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Male post-coital penile cleansing and the risk of HIV-acquisition in rural Rakai district, Uganda
Presented by FREDRICK EDWARD Makumbi, .
Makumbi F.E.1, Gray R.H.2, Wawer M.3, Nakigozi F.G.4, Serwada D.1, Kigozi G.4, Watya S.5, Sempijja V.4, Wabwire-Mangen F.1
1Makerere University, Institute of Public Health, Kampala, Uganda, 2John Hopkins University, Bloomberg School of Public Health, Population and Family Health Sciences, Baltimore, United States, 3Johns Hopkins University, Bloomberg School of Public Health, Population and Family Health Sciences, Baltimore, United States, 4Rakai Health Sciences Program, Entebbe, Uganda, 5Makerere University, Mulago Hospital, Department of Surgery, Urology Unit, Kampala, Uganda
Objectives: Post-coital penile cleansing has been suggested as an alternative to male circumcision for HIV prevention.
Methods: 2552 HIV-negative uncircumcised men enrolled in the control arm of a randomized trial of male circumcision for HIV prevention were interviewed about post-coital penile hygiene practices (washing the penis after sex, use of a dry cloth or washing or both, and the time from intercourse to cleansing after sex). HIV incidence per 100 person-years (py) and, incidence rate ratios (IRR) and 95% confidence interval (CI) were estimated by Poisson regression by methods of post-coital cleansing, adjusting for condom use, sexual partners, alcohol use and perceived risk of partners’ HIV status
Results: There were 4378 follow-up intervals during which men reported being sexually active. In 83.0% of these intervals, men reported post-coital cleansing with all partners following coitus. HIV incidence among men reporting cleansing with all partners (1.69/100py) compared to those never cleansing (1.22/100py) was not statistically significant (adj.IRR=1.20; 95%CI: 0.42-3.38). Among those reporting post-coital cleansing with all partners, 49.2% cleaned within 3 minutes after intercourse. HIV incidence was significantly higher among those reporting cleansing within 3 minutes (2.32/100 py), compared to those reporting a delay of more than 10 minutes (0.39/100py, adj.IRR= 0.13; 95%CI: 0.03 0.54). Methods used for cleansing included washing-alone (46.9%), a cloth and washing (40.6%) or a dry cloth-alone (12.4%). However, HIV incidence was higher among those reporting washing-alone (2.20/100 py), than those reporting use of a cloth and washing (1.04/100 py) and those using a cloth-alone (0.55/100 py, c2 for trend p=0.0442).
Conclusions: Post-coital penile cleaning is common in this rural population, and penile cleansing shortly after intercourse is associated with increased HIV risk in uncircumcised men, suggesting caution in promoting post-coital cleansing as an alternative to circumcision for HIV prevention in this rural setting.
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