Circumcision Significantly Lowers the Risk of HIV in Young African Men

A new study in Kenya found that male circumcision lowers the risk of HIV in young African men.

Researchers at the University of Illinois in Chicago conducted a population-level longitudinal assessment of risk compensation linked with adult male circumcision and found that it led to a drastic fall in the risk of acquiring HIV that is transmitted through blood and body fluids like semen and vaginal fluids.

It was suggested by health experts that circumcision, if promoted as HIV preventive, may cause a drop in condom use or increase promiscuity. This risk compensation could reduce the effectiveness of medical male circumcision programs. But the study found no increase in risky behavior.

The study was conducted in the east African country of Kenya during the implementation of the national, voluntary circumcision program.  The study included 3,186 uncircumcised men from Nyanza Province from 2008-2010.  Among the total participants, half were circumcised shortly after their baseline assessment and the other half remained uncircumcised.

The men, between 18 and 35 years, were assessed every six months for two years and were questioned about their perceived risk of acquiring HIV, use of condoms as well as sexual behavior.

All the participants, both circumcised and uncircumcised, were made to attend HIV testing and counseling services held at clinics and were also shown HIV educational videos that were played at the waiting areas. .

There was an increase in sexual activity among circumcised as well as uncircumcised men, especially in the younger - 18-24 years group. But, this increase in sexual activity did not increase the sexual risk behavior in both groups and the use of condom also increased. Risky behavior included engaging in sex in exchange for money or gifts, sex with a casual partner or multiple sex partners. These behaviors dropped in both the groups.

The researchers noticed that the circumcised men perceived that they had reduced their risk of acquiring HIV. Nearly 30 percent of them had considered themselves high-risk before circumcision but later only 14 percent thought so. Among the uncircumcised men, 24 percent considered themselves high risk at the beginning of the study and it reduced to 21 percent by the end of the study.

Bu the change in perception did not reflect in their sexua behavior where safe practices and condome use saw an increase. 

"Countries that have been holding back on implementing medical circumcision programs due to a lack of evidence regarding risk compensation should have no concerns about scaling-up programs," said Nelli Westercamp, the principal investigator and first author of the study who is a former UIC research project coordinator. "It was very important to do a real life, population-level study to look at this question. If men engaged in risky behaviors after circumcision, it could negate the protective effects."

The finding was documented in journal AIDS and Behavior.