title: Changes in Male Circumcision Prevalence and Risk Compensation in the Kisumu, Kenya Population, 2008-2013.
abstract: BACKGROUND
  Three randomized controlled trials showed that voluntary medical male circumcision (VMMC) reduces the risk of female-to-male HIV transmission by approximately 60%. However, data from communities where VMMC programs have been implemented are needed to assess changes in circumcision prevalence and whether men and women compensate for perceived reductions in risk by increasing their HIV risk behaviors.
  
  
  METHODS
  Scale-up of free VMMC began in Kisumu, Kenya in 2008. Between 2009 and 2013, a sequence of 3 unlinked cross-sectional surveys were conducted. All individuals 15-49 years of age residing in randomly selected households were interviewed and offered HIV testing. Male circumcision status was confirmed by examination. Design-adjusted bivariate comparisons and multivariable analyses were used for statistical inference.
  
  
  RESULTS
  The prevalence of male circumcision increased from 32% (95% CI: 26% to 38%) in 2009 to 60% (95% CI: 56% to 63%) in 2013. The adjusted prevalence ratio of HIV and genital ulcer disease in circumcised compared with uncircumcised men was 0.48 (95% CI: 0.36 to 0.66) and 0.51 (95% CI: 0.37 to 0.69), respectively. There was no association between circumcision status and sexual behaviors, HIV knowledge, or indicators of risk perception.
  
  
  CONCLUSIONS
  The conditions necessary for the VMMC program to have a significant public health impact are present in Kisumu, Kenya. Between 2009 and 2013, circumcision prevalence increased from 30% to 60%; HIV prevalence in circumcised men was half that of uncircumcised men, and there was no or minimal sexual risk compensation.
authors.affiliation: *Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL; †Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya; and ‡Nyanza Reproductive Health Society (NRHS), Kisumu, Kenya.
authors.forename: Matthew
authors.initials: M
authors.lastname: Westercamp
authors.forename: Walter
authors.initials: W
authors.lastname: Jaoko
authors.forename: Supriya
authors.initials: S
authors.lastname: Mehta
authors.forename: Pauline
authors.initials: P
authors.lastname: Abuor
authors.forename: Perez
authors.initials: P
authors.lastname: Siambe
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bailey
mesh_terms: D000293:Adolescent; D000328:Adult; D002944:Circumcision, Male / Q000523:psychology; D003430:Cross-Sectional Studies; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D007407:Interviews as Topic; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012309:Risk-Taking; D055815:Young Adult