Malawi slept on scaling up voluntary medical male circumcision despite conclusive evidence that circumcision can reduce the risk of female-to-male HIV transmission by up to 60 percent. One of the reasons was the perception in the higher ups of the HIV unit. I particularly remember Mary Shawa’s statements, the then Secretary for Nutrition, HIV and Aids in the President’s office, pointed to a reluctance to promote circumcision fearing it would lead to men falsely believing that circumcision provided complete protection from HIV transmission and, therefore, would increase risky behaviour.
A recently published study conducted in Kenya allays these fears. Conducted by University of Illinois at Chicago researchers, the study found that men do not engage in riskier behaviour after they are circumcised.
The study, published in the journal Aids and Behaviour, is the first large study to assess risk and male circumcision. The study was conducted during the implementation of the national, voluntary medical circumcision programme in Kenya. From 2008 to 2010, 3 186 uncircumcised men from Nyanza Province participated in the study. Half were circumcised and the other half chose to remain uncircumcised.
The men, between 18 and 35 years old, were assessed every six months for two years. They were asked about their perceived risk of acquiring HIV, sexual behaviour, and condom use. All participants, whether circumcised or uncircumcised, were encouraged to attend HIV testing and counselling services at clinics where they were exposed to HIV educational videos playing in the waiting areas. Participants did not receive direct risk-reduction counselling during visits.
Sexual activity increased equally in the circumcised and uncircumcised men, particularly among the youngest, those 18-24 years old. But despite an increase in sexual activity, all other sexual risk behaviour declined in both groups, and condom use increased. Risky behaviour, which included engaging in sex in exchange for money or gifts, sex with a casual partner, or having multiple sex partners, declined considerably among both groups.
Men who were circumcised often perceived they had lessened their risk of acquiring HIV. Thirty percent considered themselves high- risk before circumcision while just 14 percent considered themselves so after. Among those who chose not to be circumcised, 24 percent considered themselves high-risk at the beginning of the study and 21 percent still did at the end. However, the differences in perception of risk did not translate into differences in risky behaviour over the two years of the study.
The researchers suggest that this study “provides the best evidence to date that concerns about risk compensation should not impede widespread implementation of voluntary male medical circumcision programmes.”