{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T04:21:37Z","timestamp":1747196497014,"version":"3.40.5"},"reference-count":25,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2024,11,21]],"date-time":"2024-11-21T00:00:00Z","timestamp":1732147200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIH","award":["1AI110324"],"award-info":[{"award-number":["1AI110324"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Voluntary medical male circumcision (VMMC) reduces the risk of heterosexual acquisition of HIV by 50%\u201360%. The Uganda Ministry of Health recommends abstinence of sex 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\u20132020.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Data from the Rakai Community Cohort Study (RCCS), a cross-sectional study, were analyzed. Data included consenting males aged 15\u201349 years in RCCS who self-reported having received VMMC between the period of 2013 to 2020. ESR prevalence and associated risk factors were assessed using modified Poisson regression to estimate adjusted prevalence ratios (aPR).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Overall, 1,832 participants were included in this study. ESR decreased from 45.1% in 2013 to 14.9% in 2020 (p&lt;0.001). Across the first three surveys, ESR prevalence was consistently higher among the married participants than the never married participants, 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 participants who reported to have more than one sexual partner than participants with one partner, aPR = 1.59, 95% CI: [1.16,2.20]. In the fourth survey from 2018\u20132020, ESR prevalence was significantly higher among participants with primary education than participants with post-primary, aPR = 2.38, 95% CI: [1.31, 4.30]. However, ESR prevalence was lower among participants aged at least 45 years than participants aged 15\u201319 years, aPR = 0.0, 95% CI: [1.86e-07, 2.69e-06]. Overall, participants 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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Self-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 may decrease ESR.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0297240","type":"journal-article","created":{"date-parts":[[2024,11,21]],"date-time":"2024-11-21T18:42:49Z","timestamp":1732214569000},"page":"e0297240","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Population-based cohort data used to assess trends in early resumption of sexual activity after voluntary medical male circumcision in Rakai, Uganda"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7596-6211","authenticated-orcid":true,"given":"Alex","family":"Daama","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fred","family":"Nalugoda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward","family":"Kankaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asani","family":"Kasango","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Betty","family":"Nantume","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grace Nalwoga","family":"Kigozi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Ssekubugu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juliana","family":"Namutundu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Absalom","family":"Ssettuba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom","family":"Lutalo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Kagaayi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6193-2790","authenticated-orcid":true,"given":"Gertrude","family":"Nakigozi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stella","family":"Alamo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5674-9166","authenticated-orcid":true,"given":"Lisa A.","family":"Mills","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geoffrey","family":"Kabuye","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ron","family":"Gray","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Wawer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Serwadda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nelson","family":"Sewankambo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Godfrey","family":"Kigozi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,11,21]]},"reference":[{"issue":"7","key":"pone.0297240.ref001","first-page":"845","article-title":"The impact of male circumcision on HIV incidence and cost per infection prevented: a stochastic simulation model from Rakai","volume":"21","author":"R.H. Gray","year":"2007","journal-title":"Uganda. Aids"},{"issue":"11","key":"pone.0297240.ref002","doi-asserted-by":"crossref","first-page":"e298","DOI":"10.1371\/journal.pmed.0020298","article-title":"Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial","volume":"2","author":"B. Auvert","year":"2005","journal-title":"PLoS medicine"},{"issue":"15","key":"pone.0297240.ref003","doi-asserted-by":"crossref","first-page":"2361","DOI":"10.1097\/00002030-200010200-00018","article-title":"Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis","volume":"14","author":"H.A. Weiss","year":"2000","journal-title":"Aids"},{"key":"pone.0297240.ref004","unstructured":"Organization, W.H., Preventing HIV through safe voluntary medical male circumcision for adolescent boys and men in generalized HIV epidemics: Enhancing uptake of VMMC among adolescent boys and men at higher risk for HIV-Evidence and case studies. Technical brief. 2021: World Health Organization."},{"issue":"1","key":"pone.0297240.ref005","article-title":"\u201cNow that you are circumcised, you cannot have first sex with your wife\u201d: post circumcision sexual behaviours and beliefs among men in Wakiso district, Uganda","volume":"20","author":"S.P.S. Kibira","year":"2017","journal-title":"African Journal of Reproduction and Gynaecological Endoscopy"},{"key":"pone.0297240.ref006","unstructured":"(MOH), M.o.H., Safe Male Circumcision for HIV prevention 2010."