Sexual behaviours of circumcised men in a private practice in Alexandra, South Africa
Date
2019
Authors
Asare-Bediako, Josephine
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Abstract
Background
Three randomized controlled trials (RCT) conducted showed that voluntary medical male
circumcision (VMMC) reduces the risk of female to male HIV transmission by approximately
60%. However, data from countries such as South Africa where VMMC programs have been
scaled up are needed to assess changes in sexual behaviours of circumcised men as a result
of perceived reductions in risk and factors associated with these behaviours. This risk
compensation is a concern for policy makers and programme implementers due to its possible
negative effect on HIV incidence.
Methodology
This was a cross-sectional study conducted at a private practice in Alexandra. One hundred
and forty-three (n=143) men,18 years and older, medically circumcised three months before
commencement of the study were randomly sampled and interviewed using a questionnaire.
The questionnaire covered sociodemographic characteristics and elements of condom use,
multiple sexual partners, transactional sex and VMMC knowledge. Logistic regression was
used to determine factors associated with their sexual behaviour.
Results
Out of the one-hundred and forty-three (n=143) men interviewed, more than half (51%) of the
men reported condom use in last sexual intercourse. However, 49% indicated no condom use,
which indicates some risk compensation. Men aged 40 years and older, were slightly more
likely (UOR 1.04, 95% Cl 0.31 - 3.55) to use condoms at last sexual intercourse. HIV positive
men were found to be twice likely to use a condom at last sex (UOR 3.72 95% 1.46 - 9.46)
and engage in transactional sex (UOR 2.68 95% Cl 1.10 - 6.50) than their HIV negative
counterparts, indicating a possible link to knowledge of HIV transmission after HIV diagnosis.
Conclusion
Some risk compensation was found in this study, however, the possibility was difficult to
determine due to the lack of adequate baseline analysis of the sexual behaviour of the men
before circumcision. Several factors such as marital status and being in a long term
relationship were among the reasons given for non-condom use. Results indicate the
importance of VMMC and HIV prevention education and counselling and it is recommended
that all VMMC programmes include this aspect. Risk compensation should not impede the scale-up of VMMC.
Description
This research report is submitted in partial fulfilment of the Master of Public Health in
the Faculty of Health Sciences, at the University of the Witwatersrand