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CSU 39/2008: RISK COMPENSATION IN KISUMU, KENYA

Monday, 22nd of September 2008

CSU 39/2008: RISK COMPENSATION IN   KISUMU, KENYA
 
 Dear All,
 
 It is sometimes stated, without proof, that the promotion of male
 circumcision will lead to increases in high risk behavior, thus reducing
 or eliminating  the gains in risk reduction derived from the procedure.
 
 Only an evidence based approach will answer these concerns. In this study
 from western Kenya, Mattson and colleagues measured sexual behavior among
 male subjects in a Kenyan research project. "Circumcision did not result
 in increased HIV risk behavior."
 
 Authors' abstract from PLOS/One is reproduced below, full text is at
 http://www.plosone.org/article/info:doi/10.1371/journal.pone.0002443
 
 Good reading.
 
 BD
 
 PLoS ONE. 2008 Jun 18;3(6):e2443.
 
 Risk compensation is not associated with male circumcision in Kisumu,
 Kenya: a multi-faceted assessment of men enrolled in a randomized
 controlled trial.Mattson CL, Campbell RT, Bailey RC, Agot K, Ndinya-Achola
 JO, Moses S.
 School of Public Health, University of Illinois at Chicago,
 Chicago,Illinois, United States of America. christine.mattson@gmail.com
 
 BACKGROUND: Three randomized controlled trials (RCTs) have confirmed that
 male circumcision (MC) significantly reduces acquisition of HIV-1
 infection among men. The objective of this study was to perform a
 comprehensive, prospective evaluation of risk compensation, comparing
 circumcised versus uncircumcised controls in a sample of RCT participants.

 METHODS AND FINDINGS: Between March 2004 and September 2005, we
 systematically recruited men enrolled in a RCT of MC in Kenya. Detailed
 sexual histories were taken using a modified Timeline Followback approach
 at baseline, 6, and 12 months. Participants provided permission to obtain
 circumcision status and laboratory results from the RCT. We evaluated
 circumcised and uncircumcised men's sexual behavior using an 18-item risk
 propensity score and acquisition of incident infections of gonorrhea,
 chlamydia, and trichomoniasis. Of 1780 eligible RCT participants, 1319
 enrolled (response rate = 74%). At the baseline RCT visit, men who
 enrolled in the sub-study reported the same sexual behaviors as men who
 did not. We found a significant reduction in sexual risk behavior among
 both circumcised and uncircumcised men from baseline to 6 (p<0.01) and 12
 (p = 0.05) months post-enrollment. Longitudinal analyses indicated no
 statistically significant differences between sexual risk propensity
 scores or in incident infections of gonorrhea, chlamydia, and
 trichomoniasis between circumcised and uncircumcised men. These results
 are based on the most comprehensive analysis of risk compensation yet
 done.

CONCLUSION: In the context of a RCT, circumcision did not result in
 increased HIV risk behavior. Continued monitoring and evaluation of risk
 compensation associated with circumcision is needed as evidence supporting
 its efficacy is disseminated and MC is widely promoted for HIV
 prevention.