},{"issue":"9","key":"pone.0297240.ref007","doi-asserted-by":"crossref","first-page":"e0270545","DOI":"10.1371\/journal.pone.0270545","article-title":"Voluntary medical male circumcision in selected provinces in South Africa: Outcomes from a programmatic setting","volume":"17","author":"K. Moyo","year":"2022","journal-title":"PLoS One"},{"issue":"1","key":"pone.0297240.ref008","article-title":"Risk factors for HIV infection among circumcised men in Uganda: a case\u2010control study","volume":"18","author":"M. Ediau","year":"2015","journal-title":"African Journal of Reproduction and Gynaecological Endoscopy"},{"issue":"12","key":"pone.0297240.ref009","doi-asserted-by":"crossref","first-page":"e0168091","DOI":"10.1371\/journal.pone.0168091","article-title":"Early resumption of sex following voluntary medical male circumcision amongst school-going males","volume":"11","author":"G. George","year":"2016","journal-title":"Plos one"},{"issue":"11","key":"pone.0297240.ref010","doi-asserted-by":"crossref","first-page":"e0186831","DOI":"10.1371\/journal.pone.0186831","article-title":"Early resumption of sexual activity following voluntary medical male circumcision in Botswana: a qualitative study","volume":"12","author":"J.H. Ledikwe","year":"2017","journal-title":"PLoS One"},{"issue":"8","key":"pone.0297240.ref011","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1080\/09540121.2019.1698703","article-title":"Enhancers and barriers to uptake of male circumcision services in Northern Uganda: a qualitative study","volume":"32","author":"B.M. Nanteza","year":"2020","journal-title":"AIDS care"},{"key":"pone.0297240.ref012","unstructured":"WHO, U.A., Uneven progress on the voluntary medical male circumcision. 2022."},{"issue":"1","key":"pone.0297240.ref013","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1186\/s12889-023-15056-5","article-title":"Missed opportunity: low uptake of VMMC among men attending the OPD of a public health facility offering free VMMC services in Uganda","volume":"23","author":"R.N. Kiyai","year":"2023","journal-title":"BMC Public Health"},{"issue":"7","key":"pone.0297240.ref014","doi-asserted-by":"crossref","first-page":"e0133369","DOI":"10.1371\/journal.pone.0133369","article-title":"Improving the quality of voluntary medical male circumcision through use of the continuous quality improvement approach: a pilot in 30 PEPFAR-supported sites in Uganda","volume":"10","author":"J. Byabagambi","year":"2015","journal-title":"PloS one"},{"key":"pone.0297240.ref015","unstructured":"PEPFAR, PEPFAR\u2019s Best Practices for Voluntary Medical Male Circumcision Site Operations. 2020."},{"key":"pone.0297240.ref016","unstructured":"PEPFAR, PEPFAR Guide to Monitoring & Reporting Voluntary Medical Male Circumcision (VMMC) Indicators. 2013."},{"key":"pone.0297240.ref017","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1007\/s10461-011-0073-1","article-title":"Factors associated with the early resumption of sexual activity following medical male circumcision in Nyanza province, Kenya","volume":"16","author":"A. Herman-Roloff","year":"2012","journal-title":"AIDS and Behavior"},{"issue":"6","key":"pone.0297240.ref018","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1093\/cid\/ciw847","article-title":"Penile immune activation and risk of HIV shedding: a prospective cohort study","volume":"64","author":"E.U. Patel","year":"2017","journal-title":"Clinical Infectious Diseases"},{"issue":"6","key":"pone.0297240.ref019","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1097\/QAD.0b013e32835097ff","article-title":"Sex with stitches: assessing the resumption of sexual activity during the postcircumcision wound-healing period","volume":"26","author":"P.C. Hewett","year":"2012","journal-title":"Aids"},{"issue":"4","key":"pone.0297240.ref020","first-page":"465","article-title":"Factors associated with resumption of sex before complete wound healing in circumcised HIV-positive and HIV-negative men in Kisumu","volume":"62","author":"E. Odoyo-June","year":"2013","journal-title":"Kenya. JAIDS Journal of Acquired Immune Deficiency Syndromes"},{"issue":"9152","key":"pone.0297240.ref021","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/S0140-6736(98)06439-3","article-title":"Control of sexually transmitted diseases for AIDS prevention in Uganda: a randomised community trial","volume":"353","author":"M.J. Wawer","year":"1999","journal-title":"The lancet"},{"key":"pone.0297240.ref022","doi-asserted-by":"crossref","first-page":"e173","DOI":"10.1016\/S2352-3018(19)30378-9","article-title":"Quantifying HIV transmission flow between high-prevalence hotspots and surrounding communities: a population-based study in Rakai","volume":"7","author":"O. Ratmann","year":"2020","journal-title":"Uganda. Lancet HIV"},{"issue":"7\u20138","key":"pone.0297240.ref023","doi-asserted-by":"crossref","first-page":"e1147","DOI":"10.1093\/milmed\/usaa021","article-title":"HIV care continuum and meeting 90-90-90 targets: Cascade of care analyses of a US military cohort","volume":"185","author":"A. Anglemyer","year":"2020","journal-title":"Military medicine"},{"key":"pone.0297240.ref024","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-016-3385-2","article-title":"Factors associated with married women\u2019s support of male circumcision for HIV prevention in Uganda: a population based cross\u2013sectional study","volume":"16","author":"K. Mati","year":"2016","journal-title":"BMC Public Health"},{"issue":"3","key":"pone.0297240.ref025","doi-asserted-by":"crossref","first-page":"523","DOI":"10.4314\/ahs.v18i3.8","article-title":"HIV Epidemiology in Uganda: survey based on age, gender, number of sexual partners and frequency of testing","volume":"18","author":"J. Vithalani","year":"2018","journal-title":"African health sciences"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0297240","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,21]],"date-time":"2024-11-21T18:43:01Z","timestamp":1732214581000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0297240"}},"subtitle":[],"editor":[{"given":"Hamufare Dumisani","family":"Mugauri","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2024,11,21]]},"references-count":25,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11,21]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0297240","relation":{},"ISSN":["1932-6203"],"issn-type":[{"type":"electronic","value":"1932-6203"}],"subject":[],"published":{"date-parts":[[2024,11,21]]}}}