Page 154 - HIVMED_v21_i1.indb

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 9 Original Research

Sexual risk compensation following voluntary medical

male circumcision: Results from a prospective

cohort study amongst human immunodeficiency

virus-negative adult men in Botswana

Authors: Background: Circumcised men may increase sexual risk-taking following voluntary medical
Lisa P. Spees male circumcision (VMMC) because of decreased perceptions of risk, which may negate
1,2
Kathleen E. Wirth
3,4
5,6
Shreshth Mawandia the beneficial impact of VMMC in preventing new human immunodeficiency virus (HIV)
Semo Bazghina-werq infections.
6,7
5,6
Jenny H. Ledikwe
Objectives: We evaluated changes in sexual behaviour following VMMC.
Affiliations:
1 Department of Health Policy Method: We conducted a prospective cohort study amongst sexually active, HIV-negative
and Management, Gillings adult men undergoing VMMC in Gaborone, Botswana, during 2013–2015. Risky sexual
School of Global Public behaviour, defined as the number of sexual partners in the previous month and ≥ 1 concurrent
Health, University of North sexual partnerships during the previous 3 months, was assessed at baseline (prior to VMMC)
Carolina at Chapel Hill,
Chapel Hill, NC, United States and 3 months post-VMMC. Change over time was assessed by using inverse probability
of America weighted linear and conditional logistic regression models.
Results: We enrolled 523 men; 509 (97%) provided sexual behaviour information at baseline.
2 Lineberger Comprehensive
Cancer Center, University of At 3 months post-VMMC, 368 (72%) completed the follow-up questionnaire. At baseline, the
North Carolina, Chapel Hill, mean (95% confidence interval) number of sexual partners was 1.60 (1.48, 1.65), and 111 (31%
NC, United States of America of 353 with data) men reported engaging in concurrent partnerships. At 3 months post-VMMC,
70 (23% of 311 with data) reported fewer partners and 19% had more partners. Amongst 111
3 Department of Biostatistics,
Faculty of Health Sciences, men with a concurrent partnership at baseline, 52% reported none post-VMMC. Amongst the
Harvard T.H. Chan School of 242 (69%) without a concurrent partnership at baseline, 19% reported initiating one post-
Public Health, Boston, MA, VMMC. After adjustment for loss to follow-up, risky sexual behaviour post-VMMC (measured
United States of America as mean changes in a number of partners and proportion engaging in concurrency) was similar
to baseline levels.
4 Botswana International
Training and Education Conclusion: We found no evidence of sexual risk compensation in the 3 months following
Center for Health (I-TECH), VMMC.
Gaborone, Botswana
Keywords: circumcision; HIV prevention; Botswana; sexual behaviour; risk-taking; prospective
5 Department of Health Policy studies.
and Management, Faculty of
Medicine, Botswana
International Training and
Education Center for Health, Introduction
Gaborone, Botswana
Three randomised controlled trials (RCTs) from sub-Saharan Africa showed that voluntary
6 Department of Global medical male circumcision (VMMC) reduced human immunodeficiency virus (HIV) transmission
Health, University of from females to males by up to 60%. 1,2,3 Mathematical models suggest that HIV incidence will
Washington, Seattle, WA, decrease in circumcised men, and subsequently in women and uncircumcised men, as the uptake
United States of America
of VMMC increases. 4,5,6 Botswana has the fourth highest HIV prevalence in the world, with one in
7
7 Independent Global Health five adults infected. Whilst 83% HIV-positive individuals are receiving treatment, HIV incidence
7
7
Consultant, Washington, DC, remains high. In 2018, 8500 new HIV infections were diagnosed. In Botswana, it is estimated that
United States of America expanding VMMC coverage would avert 4900 new HIV infections through 2030. 8
There are concerns that circumcised men may be more likely to engage in risky sexual behaviours
following surgery because of their perception of the reduced risk of HIV acquisition conferred
Read online: Corresponding author: Lisa Spees, [email protected]
Read online:
Scan this QR Dates: Received: 19 Aug. 20 | Accepted: 21 Oct. 20 | Published: 14 Dec. 2020
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code with your
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smart phone or How to cite this article: Spees LP, Wirth KE, Mawandia S, Bazghina-werq S, Ledikwe JH. Sexual risk compensation following voluntary
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mobile device medical male circumcision: Results from a prospective cohort study amongst human immunodeficiency virus-negative adult men in
Botswana. S Afr J HIV Med. 2020;21(1), a1157. https://doi.org/10.4102/sajhivmed.v21i1.1157
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Copyright: © 2020. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.
http://www.sajhivmed.org.za 146 Open Access