Condom migration resulting from circumcision, microbicides and vaccines: brief review and methodological considerations

Crosby, Richard A.; Ricks, JaNelle M.; Young, April M.

doi:10.1071/sh11091

Cited by 12 publications

(12 citation statements)

References 75 publications

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“…Specifically, the perception is that circumcised men, considering themselves armed with an ''invisible condom'', will be less inclined to practice, and women less able to negotiate, condom use [18,21,49,50]. In contrast, qualitative research in newly circumcised men has repeatedly revealed the view that circumcised men find condoms easier and more comfortable to use once the foreskin has been removed [51], and a modest increase in condom use was observed in the Kisumu trial [1].…”

Section: Discussionmentioning

confidence: 99%

Risk Compensation Following Male Circumcision: Results from a Two-Year Prospective Cohort Study of Recently Circumcised and Uncircumcised Men in Nyanza Province, Kenya

et al. 2014

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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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Section: Discussionmentioning

confidence: 99%

Risk Compensation Following Male Circumcision: Results from a Two-Year Prospective Cohort Study of Recently Circumcised and Uncircumcised Men in Nyanza Province, Kenya

et al. 2014

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“…must be considered as only part of a comprehensive prevention strategy to reduce the risk of HIV-1 infection and that other preventive measures should also be used” (FDA, 2012; Gilead Sciences Inc., 2012, p. 1). Questions about risk compensation behavior have arisen for each of the emerging HIV prevention technologies (Crosby et al, 2012; Eaton & Kalichman, 2007), and they will persist as the field progresses to study new drug candidates, delivery strategies, and mechanisms for preventing infection.…”

Section: Introductionmentioning

confidence: 99%

Study designs for identifying risk compensation behavior among users of biomedical HIV prevention technologies: Balancing methodological rigor and research ethics

Underhill

2013

Social Science & Medicine

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The growing evidence base for biomedical HIV prevention interventions – such as oral pre-exposure prophylaxis, microbicides, male circumcision, treatment as prevention, and eventually prevention vaccines – has given rise to concerns about the ways in which users of these biomedical products may adjust their HIV risk behaviors based on the perception that they are prevented from infection. Known as risk compensation, this behavioral adjustment draws on the theory of “risk homeostasis,” which has previously been applied to phenomena as diverse as Lyme disease vaccination, insurance mandates, and automobile safety. Little rigorous evidence exists to answer risk compensation concerns in the biomedical HIV prevention literature, in part because the field has not systematically evaluated the study designs available for testing these behaviors. The goals of this Commentary are to explain the origins of risk compensation behavior in risk homeostasis theory, to reframe risk compensation as a testable response to the perception of reduced risk, and to assess the methodological rigor and ethical justification of study designs aiming to isolate risk compensation responses. Although the most rigorous methodological designs for assessing risk compensation behavior may be unavailable due to ethical flaws, several strategies can help investigators identify potential risk compensation behavior during Phase II, Phase III, and Phase IV testing of new technologies. Where concerns arise regarding risk compensation behavior, empirical evidence about the incidence, types, and extent of these behavioral changes can illuminate opportunities to better support the users of new HIV prevention strategies. This Commentary concludes by suggesting a new way to conceptualize risk compensation behavior in the HIV prevention context.

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“…However, it is critical to convey that the gel offers increased protection to women for whom condom use is not feasible, while also reinforcing the message that women who are already consistently using condoms should NOT switch to only using microbicide gel (since this will decrease their level of HIV protection). Several research studies have indicated that people may stop using condoms if they have access to antiretroviral (ARV)-based prevention methods instead (Crosby, Ricks, & Young, 2012;Fowler, Arkell, Abouyannis, James, & Roberts, 2014). This potential for ''condom migration'' is particularly concerning, given the great strides that have been made in promoting condoms for HIV prevention.…”

Section: Communication Challengementioning

confidence: 99%

Positioning Microbicides for HIV Prevention in Kenya

Ryan

Bockh

Tolley

et al. 2015

Social Marketing Quarterly

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This case study describes the experience of developing communication messages and materials to position microbicide gel-a product still in clinical trials-for HIV prevention in Kenya. A robust development process included stakeholder and audience consultations, a national message development workshop, two rounds of pretesting, and an evaluation study to evaluate the impact of the materials on intentions and attitudes related to microbicide use. Awareness-raising and in-depth educational materials for both potential microbicide users and health care providers were developed. The project team tested two different ways of positioning microbicides-one focused primarily on the HIV prevention benefits of the product and the other focused on other benefits, such as increased sexual pleasure and intimacy. This experience presented a number of unique social marketing and communication challenges related to the inherent characteristics of microbicides, the fact that they are not yet licensed for use, and the potential for inadvertently stigmatizing the product and encouraging condom migration. The project confirmed that marketing microbicides to women in a wide variety of sexual contexts-and gaining support of male partners-will be critical for avoiding stigmatization of the product. It also confirmed that the positioning of the product can impact interest in using microbicides and that in-depth counseling of users will be critical for ensuring correct use.

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Condom migration resulting from circumcision, microbicides and vaccines: brief review and methodological considerations

Abstract: Until stronger evidence suggests that condom migration is unlikely, it is important to be mindful of the potential for condom migration to occur in response to biomedical interventions (circumcision, microbicides and vaccines).

Cited by 12 publications

References 75 publications

Risk Compensation Following Male Circumcision: Results from a Two-Year Prospective Cohort Study of Recently Circumcised and Uncircumcised Men in Nyanza Province, Kenya

Risk Compensation Following Male Circumcision: Results from a Two-Year Prospective Cohort Study of Recently Circumcised and Uncircumcised Men in Nyanza Province, Kenya

Study designs for identifying risk compensation behavior among users of biomedical HIV prevention technologies: Balancing methodological rigor and research ethics

Positioning Microbicides for HIV Prevention in Kenya

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