16th International AIDS Conference Toronto, Canada - August 13 - 18, 2006

MALE CIRCUMCISION IN SIAYA AND BONDO DISTRICTS, KENYA: A PROSPECTIVE COHORT STUDY TO ASSESS BEHAVIOURAL DISINHIBITION FOLLOWING CIRCUMCISION

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. TuAc0205

K. Agot¹, J. Kiarie², H. Nguyen³, J. Odhiambo¹, T. Onyango⁴, N. Weiss^3
1 Impact Research & Development Organization, Kisumu, Kenya, ² University of Nairobi, Obstetrics & Gynaecology, Nairobi, Kenya, ³ University of Washington, Epidemiology, Seattle, United States, ⁴ Siaya District Hospital, District AIDS & STD Coordination, Siaya, Kenya

BACKGROUND: Evidence for the efficacy of male circumcision as an HIV prevention measure is increasing, but the possibility that men who are circumcised may subsequently adopt more risky sexual behaviors (behavioral disinhibition) is a serious concern. We compared sexual behaviors of recently circumcised men with those of uncircumcised men.

METHODS: We carried out a non-randomized prospective cohort study in two districts in western Kenya to compare sexual behaviors in a group of 324 recently circumcised men with those of 324 uncircumcised men at 1, 3, 6, 9 and 12 months after surgery/enrolment in the study. The main outcome indicators were the incidence of sexual behaviors known to place men at increased risk of acquiring HIV, specifically married men having sexual intercourse with partners other than their wife/wives, and unmarried men having partners other than their "regular" girlfriends (referred to below as "risky sex"). Condom use was also ascertained. All men in both groups received thorough sexual risk reduction counseling. Circumcised men were advised to not have sex for at least one month after surgery.

RESULTS: In the first month following circumcision, 8% of men reported having had sexual intercourse. During that time, they were 59% less likely to report having engaged in risky sex than men who remained uncircumcised, and 69% less likely to report risky sex without condom use. During the remainder of the first year of follow-up this difference disappeared, but there was no excess of reported risky sex (with or without condom use) among circumcised men.

CONCLUSIONS: During the first year post-circumcision, men did not engage in risky sexual behaviors to a greater degree than did uncircumcised men. These results suggest that, within the context of adequate counseling on risk reduction, any protective effect of male circumcision on HIV acquisition is not likely to be appreciably offset by an adverse behavioral impact.

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2006-08-13
TuAc0205

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