Article

Risk Compensation Is Not Associated with Male Circumcision in Kisumu, Kenya: A Multi-Faceted Assessment of Men Enrolled in a Randomized Controlled Trial

School of Public Health, University of Illinois at Chicago, Chicago, Illinois, United States of America.
PLoS ONE (Impact Factor: 3.53). 06/2008; 3(6):e2443. DOI: 10.1371/journal.pone.0002443
Source: PubMed

ABSTRACT Three randomized controlled trials (RCTs) have confirmed that male circumcision (MC) significantly reduces acquisition of HIV-1 infection among men. The objective of this study was to perform a comprehensive, prospective evaluation of risk compensation, comparing circumcised versus uncircumcised controls in a sample of RCT participants.
Between March 2004 and September 2005, we systematically recruited men enrolled in a RCT of MC in Kenya. Detailed sexual histories were taken using a modified Timeline Followback approach at baseline, 6, and 12 months. Participants provided permission to obtain circumcision status and laboratory results from the RCT. We evaluated circumcised and uncircumcised men's sexual behavior using an 18-item risk propensity score and acquisition of incident infections of gonorrhea, chlamydia, and trichomoniasis. Of 1780 eligible RCT participants, 1319 enrolled (response rate = 74%). At the baseline RCT visit, men who enrolled in the sub-study reported the same sexual behaviors as men who did not. We found a significant reduction in sexual risk behavior among both circumcised and uncircumcised men from baseline to 6 (p<0.01) and 12 (p = 0.05) months post-enrollment. Longitudinal analyses indicated no statistically significant differences between sexual risk propensity scores or in incident infections of gonorrhea, chlamydia, and trichomoniasis between circumcised and uncircumcised men. These results are based on the most comprehensive analysis of risk compensation yet done.
In the context of a RCT, circumcision did not result in increased HIV risk behavior. Continued monitoring and evaluation of risk compensation associated with circumcision is needed as evidence supporting its' efficacy is disseminated and MC is widely promoted for HIV prevention.

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    ABSTRACT: Background Zimbabwe adopted voluntary medical male circumcision (VMMC) as an additional HIV prevention strategy in 2009. A number of studies have been conducted to understand the determinants of VMMC uptake but few studies have examined the characteristics of men who are willing to get circumcised or the link between wanting circumcision and risky sexual behaviour. This study investigated the relationship between wanting male circumcision and engaging in risky sex behaviours. This was based on the assumption that those who are willing to undergo circumcision are already engaging in risky sexual behaviours. Data and methods Data from men age 15–45 years who were interviewed during the 2010–11 Zimbabwe Demographic and Health Survey of 2010–11 was used. A total of 7480 men were included in the sample for this study. Logistic regression was used to assess the association between wanting circumcision and risky sexual behaviours. Findings Men in the highest wealth tercile were significantly more likely to want circumcision compared to men in lower wealth terciles (OR = 1.36, p < 0.01). Wanting circumcision was also significantly associated with age. Men in the 25–34 age category reported wanting circumcision more (OR = 1.21, p < 0.05) while older men were significantly less likely to want circumcision (OR = 0.63, p < 0.01). Christian men and those residing in rural areas were also less likely to want circumcision (OR = 0.74, p < 0.05 and OR = 0.75, p < 0.001 respectively). The findings of this study indicate a strong association between wanting circumcision and having had risky sex (OR = 1.36, p < 0.01), having multiple partners (OR = 1.35, p < 0.01) and having paid for sex (OR = 1.42, p < 0.001) However, wanting circumcision was negatively associated with having used a condom at the last risky sex (OR = 0.76, p < 0.001). Conclusions The association between demand for VMMC and risky sexual behaviour need continuous monitoring. We emphasise that the promotion of VMMC for HIV prevention should not overshadow the promotion of existing methods of HIV prevention such as condoms and reduction of sexual partners.
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