title: A comparison of sexual risk behaviours and HIV seroprevalence among circumcised and uncircumcised men before and after implementation of the safe male circumcision programme in Uganda.
abstract: BACKGROUND
  Although male circumcision reduces the heterosexual HIV transmission risk, its effect may be attenuated if circumcised men increase sexual risk behaviours (SRB) due to perceived low risk. In Uganda information about the protective effects of circumcision has been publicly disseminated since 2007. If increased awareness of the protection increases SRB among circumcised men, it is likely that differences in prevalence of SRB among circumcised versus uncircumcised men will change over time. This study aimed at comparing SRBs and HIV sero-status of circumcised and uncircumcised men before and after the launch of the safe male circumcision programme.
  
  
  METHODS
  Data from the 2004 and 2011 Uganda AIDS Indicator Surveys (UAIS) were used. The analyses were based on generalized linear models, obtaining prevalence ratios (PR) as measures of association between circumcision status and multiple sexual partners, transactional sex, sex with non-marital partners, condom use at last non-marital sex, and HIV infection. In addition we conducted multivariate analyses adjusted for sociodemographic characteristics, and the multivariate models for HIV status were also adjusted for SRB.
  
  
  RESULTS
  Twenty six percent of men were circumcised in 2004 and 28% in 2011. Prevalence of SRB was higher among circumcised men in both surveys. In the unadjusted analysis, circumcision was associated with having multiple sexual partners and non-marital partners. Condom use was not associated with circumcision in 2004, but in 2011 circumcised men were less likely to report condom use with the last non-marital partner. The associations between the other sexual risk behaviours and circumcision status were stable across the two surveys." In both surveys, circumcised men were less likely to be HIV positive (Adj PR 0.55; CI: 0.41-0.73 in 2004 and Adj PR 0.64; CI: 0.49-0.83 in 2011).
  
  
  CONCLUSIONS
  There was higher prevalence of SRBs among circumcised men in both surveys, but the only significant change from 2004 to 2011 was a lower prevalence of condom use among the circumcised. Nevertheless, HIV prevalence was lower among circumcised men. Targeted messages for circumcised men and their sexual partners to continue using condoms even after circumcision should be enhanced to avoid risk compensation.
authors.affiliation: Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway. pskibira@gmail.com.|Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University, Kampala, Uganda. pskibira@gmail.com.
authors.forename: Simon Peter Sebina
authors.initials: SP
authors.lastname: Kibira
authors.affiliation: Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
authors.forename: Ingvild Fossgard
authors.initials: IF
authors.lastname: Sandøy
authors.affiliation: Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway.
authors.forename: Marguerite
authors.initials: M
authors.lastname: Daniel
authors.affiliation: Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University, Kampala, Uganda.
authors.forename: Lynn Muhimbuura
authors.initials: LM
authors.lastname: Atuyambe
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda.
authors.forename: Fredrick Edward
authors.initials: FE
authors.lastname: Makumbi
mesh_terms: D000293:Adolescent; D000328:Adult; D002944:Circumcision, Male; D017280:Condoms / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D015528:HIV Seroprevalence; D007722:Health Knowledge, Attitudes, Practice; D020010:Heterosexuality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012309:Risk-Taking; D016036:Seroepidemiologic Studies; D012725:Sexual Behavior; D012747:Sexual Partners; D011795:Surveys and Questionnaires; D014454:Uganda / Q000453:epidemiology; D047568:Unsafe Sex; D055815:Young Adult