Voluntary medical male circumcision for prevention of heterosexual transmission of HIV and risk compensation in adult males in Soweto: what do indicators and incidence rate show?
Date
2016-10-25
Authors
Mukudu, Hillary
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Abstract
Objective: Biomedical prevention of HIV transmission, resulting from medical male
circumcision, was confirmed in clinical trials and then rolled out in voluntary medical
male circumcision programmes in sub-Saharan Africa. Data assessing its
effectiveness, under programmatic conditions, are not available. Concerns about
possible risk compensation in males after circumcision have been raised. Thus, the
objectives of the study were to determine, the effectiveness of medical male
circumcision in prevention of heterosexual (female to male) transmission of HIV and
differences in presence or absence of risk compensation behaviour in males before
and after medical male circumcision.
Methods: A prospective cohort of 233 seronegative adult males aged 18-40 years
seeking medical male circumcision at a public hospital were followed for a median
period of 363 (IQR 302–397) days after which HIV serostatus rate and risky sexual
behaviour were re-ascertained. HIV risk factors before and after medical male
circumcision were compared by calculating odds ratio (OR) with the 95% confidence
interval and p-value using McNemar’s test given paired participants’ data. Logistic
regression was used to determine predictors of risky sexual behaviour.
Results: HIV incidence rate post medical male circumcision was found to be 2.64
(95% CI 0.54–4.75) per 100 person years. There was evidence of risk compensation
in the post circumcision period in that, participants were three times (OR 2.70 95% CI
1.34–5.69, p=0.003) more likely to have sexual intercourse after than before medical
male circumcision. This was mainly due to 7.3% of the participants having either their
sexual debut after medical male circumcision or not having sexual intercourse in six
months before medical male circumcision but after. Conversely they were found to be
3.5 times (OR=3.50 95% CI 1.88–7.14, p=<0.0001) more likely to perceive
themselves to be at risk of HIV and 58% (OR=0.42 95% CI 0.16–1.01, p=0.05) less
likely to use alcohol with sex after than before medical male circumcision.
Conclusion: These findings suggest that HIV incidence in males post medical male
circumcision remains high but in a programme setting, but appears to reduce risky
sexual behaviour. Some aspects of risk compensation after medical male
circumcision still need to be addressed, as shown by increased sexual encounters..
Description
A research report submitted to the School of Public Health, faculty of Health
Sciences, University of the Witwatersrand, in partial fulfilment of the requirements
for the degree of master of science in epidemiology and biostatistics
Johannesburg, December 2015