title: Assessment of changes in risk behaviors during 3 years of posttrial follow-up of male circumcision trial participants uncircumcised at trial closure in Rakai, Uganda.
abstract: Risk compensation associated with male circumcision has been a concern for male circumcision scale-up programs. Using posttrial data collected during 2007-2011 on 2,137 male circumcision trial participants who were uncircumcised at trial closure in Rakai, Uganda, the authors evaluated their sexual behavioral changes during approximately 3 years' follow-up after trial closure. Eighty-one percent of the men self-selected for male circumcision during the period, and their sociodemographic and risk profiles were comparable to those of men remaining uncircumcised. Linear models for marginal probabilities of repeated outcomes estimate that 3.3% (P < 0.0001) of the male circumcision acceptors reduced their engagement in nonmarital relations, whereas there was no significant change among men remaining uncircumcised. Significant decreases in condom use occurred in both male circumcision acceptors (-9.2% with all partners and -7.0% with nonmarital partners) and nonacceptors (-12.4% and -13.5%, respectively), and these were predominantly among younger men. However, the magnitudes of decrease in condom use were not significantly different between the 2 groups. Additionally, significant decreases in sex-related alcohol consumption were observed in both groups (-7.8% in male circumcision acceptors and -6.1% in nonacceptors), mainly among older men. In summary, there was no evidence of risk compensation associated with male circumcision among this cohort of men during 3 years of posttrial follow-up.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, 627 North Washington Street, Room 2C, Baltimore, MD 21205, USA. xikong@jhsph.edu
authors.forename: Xiangrong
authors.initials: X
authors.lastname: Kong
authors.forename: Godfrey
authors.initials: G
authors.lastname: Kigozi
authors.forename: Fred
authors.initials: F
authors.lastname: Nalugoda
authors.forename: Richard
authors.initials: R
authors.lastname: Musoke
authors.forename: Joseph
authors.initials: J
authors.lastname: Kagaayi
authors.forename: Carl
authors.initials: C
authors.lastname: Latkin
authors.forename: Robert
authors.initials: R
authors.lastname: Ssekubugu
authors.forename: Tom
authors.initials: T
authors.lastname: Lutalo
authors.forename: Betty
authors.initials: B
authors.lastname: Nantume
authors.forename: Iga
authors.initials: I
authors.lastname: Boaz
authors.forename: Maria
authors.initials: M
authors.lastname: Wawer
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.forename: Ronald
authors.initials: R
authors.lastname: Gray
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D002944:Circumcision, Male / Q000523:psychology*; D017280:Condoms / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D015658:HIV Infections / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012725:Sexual Behavior / Q000706:statistics & numerical data; D014454:Uganda / Q000453:epidemiology; D047568:Unsafe Sex / Q000706:statistics & numerical data*; D055815:Young Adult