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Risk compensation following medical male circumcision: results from a one-year prospective cohort study of circumcised and uncircumcised school-going youth in KwaZulu-Natal, South Africa

Tuesday, 19th of July 2016

 

This year’s AIDS conference includes 9 sessions on male circumcision.

Among the most discussed topics in circumcision is whether risk compensation occurs.

Here are the conclusions of one South African study.

Conference abstracts, International AIDS Conference, Durban, July 2016

Risk compensation following medical male circumcision: results from a one-year prospective cohort study of circumcised and uncircumcised school-going youth in KwaZulu-Natal, South Africa

Presenter

Kaymarlin Govender

Authors

K. Govender^1,2, G. George¹, S. Beckett¹, C. Montague³, J. Frohlich³

Institutions

¹University of KwaZulu-Natal, Health Economic and HIV/AIDS Research Division, Durban, South Africa, ²University of KwaZulu-Natal, Psychology, Durban, South Africa, ³Centre for the AIDS Programme of Research in South Africa, Durban, South Africa

Background: Voluntary medical male circumcision (VMMC) in young men is an important component of national HIV prevention programmes, given its protective effect in the heterosexual transmission of HIV. Concerns have been raised that circumcised men will increase their sexual risk behaviours following circumcision as a result of lowered perceptions of HIV-risk. This possibility of risk compensation has the potential to reverse the public health benefit of VMMC. Accordingly, this study documented sexual practices of circumcised (n= 616) and uncircumcised (n=589) learners in 42 mixed sex secondary schools over a 12 month period in Vulindlela, KwaZulu-Natal who were targeted by a national department of health VMMC campaign.
Methods: During the VMMC campaign (March 2011 To February 2013) 5165 learners were circumcised and 5923 refused to be circumcised. We randomly selected participants for each cohort from March 2012 until May 2013. Study participants aged 16 to 24 years were interviewed at baseline, 6 months after baseline and at 12 months. Mixed effect models were used to account for the longitudinal data and the clustering of learners in schools.
Results: The uncircumcised cohort was slightly older than the circumcised group (17.4 vs 17.7 years, p < .01). In terms of sexual behaviours, the uncircumcised cohort was more likely to be sexually active at the baseline interview (54 vs. 41%; p < .01). There were no statistically significant differences between the circumcised and uncircumcised cohort in terms of number of sexual acts in the previous 6 months (p=.32) and the number of sexual partners in the previous 6 months (p = .77). Further, perceptions of HIV risk were significantly lower in the circumcised cohort than in the uncircumcised cohort at study endpoint (p = .01). The uncircumcised group reported higher incidence of transactional sex than the circumcised group (7% vs. 2%, p < .01).
Conclusions: There was no evidence of risk compensation in this study. Early involvement of young men in VMMC is optimal for HIV prevention, however the intensification of prevention activities needs to be addressed for high risk young men such as those who engage in transactional sex and refuse circumcision.View the full AIDS 2016 programme

 

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