No evidence of increased risk behaviours among recently circumcised men

Risk compensation following male circumcision: results from a two-year prospective cohort study of recently circumcised and uncircumcised men in Nyanza province, Kenya 

Westercamp N, Agot K, Jaoko W, Bailey RC. AIDS Behav. 2014 Sep;18(9):1764-75. doi: 10.1007/s10461-014-0846-4. Epub 22 July 2014.

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.

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Editor’s notes:  There has always been a concern that scale-up of voluntary medical male circumcision (VMMC) may be accompanied by risk compensation – i.e. an increase in risky behaviour in response to perceived risk reduction. To date, data on risk compensation following VMMC have been from the trial populations (including extended follow-up), and this is the first longitudinal study to assess risk compensation associated with MC in the context of a successful national scale-up in Kenya. The study is reassuring in that it showed no evidence of behavioural risk compensation over two years of follow-up. Further, the men exposed to the VMMC programme (both as circumcised clients and through informational messages as uncircumcised controls), meaningfully shifted towards safer sexual behaviours.  This suggests that, as long as VMMC programmes include emphasis on continuing risk reducing practices, there seems to be little risk compensation following scale-up of male circumcision.

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