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Research Article

Risk Compensation Is Not Associated with Male Circumcision in Kisumu, Kenya: A Multi-Faceted Assessment of Men Enrolled in a Randomized Controlled Trial

  • Christine L. Mattson mail,

    christine.mattson@gmail.com

    Affiliation: School of Public Health, University of Illinois at Chicago, Chicago, Illinois, United States of America

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  • Richard T. Campbell,

    Affiliation: School of Public Health, University of Illinois at Chicago, Chicago, Illinois, United States of America

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  • Robert C. Bailey,

    Affiliation: School of Public Health, University of Illinois at Chicago, Chicago, Illinois, United States of America

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  • Kawango Agot,

    Affiliation: UNIM Project, Kisumu, Kenya

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  • J. O. Ndinya-Achola,

    Affiliation: Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya

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  • Stephen Moses

    Affiliation: Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada

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  • Published: June 18, 2008
  • DOI: 10.1371/journal.pone.0002443

Reader Comments (1)

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Increase in belief that circumcision reduces risk of aquiring HIV

Posted by rtatoud on 26 Jun 2008 at 16:26 GMT

I am perplexed by the interpretation that risk behaviour does not change when the belief that circumcision reduces risk of aquiring HIV increases from 57 to 77%. Ok it is in both gorups but there is no explanation given about why or discussion of the consequences of this belief. Could it be that uncircumcised men believe that circumcision reduces risk of aquiring HIV by proxy? And ultimately, on the long run could this become a common belief?


RE: Increase in belief that circumcision reduces risk of aquiring HIV

cmattson replied to rtatoud on 29 Jun 2008 at 16:55 GMT

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.