By Liz Highleyman

As previously reported, the National Institutes of Health halted 2 randomized controlled trials of adult male circumcision in Kenya and Uganda in December, after an interim analysis showed the procedure reduced the risk of HIV acquisition infection by about half.

Some public health experts have expressed concern, however, that a less than 100% protective intervention such as circumcision, if believed to reduce risk, could actually encourage unsafe sexual practices and decreased condom use.

As reported in the January 1, 2007 Journal of Acquired Immune Deficiency Syndromes, researchers involved with the Kenya study compared the sexual behavior of 324 recently circumcised and 324 uncircumcised men at 1, 3, 6, 9, and 12 months after circumcision or study enrollment. The researchers assessed reported incidence of risky sexual behavior, defined as having sex with partners other than wives for married men, or regular girlfriends for unmarried men.

Results

• During the first month following circumcision, men were 63% less likely to report engaging in 0-0.5 risky sexual acts per week and 61% less likely to report more than 0.5 such acts per week, compared with uncircumcised men.

• This difference disappeared during the remainder of the follow-up period, with no excess of reported risky sexual acts among circumcised men.

• Similar results were observed for risky unprotected sex acts, number of risky sex partners, and condom use.

Conclusion

In conclusion, the authors wrote, "During the first year post-circumcision, men did not engage in more risky sexual behaviors than uncircumcised men, suggesting that any protective effect of male circumcision on HIV acquisition is unlikely to be offset by an adverse behavioral impact."

Impact Research and Development Organization, Kisumu, Kenya; Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya; Department of Epidemiology, University of Washington, Seattle, WA; Ministry of Health, Siaya District Hospital, Siaya, Kenya.

1/19/07

Reference
K E Agot, J N Kiarie, H Q Nguyen, and others. Male Circumcision in Siaya and Bondo Districts, Kenya: Prospective Cohort Study to Assess Behavioral Disinhibition Following Circumcision. Journal of Acquired Immune Deficiency Syndromes 44(1): 66-70. January 1, 2007.