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Figure 3 shows the summary of the change in the number reported fewer partners and 59 (19%) had more partners
of sexual partners and engagement in concurrent sexual (Figure 3). For concurrency (past 3 months), at baseline,
partnerships at the 3-month follow-up visit (relative to 111 (31% of n = 353 with available data) reported engaging in
baseline). Amongst the 368 men who attended the follow-up one or more concurrent sexual partnerships. By 3 months
visit at 3 months, 57 (15%) did not provide information on the post-VMMC, 58 (52% of 111) had ended the concurrent
number of partners during the past 1 month at either baseline partnership. In contrast, amongst the 242 (69%) who did not
and/or follow-up. Data on engagement in concurrent sexual report any concurrent sexual partnerships at baseline,
partnerships were available for 353 (96%) of the 368 men who 47 (19% of 242) had initiated a concurrent partnership at
attended follow-up. 3 months (Figure 3). After adjustment for possible selection
bias because of loss to follow-up at 3 months, we found no
At baseline, the mean (95% CI) number of sexual partners evidence of sexual risk compensation following VMMC:
(past 1 month) was 1.60 (1.48, 1.65). Although the majority mean change in number of partners was -0.04 (95% CI: -0.15,
(59% of n = 311 with available data) of men reported the same 0.08; p = 0.61) and the proportion engaging in concurrency
number of partners at 3 months post-VMMC, 70 (23%) was 0.04 (95% CI: -0.05, 0.14; p = 0.38).

Tables 2 and 3 present the results of post-hoc analyses aimed
250 248 at identifying predictors of any engagement (irrespective of
change from baseline or pre-circumcision) in high-risk sexual
Number of par vipants 150 182 behaviour at 3 months post-VMMC. In multivariable-
200
adjusted models (simultaneously adjusted for potential
selection bias because of loss to follow-up), alcohol
consumption (Table 2; risk ratio [RR]: 1.72; 95% CI: 1.19, 2.49)
100
50
positively associated with reporting two or more partners
17 52 41 12 58 47 and transactional sex (RR: 1.77; 95% CI: 1.13, 2.77) were
1 6 (past 1 month) at follow-up. Alcohol consumption was also
0 positively associated with concurrency at 3 months post-
9 Fewer 2 Fewer 1 Fewer No changes 1 more 2 more 3 more Ended No change Ini tated VMMC (Table 3; RR: 2.30; 95% CI: 1.45, 3.66). In contrast,

Number of partners Concurrent partnerships, older age at first sexual intercourse (21 years and older) was
negatively associated with multiple sexual partners (Table 2;
past one month past three months
RR: 0.50; 95% CI: 0.30, 0.84) at follow-up. No other attitudinal
FIGURE 3: Summary of change in the number of sexual partners (past 1 month) or behavioural covariates were significantly associated
and engagement in concurrent partnerships at 3 months amongst men with either outcome in either univariable- or multivariable-
undergoing voluntary medical male circumcision in Gaborone, Botswana,
2012–2015. adjusted analyses.
TABLE 2: Univariable- and multivariable-adjusted attitudinal and behavioural predictors of multiple sexual partners (past 1 month) at 3 months amongst men undergoing
voluntary medical male circumcision in Gaborone, Botswana, 2012–2015.
Attitudinal and behavioural predictors Univariable-adjusted† Multivariable-adjusted†,‡
RR 95% CI p RR 95% CI p
Reasons for circumcision
Personal hygiene 1 ref. - 1 ref. -
HIV protection 0.96 0.68–1.35 0.80 0.99 0.70–1.40 0.96
Other 0.90 0.60–1.35 0.61 0.86 0.58–1.28 0.45
Knowledge of HIV risk
Correct knowledge: VMMC partially reduces HIV risk for men 1.12 0.71–1.77 0.62 1.15 0.73–1.83 0.54
Correct knowledge: VMMC does not impact HIV risk for women 1.14 0.73–1.78 0.55 1.13 0.71–1.80 0.60
Risk compensation scale§
Condom use is not necessary if the man is circumcised 1.02 0.86–1.21 0.80 1.04 0.86–1.25 0.69
If I am circumcised, sex is safe without a condom 0.99 0.85–1.17 0.95 0.97 0.82–1.14 0.70
Being circumcised means a man can worry less about HIV 1.03 0.92–1.14 0.63 1.05 0.94–1.17 0.36
If a man is circumcised, he can have more sexual partners 1.10 0.87–1.39 0.42 1.08 0.86–1.37 0.49
Alcohol consumption 1.80 1.23–2.62 0.002 1.80 1.23–2.62 0.004
Age at first sexual intercourse (years)
< 18 1 ref. - 1 ref. -
18–20 0.98 0.72–1.34 0.92 0.92 0.68–124 0.59
≥ 21 0.51 0.30–0.85 0.01 0.50 0.30–0.84 0.01
Exchanged money for sex, past 12 months 1.64 1.07–2.52 0.02 1.77 1.13–2.77 0.01
RR, risk ratio; CI, confidence intervals; HIV, human immunodeficiency virus; VMMC, voluntary medical male circumcision.
†, Estimated from a weighted modified Poisson regression model with weights constructed to adjust for selection bias because of loss to follow-up.
‡, Estimated from a weighted modified Poisson regression model with weights constructed to adjust for selection bias because of loss to follow-up and confounding because of the following
baseline covariates: age, relationship status, religious affiliation, education, employment and household use of woods as cooking fuel.
§, Responses based on Likert scale (range 0–5 with 0 and 5 denoting ‘strongly disagree’ and ‘strongly agree’, respectively).

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