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

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.

Beyond HIV prevalence: identifying people living with HIV within underserved areas in South Africa

“…34 Besides the direct impact of MC on the reduction of HIV acquisition, MC could also generate secondary benefits by affecting the sexual behaviour of circumcised men. 35 For example, circumcised men tend to be concerned more about partner’s HIV status and to use condoms more frequently compared with non-circumcised men in South Africa. 35 Likewise, poverty was also a significant explanatory variable associated with the spatial structure of HIV for both men and women.…”

Service delivery interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review

“…While these measures are a potential measure of service quality, this is also challenging, as individual clients may opt-out of these services, and 100% uptake on either of these measures might indicate coercive or nonoptional uptake. Further, despite the lack of studies quantifying uptake of counseling during VMMC, relationships between VMMC, counseling, and risk compensation have been assessed substantially in the literature; evidence indicates that VMMC leads to little or no risk compensation in sub-Saharan Africa [54][55][56][57][58][59][60].…”

Sexual risk compensation following voluntary medical male circumcision: Results from a prospective cohort study amongst human immunodeficiency virus-negative adult men in Botswana

“…Our overall findings are consistent with previous reports from South Africa showing little to no evidence of risk compensation following VMMC. 13 , 14 …”

“…However, little is known about how sexual behaviour changes in real-world settings, as there have been only two studies that examined men’s sexual behaviours before and after undergoing VMMC. 13 , 14 Although the two studies, both conducted in South Africa, found minimal or no evidence of risk compensation, no studies have examined risk compensation in Botswana, where the rate of multiple and concurrent sexual partnerships is particularly high. Recently published findings from a large population-based sample found that 31% of sexually active adults in Botswana had concurrent sexual partners in the past year.…”