Sexual behaviours of circumcised men in a private practice in Alexandra, South Africa
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.
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