HIV and risk behaviour - Risk compensation: the Achilles' heel of innovations in HIV prevention?

Office of HIV/AIDS, United States Agency for International Development, Washington, DC 20523-3700, USA.
BMJ (online) (Impact Factor: 17.45). 04/2006; 332(7541):605-7. DOI: 10.1136/bmj.332.7541.605
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Available from: James D Shelton, Feb 24, 2014
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    • "ision could reduce the risk of HIV infection so that the use of condoms might only be necessary to avoid pregnancy . These findings are important because if men have more frequent sex without condoms , or are less motivated to use condoms to prevent pregnancy or other STIs , the protective benefits of circumcision may be substantially undermined ( Cassell et al . 2006 ; Thompson , Thompson , and Rivara 2001 ) . There are important limitations to our findings . Men in the focus groups were part of a larger home - based counselling and testing study and had received messages about VMMC before being part of the study . Additionally , data was collected within focus groups in which men were asked to arti"
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    ABSTRACT: While the uptake of voluntary medical male circumcision (VMMC) is increasing, South Africa has only attained 20% of its target to circumcise 80% of adult men by 2015. Understanding the factors influencing uptake is essential to meeting these targets. This qualitative study reports on findings from focus-group discussions with men in rural KwaZulu-Natal, South Africa, about what factors influence their perceptions of VMMC. The study found that VMMC is linked to perceptions of masculinity and male gender identity including sexual health, sexual performance and pleasure, possible risk compensation and self-identity. Findings highlight the need to understand how these perceptions of sexual health and performance affect men's decisions to undergo circumcision and the implications for uptake of VMMC. The study also highlights the need for individualised and contextualised information and counselling that can identify, understand and address the perceptions men have of VMMC, and the impacts they believe it will have on them.
    Culture Health & Sexuality 01/2015; 17(7):1-12. DOI:10.1080/13691058.2014.992045 · 1.55 Impact Factor
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    • "Behavioral disinhibition, also known as risk compensation, addresses the possibility that certain HIV-risk reduction measures may increase risky behaviors due to decreased self-perceived risk (Cassell et al. 2006, Wilde 1994). Thus, while applying the innovative " risk-homeostasis model " to HIV prevention, the main concern is that assuming protective benefits of promising interventions may be offset by increased risky behaviors. "
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    ABSTRACT: Antiretroviral drugs are being tried as candidates for the pre-exposure prophylaxis (PrEP) against HIV for a considerable period, due to their potential for immediate inhibition of viral replication. Discrepancies in the findings called for a critical review of the relevant efforts and their outcomes. A systematic literature search identified 143 eligible articles of which only 5 reported complete findings while another 11 were still on-going. Observed moderate efficacy and good safety profile seemed to identify PrEP as a promising step for minimizing the spread of HIV to relatively unaffected population and controlling the epidemic among high risk population groups. But the duration of this efficacy was found to depend heavily on the availability, adherence and other related issues like cost, political commitment, ethical consideration etc. To prevent potential cultural and behavioral modifications, proper pre-administration counseling also seemed critical for the success of PrEP as a cost-effective intervention with adequate coverage.
    Artificial Cells 07/2014; DOI:10.3109/21691401.2014.934458 · 1.02 Impact Factor
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    • "Risk compensation in the face of widespread promotion of MC is a concern [49]. However, higher risk sexual behavior, including decreasing condom use or increasing the number of partners in response to men getting circumcised was not reported by the women in our study. "
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    ABSTRACT: It is important to understand how women's sexual practices may be influenced by male circumcision (MC) as an HIV prevention effort. Women's beliefs about MC and sexual behaviour will likely influence the scale-up and uptake of medical MC. We conducted qualitative interviews with 30 sexually active women in Kisumu, Kenya. Women discussed MC related to perceived health benefits, condom use, sexual behaviour, knowledge of susceptibility to HIV and sexually transmitted infections (STIs), circumcision preference, and influence on circumcision uptake. Respondents had a good understanding of the partial protection of MC for acquisition of HIV for men. Women perceived circumcised men as cleaner, carrying fewer diseases, and taking more time to reach ejaculation. Male's circumcision status is a salient factor for women's sexual decision making, including partner choice, and condom use. It will be important that educational information affirms that MC provides only partial protection against female to male transmission of HIV and some STIs; that other HIV and STI prevention methods such as condoms need to be used in conjunction with MC; that MC does not preclude a man from having HIV; and that couples should develop plans for not having sex while the man is healing.
    PLoS ONE 05/2014; 9(5):e97748. DOI:10.1371/journal.pone.0097748 · 3.23 Impact Factor
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