Male circumcision for HIV prevention: Awareness, risk compensation, and risk perceptions among South African women

Kalichman, Seth C.; Mathews, Catherine; Kalichman, Moira O.; Eaton, Lisa A.; Nkoko, Koena

doi:10.1080/17441692.2018.1427277

Cited by 15 publications

(7 citation statements)

References 34 publications

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“…Studies in KwaZulu-Natal 63,64 and Orange Farm 65 in South Africa, similar to studies in Zimbabwe 66 , Kenya 67 and Uganda 68 , found no evidence for changed risk behaviours after MMC. However, surveys in Cape Town found perceptions or expectations of MMC-related risk compensation in both men and women [69][70][71] . A further source of impact overestimation could be elevated risk during wound healing.…”

Section: Limitationsmentioning

confidence: 99%

The impact of the program for medical male circumcision on HIV in South Africa: analysis using three epidemiological models

Korenromp¹,

Bershteyn

Mudimu

et al. 2021

Gates Open Res

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Background: South Africa began offering medical male circumcision (MMC) in 2010. We evaluated the current and future impact of this program to see if it is effective in preventing new HIV infections. Methods: The Thembisa, Goals and Epidemiological Modeling Software (EMOD) HIV transmission models were calibrated to South Africa’s HIV epidemic, fitting to household survey data on HIV prevalence, risk behaviors, and proportions of men circumcised, and to programmatic data on intervention roll-out including program-reported MMCs over 2009-2017. We compared the actual program accomplishments through 2017 and program targets through 2021 with a counterfactual scenario of no MMC program. Results: The MMC program averted 71,000-83,000 new HIV infections from 2010 to 2017. The future benefit of the circumcision already conducted will grow to 496,000-518,000 infections (6-7% of all new infections) by 2030. If program targets are met by 2021 the benefits will increase to 723,000-760,000 infections averted by 2030. The cost would be $1,070-1,220 per infection averted relative to no MMC. The savings from averted treatment needs would become larger than the costs of the MMC program around 2034-2039. In the Thembisa model, when modelling South Africa’s 9 provinces individually, the 9-provinces-aggregate results were similar to those of the single national model. Across provinces, projected long-term impacts were largest in Free State, KwaZulu-Natal and Mpumalanga (23-27% reduction over 2017-2030), reflecting these provinces’ greater MMC scale-up. Conclusions: MMC has already had a modest impact on HIV incidence in South Africa and can substantially impact South Africa’s HIV epidemic in the coming years.

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Section: Limitationsmentioning

confidence: 99%

The impact of the program for medical male circumcision on HIV in South Africa: analysis using three epidemiological models

Korenromp¹,

Bershteyn

Mudimu

et al. 2021

Gates Open Res

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“…Behavioral risk compensation is not limited to men only as women may change their behavior in the belief that VMMC protects them. In one study in South Africa, women who were aware of the benefits believed that VMMC reduced the need to worry about HIV and were less likely to use condoms with circumcised men [ 21 ]. Furthermore, even when the men are circumcised, some resume sexual activity before the 6 weeks post circumcision wound healing period and this increases the risk of HIV [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

A comparison of the prevalence of sexually transmitted infections among circumcised and uncircumcised adult males in Rustenburg, South Africa: a cross-sectional study

2021

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Background South Africa has a persistent burden of sexually transmitted infections (STIs). Male circumcision has been shown to be effective in preventing HIV and STIs, but data are scarce on the protective effect of circumcision in high-risk populations such as migrant miners. The objective of this study was to assess the effect of medical and traditional circumcision on the prevalence of STIs after adjusting for other risk factors in Rustenburg, a mining town in North West Province, South Africa. Methods This cross-sectional study used baseline data collected from a cohort study. Adult males in a mining town were assessed for STIs (gonorrhea, chlamydia, and trichomoniasis) using syndromic assessment. Data on circumcision status and other risk factors for STI syndromes were collected using an interviewer-administered questionnaire. The following symptoms were assessed; penile discharge, painful urination, dyspareunia or penile sores. These symptoms indicate sexually transmitted infection in general since laboratory tests were not performed. Multivariable log binomial regression was used to assess the independent effect of circumcision on STI presence after adjusting for confounders. Results A total of 339 participants with a median age of 25 years (IQR 22–29) were included in the study, of whom 116 (34.2%) were circumcised. The overall STIs prevalence was 27.4% (95% CI 22.8 to 32.6%) and was lower in the circumcised participants compared with those who were uncircumcised (15.5% vs 33.6%, respectively, p < 0.001). Both medical (OR 0.57, 95% CI 0.34–0.95, p = 0.030) and traditional circumcision (OR 0.34, 95% CI 0.13–0.86, p = 0.022) were strongly associated with a lower risk of STIs after adjustment for employment and condom use. Conclusion In this high-risk population in a mining town in South Africa, with a relatively high prevalence of STIs, and where one third of males are circumcised, both medical and traditional circumcision appear to be protective against STIs.

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“…Behavioral risk compensation is not limited to men only as women may change their behavior in the belief that VMMC protects them. In one study in South Africa, women who were aware of the benefits believed that VMMC reduced the need to worry about HIV and were less likely to use condoms with circumcised men (20). STIs tend to be diagnosed late in women and commercial sex workers may act as reservoirs of infection and increase the risk of incident cases and re-infection (21).…”

Section: Introductionmentioning

confidence: 99%

A Comparison of the Prevalence of Sexually Transmitted Infections Among Circumcised and Uncircumcised Adult Males in Rustenburg, South Africa: A Cross-Sectional Study

Iyemosolo

Chivese

Esterhuizen

2020

Preprint

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Background South Africa has a persistent burden of sexually transmitted infections (STIs), despite improvements in prevention, treatment, screening, and surveillance. Male circumcision has been shown to be effective in preventing HIV, and other STIs. However, there is minimal data on the protective effect of circumcision in high-risk populations such as migrant miners. The objective of this study was to compare the prevalence of STIs between circumcised and uncircumcised adult males in Rustenburg, North West Province, South Africa Methods The study used baseline data collected in an observational cohort study. Adult males in a mining town were assessed for STIs (gonorrhea, chlamydia, and trichomoniasis) using syndromic assessment. Data on circumcision status and other risk factors for STIs were collected using an interview administered structured questionnaire. Multiple logistic regression analysis was used to assess the independent effect of circumcision on STI presence after adjusting for confounders. Results A total of 339 participants with a median age of 25 years (IQR 22–29) were included in the study, of whom 116 (34.2%) of whom were circumcised. The overall STIs prevalence was 27.4% (95% CI 22.8–32.6%) and was lower in the circumcised participants compared with those who were uncircumcised (15.5% vs 33.6%, respectively, p < 0.001). Circumcision was strongly associated with a lower risk of STIs (OR 0.359, 95% CI 0.196–0.656, p = 0.001) after adjustment for employment and condom use. Conclusion In this high-risk population, with a relatively high prevalence of STI, and 34% circumcision, circumcision appears to be protective against STIs.

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Male circumcision for HIV prevention: Awareness, risk compensation, and risk perceptions among South African women

Cited by 15 publications

References 34 publications

The impact of the program for medical male circumcision on HIV in South Africa: analysis using three epidemiological models

The impact of the program for medical male circumcision on HIV in South Africa: analysis using three epidemiological models

A comparison of the prevalence of sexually transmitted infections among circumcised and uncircumcised adult males in Rustenburg, South Africa: a cross-sectional study

A Comparison of the Prevalence of Sexually Transmitted Infections Among Circumcised and Uncircumcised Adult Males in Rustenburg, South Africa: A Cross-Sectional Study

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