Our results indicate a statistically significant reduction in risk behavior for both circumcised and uncircumcised men from baseline to 6 (p<0.01) and 12 (p<0.01) months post-enrollment. There were no statistically significant differences in the risk behavior of circumcised or uncircumcised men according to the risk score or in the acquisition of incident infections of gonorrhea, chlamydia, and trichomoniasis. We state that the belief that circumcision reduces the risk of acquiring HIV did not result in increased risk behavior because risk behavior decreased throughout the course of the study and the belief was not associated with the sexual risk score or with the acquisition of incident STIs in multivariable models. Also, as you point out, the belief did not vary according to circumcision status at any time point.

This belief likely will become more common as the results of the three randomized controlled trials demonstrating the protective effect of circumcision are further disseminated. However, our analysis indicates that when men were counseled on risk reduction strategies, believing circumcision reduces the risk of acquiring HIV did not result in increased risk behavior. Thus, it will be important to integrate male circumcision services with a full complement of HIV prevention tools including comprehensive counseling about the limitations of the protective effect of circumcision against HIV infection.