“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.

Acknowledgments

We would like to thank Martha Perez, Miriam Nova, Riqui Rosario, and Nicolas González for their assistance in recruitment and data collection.

Funding

This project was supported by a National Center for Advancing Translational Sciences, National Institutes of Health grant (UL1TR000050). We are grateful to the Carolina Population Center for training support (T32 HD007168) and for general support (R24 HD050924). P. J. Fleming was supported by a UNC STD/HIV training grant (T32AI007001) and subsequently by a NIDA training grant (T32 DA023356). Fieldwork was generously supported by the Explorations in Global Health Award from the UNC Institute for Global Health and Infectious Disease, UNC Carolina Population Center’s Research Residency Award, the Mellon Dissertation Fellowship from UNC’s Institute for the Study of the Americas, and the Koch Travel Award from the Gillings School of Global Public Health at UNC.

Additional information

Funding

This project was supported by a National Center for Advancing Translational Sciences, National Institutes of Health grant (UL1TR000050). We are grateful to the Carolina Population Center for training support (T32 HD007168) and for general support (R24 HD050924). P. J. Fleming was supported by a UNC STD/HIV training grant (T32AI007001) and subsequently by a NIDA training grant (T32 DA023356). Fieldwork was generously supported by the Explorations in Global Health Award from the UNC Institute for Global Health and Infectious Disease, UNC Carolina Population Center’s Research Residency Award, the Mellon Dissertation Fellowship from UNC’s Institute for the Study of the Americas, and the Koch Travel Award from the Gillings School of Global Public Health at UNC.