Sexual risk compensation following voluntary medical male circumcision: Results from a prospective cohort study amongst human immunodeficiency virus-negative adult men in Botswana

• Published in: Southern African journal of HIV medicine Vol. 21; no. 1; p. 1157
• Main Authors: Spees, Lisa P, Wirth, Kathleen E, Mawandia, Shreshth, Bazghina-Werq, Semo, Ledikwe, Jenny H
• Format: Journal Article
• Language: English
• Published: South Africa African Online Scientific Information Systems (Pty) Ltd t/a AOSIS 2020; AOSIS (Pty) Ltd; AOSIS; Southern African HIV Clinicians Society
• Subjects: Acquired immune deficiency syndrome; Adults; AIDS; Biology; botswana; Circumcision; Cohort analysis; Compensation; Compensation and benefits; Consent; Data collection; Education; Females; Health Care Sciences & Services; Health Policy & Services; HIV; hiv prevention; Human immunodeficiency virus; Immunology; Infections; Males; Medical tests; Men; Original Research; prospective studies; Questionnaires; Regression analysis; risk-taking; Sexual behavior; sexual behaviour; Sexual intercourse; Sexual partners; South Africa; Uganda; Kenya; Botswana; circumcision; HIV prevention; risk-taking; Botswana; prospective studies; sexual behaviour
• ISSN: 1608-9693; 2078-6751; 2078-6751
• DOI: 10.4102/SAJHIVMED.V21I1.1157

Circumcised men may increase sexual risk-taking following voluntary medical male circumcision (VMMC) because of decreased perceptions of risk, which may negate the beneficial impact of VMMC in preventing new human immunodeficiency virus (HIV) infections. We evaluated changes in sexual behaviour following VMMC. We conducted a prospective cohort study amongst sexually active, HIV-negative adult men undergoing VMMC in Gaborone, Botswana, during 2013-2015. Risky sexual behaviour, defined as the number of sexual partners in the previous month and ≥ 1 concurrent sexual partnerships during the previous 3 months, was assessed at baseline (prior to VMMC) and 3 months post-VMMC. Change over time was assessed by using inverse probability weighted linear and conditional logistic regression models. We enrolled 523 men; 509 (97%) provided sexual behaviour information at baseline. At 3 months post-VMMC, 368 (72%) completed the follow-up questionnaire. At baseline, the mean (95% confidence interval) number of sexual partners was 1.60 (1.48, 1.65), and 111 (31% of 353 with data) men reported engaging in concurrent partnerships. At 3 months post-VMMC, 70 (23% of 311 with data) reported fewer partners and 19% had more partners. Amongst 111 men with a concurrent partnership at baseline, 52% reported none post-VMMC. Amongst the 242 (69%) without a concurrent partnership at baseline, 19% reported initiating one post-VMMC. After adjustment for loss to follow-up, risky sexual behaviour post-VMMC (measured as mean changes in a number of partners and proportion engaging in concurrency) was similar to baseline levels. We found no evidence of sexual risk compensation in the 3 months following VMMC.