“Perceptions of Risk and Sexual Behavior Change following Adult Male Circumcision in Urban Swaziland” Paper for presentation at PAA Annual Conference for Session 40 ‘Sexual Behavior, Condom Use and STIs,’ Thursday, April 15th 1:30-3:20pm

Background: Male circumcision has been shown to reduce the risk of heterosexual transmission of HIV infection in men by up to 60% in three randomized controlled trials. However, little is known about the sexual behavior change of men who have been circumcised and whether the protective effect of circumcision leads to riskier sexual behavior. Objectives: To understand Swazi men’s perceptions of their sexual risk following circumcision and to establish whether they take part in riskier sexual behavior after being circumcised as adults. Methods: This study uses qualitative in-depth interviews to understand men’s sexual behavior after circumcision. Men in urban Swaziland, circumcised in the last 12 months, were recruited and asked about their perceptions of sexual risk, and sexual behavior post-circumcision. Results: Although behavioral disinhibition was investigated, results show that men report greater sexual responsibility and sexual satisfaction after the procedure. Results also indicate that HIV counseling and testing may act as a barrier to men seeking circumcision, which reinforces the need for consistent messaging supporting HIV counseling and testing practices with male circumcision scale-up. Conclusion: Contrary to concerns about men participating in riskier sexual behaviors following adult male circumcision, reducing one’s the risk of HIV acquisition does not directly lead to riskier behaviors. Men decide to undergo the procedure primarily for the health-related benefits, as their main intention is to make themselves safer during sexual intercourse.