Men undergoing circumcision in Kenya are no more likely than their uncircumcised peers to engage in risky sex in the first year after the procedure, a study published in the January 1st edition of the Journal of Acquired Immune Deficiency Syndromes has found. This finding is in contrast to some previous randomised controlled trials that found that the potentially protective effects of circumcision against HIV and other sexually transmitted infections was off-set by increased sexual risk-taking by men who had been circumcised.
The investigators believe that a strength of their study was the setting in which it was conducted – a public health facility where circumcision is provided, as opposed to the “highly controlled research settings where circumcision studies have been conducted.”
The study was conducted between 2002 and 2004 and involved men 324 men undergoing circumcision and an equal number of demographically matched men remaining uncircumcised attending the Siaya and Bondo district hospitals in Kenya. The study was not linked to a randomised trial taking place in the Kisumu district of Kenya. That trial was halted in December 2006 after an interim analysis showed that circumcision of adult males reduced the risk of HIV acquisition by around 50% during the follow-up period.
Men joining the Siaya/Bondo study provided sexual histories at enrolment to the study and returned for follow-up visits at which they provided details of their sexual activity throughout the first year following circumcision. The investigators defined “risky sex” as sexual intercourse with an individual other than the patient’s wife or regular partner, and “unprotected risky sex” was sex without a condom with an individual other than a wife or regular partner. Data were also gathered on the frequency of sex acts,
The investigators found that men who chose to be circumcised were significantly more likely than men who chose to remain uncircumcised to have had risky sex in the three months before entry to the study (p = 0.025) and to have had unprotected risky sex during this period (p = 0.03).
In the month following circumcision, men undergoing the procedure were 60% less likely to report risky sex than men remaining uncircumcised, and 87% less likely than uncircumcised men to report unprotected risky sex. The investigators attribute this to sexual disinhibition due to healing of the penis following the circumcision operation and counselling about safer sex.
However, in the year following circumcision, there ceased to be any difference in the amount of risky and unprotected risky sex reported by circumcised and uncircumcised men. The investigators stress, “at no point during this year was there any appreciable reported excess of risky sex or unprotected risky sex among circumcised men.”
The most common reason cited for circumcision was protection from HIV/sexually transmitted infections (47%). Yet the investigators found that men who reported this motivation for circumcision were no more likely than those citing hygiene (24%), the avoidance of injuries during sex (14%), or the influence of friends (10%) to have risky or unprotected risky sex in the year after the operation.
“Our results suggest that, within the context of adequate counselling on risk reduction, any physical benefits arising from circumcision are not likely to be appreciably offset by an adverse behavioural impact of the procedure”, conclude the investigators.
Kawango EA et al. Male circumcision in Siaya and Bondo districts, Kenya: prospective cohort study to assess behavioural disinhibition following circumcision. J Acquir Immune Defic Syndr 44: 66 – 70, 2007.