Mukudu, Hillary2016-10-252016-10-252016-10-25http://hdl.handle.net/10539/21265A 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 2015Objective: 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..enThesis