Studies suggesting that circumcision can reduce a man’s risk of acquiring HIV have almost become a double-edged sword, seeing as men tend to perceive HIV prevention as a safety blanket for participating in high risk sexual behavior such as unprotected sex with frequent partners. Researchers from the University of Illinois at Chicago working in Kenya have concluded a study revealing that circumcision does not promote risky sexual behavior in men, but how big a role does male circumcision play when it comes to HIV prevention?
"Countries that have been holding back on implementing medical circumcision programs due to a lack of evidence regarding risk compensation should have no concerns about scaling-up programs," lead researcher, Nelli Westercamp, said in a statement. "It was very important to do a real life, population-level study to look at this question. If men engaged in risky behaviors after circumcision, it could negate the protective effects."
Westercamp and her colleagues recruited 3,186 uncircumcised men between the age of 18 and 35 from the Nyanza Province in Kenya. Following the start of the research in 2008, half of the study’s participants chose to be circumcised while the other half chose to remain uncircumcised. The research team conducted assessments every six months for a two year period, which included surveys regarding their perceived risk of HIV transmission, sexual behavior, and condom use. Although both groups did not receive one-on-one HIV risk-reduction counseling, researchers did encourage each participant to attend HIV testing and counseling services at local clinics.
While 30 percent of circumcised men thought they were at a high risk for HIV transmission before the procedure, 14 percent thought the same after the procedure. Twenty-four percent of uncircumcised men thought they were at a high risk to HIV transmission compared to 21 percent at the end of the study. In spite of a reduced perceivable risk among circumcised men, this way of thinking did not correlate to high-risk sexual behavior. Both circumcised and uncircumcised men became more sexually active between the age of 18 and 24, however, their increase in sexual activity also did not spill over into risky sexual behavior. In fact, condom use among both groups increased over the course of the study. By the end of the study all participants were less likely to engage in sex for money or services, casual sex, or have multiple sexual partners.
According to the World Health Organization, circumcision can only play a small role in the grand scheme of HIV prevention. A string of recent studies have suggested that male circumcision can reduce the risk of a heterosexual male acquiring HIV by 60 percent causing WHO/UNAIDS to recommend circumcision as form of HIV prevention in countries affected by heterosexual epidemics. In addition to circumcision, the WHO still heavily encourages constant HIV testing and counseling services, sexually transmitted infection treatment, safer sexual behaviors, and the use of condoms.
Source: Bailey R, Jaoko W, Agot K, Westercamp N. Risk Compensation Following Male Circumcision: Results from a Two-Year Prospective Cohort Study of Recently Circumcised and Uncircumcised Men in Nyanza Province, Kenya. AIDS and Behavior. 2014.