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. 2019 Mar 7;14(3):e0213571.
doi: 10.1371/journal.pone.0213571. eCollection 2019.

Voluntary medical male circumcision (VMMC) for prevention of heterosexual transmission of HIV and risk compensation in adult males in Soweto: Findings from a programmatic setting

Hillary Mukudu  1   2 , Janan Dietrich  1 , Kennedy Otwombe  1 , Mmatsie Manentsa  1 , Khuthadzo Hlongwane  1 , Maetal Haas-Kogan  3 , Benn Sartorius  4 , Neil Martinson  1
Affiliations

Voluntary medical male circumcision (VMMC) for prevention of heterosexual transmission of HIV and risk compensation in adult males in Soweto: Findings from a programmatic setting

Hillary Mukudu et al. PLoS One. .

Abstract

Background: Clinical trials have clearly shown a reduction in HIV acquisition through voluntary medical male circumcision (VMMC). However, data assessing risk compensation under programmatic conditions is limited.

Methods: This was a prospective cohort of HIV seronegative males aged 18-40 years receiving VMMC between November 2012 and July 2014. HIV serostatus was determined pre and post VMMC. Risk compensation was defined as a decrease in condom use at last sex act and/or an increase in concurrent sexual relationships, both measured twelve months post-circumcision.

Results: A total of 233 males were enrolled and underwent voluntary medical male circumcision (VMMC) for prevention against HIV. There was no evidence of risk compensation post-circumcision as defined in this study. Significant increases in proportion of participants in the 18-24 years age group who knew the HIV status of their sexual partner (39% to 56%, p = 0.0019), self-reported condom use at last sex act (21% to 34%, p = 0.0106) and those reporting vaginal sexual intercourse in the past 12 months (67% to 79%, p-value = <0.0001) were found. In both 18-24 and 25-40 years age groups, there was a significant increase in perception of being at risk of contracting HIV (70% to 84%, p-value = <0.0001).

Conclusion: No significant risk compensation was observed in this study on comparing pre-and post-circumcision behaviour. An increase in proportion of participants in the 18-24 years age group who had vaginal intercourse in the first 12 months post-circumcision as a possibility of risk compensation was minimal and negated by an increase in proportion of those reporting using a condom at the last sex act, increase in knowledge of partner's HIV status and lack of increase in alcohol post-circumcision.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Screening, enrolment and follow-up of study participants.
See this image and copyright information in PMC

References

    1. WHO. Voluntary Medical Male Circumcision for Hiv Prevention in 14 Priority Countries in East and Southern Africa. Progess Br [Internet]. 2015;2015–6. http://apps.who.int/iris/bitstream/10665/179933/1/WHO_HIV_2015.21_eng.pdf
    1. Mills E, Cooper C, Anema A, Guyatt G. Male circumcision for the prevention of heterosexually acquired HIV infection: a meta-analysis of randomized trials involving 11,050 men. HIV Med [Internet]. 2008. July [cited 2013 Feb 27];9(6):332–5. http://www.ncbi.nlm.nih.gov/pubmed/18705758 - PubMed
    1. Shisana O, Rehle T, Simbayi LC, Zuma K, Jooste S, Zungu N. South African National HIV Prevalence, Incidence and Behaviour Survey, 2012. In HSRC Press; 2014. p. 35–45. http://www.hsrc.ac.za/en/research-outputs/view/6871 - PubMed
    1. Weiss HA, Dickson KE, Agot K, Hankins CA. Male circumcision for HIV prevention: current research and programmatic issues. AIDS. 2010;24 Suppl 4:S61–9. - PMC - PubMed
    1. Westercamp M, Bailey RC, Bukusi E, Montandon M, Kwena Z, Cohen CR. Male circumcision in the general population of Kisumu, Kenya: beliefs about protection, risk behaviors, HIV, and STIs. PLoS One [Internet]. 2010. January [cited 2014 Jan 15];5(12):e15552 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3002946&tool=p... - PMC - PubMed

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