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

AIDS Behav. 2014 Sep;18(9):1764-75. doi: 10.1007/s10461-014-0846-4.

Abstract

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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Case-Control Studies
  • Circumcision, Male / psychology
  • Circumcision, Male / statistics & numerical data*
  • Condoms / statistics & numerical data
  • Follow-Up Studies
  • HIV Infections / epidemiology
  • HIV Infections / prevention & control*
  • Humans
  • Kenya / epidemiology
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Factors
  • Risk-Taking
  • Rural Population / statistics & numerical data*
  • Sexual Behavior / statistics & numerical data*