title: "I Feel Like More of a Man": A Mixed Methods Study of Masculinity, Sexual Performance, and Circumcision for HIV Prevention.
abstract: 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 little research on these dynamics among men who have been circumcised 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 six to 12 months post-circumcision (N = 293) as well as in-depth interviews conducted with a subsample 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 partners 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.
authors.affiliation: a Division of Global Public Health , University of California , San Diego.|b Department of Health Behavior , Gillings School of Global Public Health, University of North Carolina at Chapel Hill.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Fleming
authors.affiliation: b Department of Health Behavior , Gillings School of Global Public Health, University of North Carolina at Chapel Hill.|c Carolina Population Center , University of North Carolina at Chapel Hill.
authors.forename: Clare
authors.initials: C
authors.lastname: Barrington
authors.affiliation: d Carolina Population Center and the Department of Sociology , University of North Carolina at Chapel Hill.
authors.forename: Lisa D
authors.initials: LD
authors.lastname: Pearce
authors.affiliation: e Clinica de Familia , La Romana , Dominican Republic.
authors.forename: Leonel
authors.initials: L
authors.lastname: Lerebours
authors.affiliation: f HIV Vaccine Trials Unit , Instituto Dermatológico y Cirugía de Piel , Santo Domingo , Dominican Republic.
authors.forename: Yeycy
authors.initials: Y
authors.lastname: Donastorg
authors.affiliation: g Division of Infectious Diseases , University of Illinois at Chicago.
authors.forename: Maximo O
authors.initials: MO
authors.lastname: Brito
mesh_terms: D000293:Adolescent; D000328:Adult; D002944:Circumcision, Male / Q000523:psychology*; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D008297:Male; D057228:Masculinity; D008875:Middle Aged; D036301:Qualitative Research; D012725:Sexual Behavior / Q000523:psychology*; D055815:Young Adult