Risk Compensation Following Male Circumcision: Results from a Two-Year Prospective Cohort Study of Recently Circumcised and Uncircumcised Men in Nyanza Province, Kenya
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We present the results of the first study of longitudinal change in HIV-associated risk behaviors in men before and after circumcision in the context of a population-level voluntary medical male circumcision (VMMC) program. The behaviors of 1,588 newly circumcised men and 1,598 age-matched uncircumcised controls were assessed at baseline, 6, 12, 18 and 24 months of follow-up. Despite the precipitous decline in perception of high HIV risk among circumcised men (30–14 vs. 24–21 % in controls) and increased sexual activity among the youngest participants (18–24 years; p-time < 0.0001, p-group = 0.96), all specific risk behaviors decreased over time similarly in both groups. The proportion of men reporting condom use at last sex increased for both groups, with a greater increase among circumcised men (30 vs. 6 %). We found no evidence of risk compensation in men following circumcision. Concerns about risk compensation should not impede the widespread scale-up of VMMC initiatives.
KeywordsRisk compensation Behavioral disinhibition Male circumcision HIV/AIDS Sexual behavior Africa
Support for this study was provided by a Grant to FHI360 from the Bill and Melinda Gates Foundation to support the Male Circumcision Consortium, a partnership between FHI360, EngenderHealth, and University of Illinois at Chicago working closely with the Nyanza Reproductive Health Society (Grant #47394). Robert C. Bailey received support from the Chicago Developmental Center for AIDS Research, an NIH funded program (P30 AI 082151). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
We thank all of the participants, without whom this work would not have been possible. We are grateful to Timothy Okeyo, Cosam Ang’awa, Yusto Okembia, Kevine Amolloh, Kelvin Akoth, Kennedy Otieno, Danstan Ochieng’, Victor Odula, George Kidi, David Ang’awa, Evans Otieno, Erik Ogutu, George Ong’eng’a, and Richard Okello for their dedication in recruitment, data collection, tracing, and overall commitment to the study; to Nicholas Obwama and Joseph Abuya for their tireless data entry and cleaning efforts; to Matthew Westercamp for his invaluable input and for reading and editing multiple versions of this manuscript; to Christine L. Mattson for inspiration; and to the entire NRHS staff for their assistance in making this study a success.
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