“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

Demora en el diagnóstico de tuberculosis e inicio de tratamiento, República Dominicana, julio-diciembre 2010

The study objectives were to determine the time between the onset of Symptoms of initiation of antituberculosis treatment and to identify risk factors associated with delay. We conducted a retrospective in patients with tuberculosis in July-December 2010 and entered treatment/ the sample selection was multistage, first selecting health facilities and the patients filled in a structures instrumented, the data were analyzed in Epi Info, there were single frequencies, statistical analysis using measures of central tendency and OR were calculated for the association of risk. The average delay was 19 days (onset attention demand), the average total delay (diagnosis-initiation of treatment) was 5 days, and national standard set the star of treatment within 3 days, this delay exceeds the provisions of the rules. We recommend prospective studies, dissemination of TB information.Los objetivos del estudio fueron determinar el tiempo transcurrido entre la aparición de síntomas y el inicio del tratamiento antituberculosis y determinar los factores de riesgo asociados a la demora. Realizamos un estudio, retrospectivo en pacientes diagnosticados con tuberculosis en julio-dic 2010 y que ingresaron a tratamiento. La selección de la muestra fue polietapica, seleccionando primero los establecimientos de salud y luego los pacientes, se lleno un instrumento estructurado, los datos se analizaron en Epi Info, se realizaron frecuencias simples y múltiples, el análisis estadístico mediante las medidas de tendencia central y se calcularon OR para la asociación de riesgos. El promedio de demora fue 19 días (inicio de síntomas -demanda atención), la media de demora total, (diagnostico-inicio de tratamiento), fue 5 días, las normas nacionales, establecen iniciar tratamiento antes de 3 días, esta demora excede lo previsto por las normas. Recomendamos realizar estudios prospectivos, difundir información de prevención Tuberculosis

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

A Clinical Trial to Introduce Voluntary Medical Male Circumcision for HIV Prevention in Areas of High Prevalence in the Dominican Republic

<div><p>Background</p><p>Voluntary Medical Male Circumcision (VMMC) is an effective strategy to reduce the risk of HIV infection. Studies conducted in the Dominican Republic (DR) suggest that acceptability of VMMC among men may be as high as 67%. The goal of this clinical trial was to assess the acceptability, uptake and safety for VMMC services in two areas of high HIV prevalence in the country.</p><p>Methods</p><p>This was a single-arm, non-randomized, pragmatic clinical trial. Study personnel received background information about the risks and benefits of VMMC and practical training on the surgical technique. A native speaking research assistant administered a questionnaire of demographics, sexual practices and knowledge about VMMC. One week after the surgery, participants returned for wound inspection and to answer questions about their post-surgical experience.</p><p>Results</p><p>539 men consented for the study. Fifty seven were excluded from participation for medical or anatomical reasons and 28 decided not to have the procedure after providing consent. A total of 454 men were circumcised using the Forceps Guided Method Under Local Anesthesia. The rate of adverse events (AE) was 4.4% (20% moderate, 80% mild). There were no serious AEs and all complications resolved promptly with treatment. Eighty eight percent of clients reported being “very satisfied” and 12% were “somewhat satisfied” with the outcome at the one-week postoperative visit.</p><p>Conclusions</p><p>Recruitment and uptake were satisfactory. Client satisfaction with VMMC was high and the rate of AEs was low. Roll out of VMMC in targeted areas of the DR is feasible and should be considered.</p><p>Trial Registration</p><p>ClinicalTrials.gov <a href="https://clinicaltrials.gov/ct2/show/NCT02337179?term=NCT02337179&rank=1" target="_blank">NCT02337179</a></p></div

Study Flow Diagram.

<p>Study Flow Diagram.</p

Adverse Events.

<p>Adverse Events.</p

“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