Does Incident Circumcision Lead to Risk Compensation? Evidence From a Population Cohort in KwaZulu-Natal, South Africa

Overview

Journal J Acquir Immune Defic Syndr

Specialty Infectious Diseases

Date 2018 Dec 12

PMID 30531298

Citations 11

Authors

Katrina F Ortblad

Guy Harling

Natsayi Chimbindi

Frank Tanser

Joshua A Salomon

Till Barnighausen

Affiliations

Soon will be listed here.

Abstract

Background: Voluntary medical male circumcision reduces men's risk of HIV acquisition and may thus increase HIV risk-related sexual behaviors through risk compensation. We analyze longitudinal data from one of Africa's largest population cohorts using fixed-effects panel estimation to measure the effect of incident circumcision on sexual behaviors.

Setting: KwaZulu-Natal, South Africa.

Methods: An open population cohort of men was followed from 2009 to 2015. Men self-reported their circumcision status and sexual behavior annually. We used linear regression models with individual-level fixed effects to measure the effect of incident circumcision on recent sex (past 12 months) and sexual behaviors that increase HIV risk (not using a condom at last sex, never using condoms with the most recent sexual partner, concurrent sexual partners at present, and multiple sexual partners in the past 12 months). We controlled for potential time-varying confounders: calendar year, age, education, and sexual debut.

Results: The 5127 men in the cohort had a median age of 18 years (interquartile range 16-24) at cohort entry. Over the study period, almost 1 in 5 of these men (19.4%) became newly circumcised. Incident circumcision affected neither recent sex [percentage point (PP) change 0.0, 95% confidence interval: -1.2 to 1.3] nor sexual behaviors that increase HIV risk (PP -1.6, 95% confidence interval: -4.5 to 1.4).

Conclusions: The data from this study strongly reject the hypothesis that circumcision affects sexual risk-taking. Risk compensation should not serve as an argument against increased and accelerated scale-up of circumcision in this and similar communities in South Africa.

Citing Articles

Deficits and opportunities, pivots and shifts for scaling-up voluntary medical male circumcision in Uganda: a qualitative reflexive thematic analysis study.

Byabagambi J, Hollingsworth B, Limmer M BMC Public Health. 2024; 24(1):2232.

PMID: 39152417 PMC: 11329999. DOI: 10.1186/s12889-024-19796-w.

Understanding the Evolving Role of Voluntary Medical Male Circumcision as a Public Health Strategy in Eastern and Southern Africa: Opportunities and Challenges.

Bershteyn A, Mudimu E, Platais I, Mwalili S, Zulu J, Mwanza W Curr HIV/AIDS Rep. 2022; 19(6):526-536.

PMID: 36459306 PMC: 9759505. DOI: 10.1007/s11904-022-00639-5.

Association between medical male circumcision and HIV risk compensation among heterosexual men: a systematic review and meta-analysis.

Gao Y, Yuan T, Zhan Y, Qian H, Sun Y, Zheng W Lancet Glob Health. 2021; 9(7):e932-e941.

PMID: 33939956 PMC: 8690595. DOI: 10.1016/S2214-109X(21)00102-9.

Risk compensation after HIV-1 vaccination may accelerate viral adaptation and reduce cost-effectiveness: a modeling study.

Peebles K, Mittler J, Goodreau S, Murphy J, Reid M, Abernethy N Sci Rep. 2021; 11(1):6798.

PMID: 33762616 PMC: 7991033. DOI: 10.1038/s41598-021-85487-w.

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

Korenromp E, Bershteyn A, Mudimu E, Weiner R, Bonecwe C, Loykissoonlal D Gates Open Res. 2021; 5:15.

PMID: 33615145 PMC: 7878969. DOI: 10.12688/gatesopenres.13220.1.

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