MedicalResearch.com Interview with:
Dr. Nelli Westercamp PhD, MPH, MBA
University of Illinois at Chicago
School of Public Health
Kenya, Epidemiology and Public Health
Medical Research: What are the main findings of the study?
Dr. Westercamp: The three clinical control trials in Kenya, Uganda and South Africa found that male circumcision reduces the risk of female to male transmission by up to 60%, prompting the endorsement of medical male circumcision as an HIV prevention intervention by the WHO and UNAIDS. However, as medical male circumcision services for HIV prevention are being rolled out in the priority countries, questions remain whether the male circumcision promotion will actually translate into decreases in HIV infections. One factor that could reduce the effectiveness of male circumcision for HIV prevention at the population level is the behavioral risk compensation. In other words, if men who become circumcised believe that they are fully protected against HIV and engage in higher sexual risk taking behaviors as a result of this belief, this could reduce or even negate the protective effect of male circumcision against HIV.
To answer this question, we conducted a large prospective study concurrently with the scale up of male circumcision services in Western Kenya. We recruited 1,588 men seeking circumcision services as well as 1,598 men who decided to remain uncircumcised and assessed their sexual behaviors over 2 years, every 6 months. We then compared the behaviors of circumcised men before and after circumcision and also the behaviors of circumcised and uncircumcised men over time.
In the beginning of the study, we found that men choosing to become circumcised believed they were at higher risk of HIV than their uncircumcised counterparts. This perception of HIV risk declined significantly among the circumcised men after circumcision (from 30% at baseline to 14% at 24 months of follow up), while remaining relatively stable among the uncircumcised men (24% to 21%, respectively). Looking at sexual risk behaviors, we saw that the overall level of sexual activity increased equally in both groups, mostly driven by the youngest age group (18-24 year old). However, despite the decrease in risk perception among circumcised men and the increase in sexual activity among all men, all other risky behaviors decreased in both groups and protective behaviors – such as condom use – increased, particularly among circumcised men.
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