Original Research

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

Lisa P. Spees, Kathleen E. Wirth, Shreshth Mawandia, Semo Bazghina-werq, Jenny H. Ledikwe
Southern African Journal of HIV Medicine | Vol 21, No 1 | a1157 | DOI: https://doi.org/10.4102/sajhivmed.v21i1.1157 | © 2020 Lisa P. Spees, Kathleen E. Wirth, Shreshth Mawandia, Semo Bazghina-werq, Jenny H. Ledikwe | This work is licensed under CC Attribution 4.0
Submitted: 19 August 2020 | Published: 14 December 2020

About the author(s)

Lisa P. Spees, Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; and, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States of America
Kathleen E. Wirth, Department of Biostatistics, Faculty of Health Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America; and, Botswana International Training and Education Center for Health (I-TECH), Gaborone, Botswana
Shreshth Mawandia, Department of Health Policy and Management, Faculty of Medicine, Botswana International Training and Education Center for Health, Gaborone, Botswana; and, Department of Global Health, University of Washington, Seattle, WA, United States of America
Semo Bazghina-werq, Department of Global Health, University of Washington, Seattle, WA, United States of America; and, Independent Global Health Consultant, Washington, DC, United States of America
Jenny H. Ledikwe, Department of Health Policy and Management, Faculty of Medicine, Botswana International Training and Education Center for Health, Gaborone, Botswana; and, Department of Global Health, University of Washington, Seattle, WA, United States of America


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Abstract

Background: 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.

Objectives: We evaluated changes in sexual behaviour following VMMC.

Method: 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.

Results: 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.

Conclusion: We found no evidence of sexual risk compensation in the 3 months following VMMC.


Keywords

circumcision; HIV prevention; Botswana; sexual behaviour; risk-taking; prospective studies

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