Risk Compensation Following Medical Male Circumcision: Results from a 1-Year Prospective Cohort Study of Young School-Going Men in KwaZulu-Natal, South Africa



This study sought to assess risk compensation following voluntary medical male circumcision of young school-going men. Risk compensation is defined as an inadvertent increase in sexual risk behaviors and a corresponding decrease in self-perceived risk for contracting HIV following the application of a risk reduction technology.


This study documented the sexual practices of circumcised (n = 485) and uncircumcised (n = 496) young men in 42 secondary schools at three time points (baseline and 6 and 12 months) in a sub-district of KwaZulu-Natal, South Africa. Study participants were aged from 16 to 24 years old.


At the end of the study period, there was no significant difference between the two cohorts concerning learners’ perceptions of being at risk of contracting HIV (interaction effect: b = −0.12, p = 0.40). There was also no significant difference in the number of sexual partners in the previous month (interaction effect: b = −0.23, p = 0.15). The proportion of learners who have never used a condom decreased significantly over time (time effect: b = −0.27, p = 0.01), and there was no difference between the circumcised and uncircumcised learners (interaction effect: b = −0.09, p = 0.91).


Risk compensation, as evidenced in this study over a 1-year period, was not associated with undergoing voluntary medical male circumcision (VMMC) in our sample of young school-going men. However, it is of concern that at the end of this study, less than half of the sexually active sample in a high-HIV-prevalence community used condoms consistently in the previous month (39% for both study cohorts). The latter underscores the need to view VMMC as a potential entry point for planned HIV and sexuality education interventions targeting young men in this community.

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The authors would like to thank the Swedish International Development Cooperation Agency for funding the study (grant number 51040023-01). We would also like to thank all the participants and fieldworkers without whom this study would have not been possible.

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Correspondence to S Beckett.

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The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Permission to publicize the study and elicit learner participation in the selected schools was sought from the headmaster/headmistress of the school. A waiver of parental/guardian informed consent for learners who were aged from 16 to 18 years was sought and obtained from the University of KwaZulu-Natal Biomedical Research Ethics Committee (BF128/11).

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Govender, K., George, G., Beckett, S. et al. Risk Compensation Following Medical Male Circumcision: Results from a 1-Year Prospective Cohort Study of Young School-Going Men in KwaZulu-Natal, South Africa . Int.J. Behav. Med. 25, 123–130 (2018). https://doi.org/10.1007/s12529-017-9673-0

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  • Youth
  • Voluntary medical male circumcision
  • Risk compensation
  • HIV
  • HIV prevention