title: Risk compensation following male circumcision: results from a two-year prospective cohort study of recently circumcised and uncircumcised men in Nyanza Province, Kenya.
abstract: We present the results of the first study of longitudinal change in HIV-associated risk behaviors in men before and after circumcision in the context of a population-level voluntary medical male circumcision (VMMC) program. The behaviors of 1,588 newly circumcised men and 1,598 age-matched uncircumcised controls were assessed at baseline, 6, 12, 18 and 24 months of follow-up. Despite the precipitous decline in perception of high HIV risk among circumcised men (30-14 vs. 24-21 % in controls) and increased sexual activity among the youngest participants (18-24 years; p-time < 0.0001, p-group = 0.96), all specific risk behaviors decreased over time similarly in both groups. The proportion of men reporting condom use at last sex increased for both groups, with a greater increase among circumcised men (30 vs. 6 %). We found no evidence of risk compensation in men following circumcision. Concerns about risk compensation should not impede the widespread scale-up of VMMC initiatives.
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St. MC 923, Chicago, IL, 60612, USA, nweste1@uic.edu.
authors.forename: Nelli
authors.initials: N
authors.lastname: Westercamp
authors.forename: Kawango
authors.initials: K
authors.lastname: Agot
authors.forename: Walter
authors.initials: W
authors.lastname: Jaoko
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bailey
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002944:Circumcision, Male / Q000523:psychology / Q000706:statistics & numerical data*; D017280:Condoms / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012309:Risk-Taking; D012424:Rural Population / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000706:statistics & numerical data*