs between Haitians and Dominicans could potentially influence their acceptability of MC, we conducted a comparative analysis based on national origin.A survey was administered to a convenience sample of 368 men. The questionnaire was divided in 3 sections: 1) Background demographics (including national origin), 2) Male circumcision and 3) Sexual health. Stratified and logistic multivariate regression analyses were performed to identify factors associated with the acceptability of MC.The sample consisted of 238 (65%) Dominicans and 130 (35%) Haitian immigrants. Almost all participants were uncircumcised (95%) and about half (52%) were single. The overall acceptability of MC was 29%. The number of men willing to be circumcised increased to 67% after an information session explaining the benefits of the procedure. 74% of men reported that they would be willing to circumcise their sons after hearing that information. In multivariate analysis, Haitian nationality (OR=1.86, 95% CI 1.01-3.41), knowing that circumcision improves hygiene (OR=2.78, 95% CI 1.29-6.0) and not believing that circumcision decreases sexual pleasure (OR=2.18, 95% CI 1.20-3.94) were associated with a higher acceptability of the procedure. Although age was not significantly associated with the willingness to be circumcised in the multivariate analysis, stratified analysis based on national origin suggested that younger Dominicans (<30 years of age) are more likely to accept the procedure when compared to their older counterparts (OR=2.17, 95% CI 1.14-4.12).An important number of sexually active men in the DR may be willing to be circumcised if educational resources detailing the benefits of the procedure are made available. These educational activities would constitute a great opportunity to teach about sexual health and reinforce safe sex practices

Epidemiology and management of mycobacterial infections in the immunocompromised patient

Reactivation tuberculosis (TB) and Mycobacterium avium complex (MAC) disease are significant causes of morbidity in HIV infected patients, especially in resource-constrained settings. These diseases are the most common AIDS-presenting illnesses in some countries. Although morbidity and mortality have significantly decreased with the advent of Highly Active Antiretroviral Therapy, significant challenges exist in treating patients, among them overlapping medication toxicities, drug-drug interactions and the risk of developing Immune Reconstitution Inflammatory Syndrome. Mycobacterial resistance to existing antimicrobials continues to rise, further complicating the management of these patients and presenting a public health challenge. Solid organ and hematopoietic stem cell transplant recipients are also at increased risk of developing TB and MAC disease. In addition, although patients with cellular immune defects are perceived to be at higher risk for non-tuberculous mycobacterial infection, limited data exist on the frequency of these infections in this patient population. Incidence may be influenced by the degree of immunosuppression and the types of immunosuppressants used. Diagnosis is sometimes challenging, and the clinician needs to keep a high index of suspicion to correctly diagnose the syndromes caused by these bacteria. The author will review the epidemiology, clinical presentation, diagnostic methods and principles of treatment of the most common mycobacteria that cause disease in HIV and transplant recipients, and will discuss some of the nuances in the management of these patients

Zika Virus Epidemic in Pregnant Women, Dominican Republic, 2016–2017

Zika virus infection during pregnancy may result in birth defects and pregnancy complications. We describe the Zika virus outbreak in pregnant women in the Dominican Republic during 2016–2017. We conducted multinomial logistic regression to identify factors associated with fetal losses and preterm birth. The Ministry of Health identified 1,282 pregnant women with suspected Zika virus infection, a substantial proportion during their first trimester. Fetal loss was reported for ≈10% of the reported pregnancies, and 3 cases of fetal microcephaly were reported. Women infected during the first trimester were more likely to have early fetal loss (adjusted odds ratio 5.9, 95% CI 3.5–10.0). Experiencing fever during infection was associated with increased odds of premature birth (adjusted odds ratio 1.65, 95% CI 1.03–2.65). There was widespread morbidity during the epidemic. Our findings strengthen the evidence for a broad range of adverse pregnancy outcomes resulting from Zika virus infection

Masculine gender norms, male circumcision, and men’s engagement with health care in the Dominican Republic

Overall, adult men are less likely to seek and receive health care than women, but male circumcision for HIV prevention has been successful in engaging men in health services. The purpose of this paper is to examine the relationship between masculine norms and health care-seeking among men participating in a voluntary male medical circumcision (VMMC) programme in the Dominican Republic (DR). We employed a mixed methods approach integrating survey data collected 6–12 months post-circumcision (n = 293) and in-depth interviews with a sub-sample of these men (n = 30). In our qualitative analysis, we found that health care-seeking is connected to masculine norms among men in the DR, including the perceptions of medical facilities as feminine spaces. Participants’ narratives demonstrate that male circumcision programmes may facilitate men overcoming masculinity-related barriers to health care engagement. In quantitative analysis, we found that being concerned about being perceived as masculine was associated with health care-seeking behaviour in the past five years, though this association was not retained in multivariable analyses. Findings indicate that male circumcision programmes can familiarise men with the healthcare system and masculinise health care-seeking and utilisation, easing associated discomfort

The association between men’s concern about demonstrating masculine characteristics and their sexual risk behaviors: Findings from the Dominican Republic

Quantitative analyses exploring the relationship between masculinities and men’s sexual risk behaviors have most commonly used one dimension of masculinities: men’s gender ideology. Examining other dimensions may enhance our understanding of and ability to intervene upon this relationship. In this article, we examined the association between gender role conflict/stress (GRC/S)—men’s concern about demonstrating masculine characteristics—and three different sexual risk behaviors (having two or more sex partners in the last 30 days; never/inconsistent condom use with non-steady partners; and drinking alcohol at last sex) among a sample of heterosexual men in the Dominican Republic who were participating in an HIV prevention intervention (n = 293). The GRC/S Scale we used was adapted for this specific cultural context and has 17 items (α = 0.75). We used logistic regression to assess the relationship between GRC/S and each sexual behavior, controlling for sociodemographic characteristics. In adjusted models, a higher GRC/S score was significantly associated with increased odds of having two or more sex partners in the past 30 days (AOR 1.33, 95 % CI 1.01–1.74), never/inconsistent condom use with non-steady partners (AOR 1.45, 95 % CI 1.04–2.01), and drinking alcohol at last sex (AOR 1.56, 95 % CI 1.13–2.17). These results highlight the importance of expanding beyond gender ideology to understanding the influence of GRC/S on men’s sexual risk behaviors. Interventions should address men’s concern about demonstrating masculine characteristics to reduce the social and internalized pressure men feel to engage in sexual risk behaviors

Subject characteristics by national origin.

<p>Subject characteristics by national origin.</p

Perceived benefits of circumcision by national origin.

<p>Perceived benefits of circumcision by national origin.</p

Willingness to be circumcised. Multivariate analysis.

<p>Willingness to be circumcised. Multivariate analysis.</p