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Study: No Circumcision Link to Risky Behavior

  • Joe DeCapua

A Rwandan youth is tested for the AIDS virus before he receives a free male circumcision at the Shingiro Health Center in Musanze. (Courtesy the Global Fund)

A Rwandan youth is tested for the AIDS virus before he receives a free male circumcision at the Shingiro Health Center in Musanze. (Courtesy the Global Fund)

A new study that could boost HIV prevention efforts says African men do not engage in riskier sexual behavior after being circumcised. Research has shown that circumcision can greatly reduce men’s risk of being infected with the AIDS virus. The study’s been released as the 20th International AIDS Conference opens in Melbourne, Australia.

The study was done in Kenya’s Nyanza Province, a region where male circumcision is not common. Nelli Westercamp is the study’s principle investigator and lead author and affiliated with the University of Illinois at Chicago.

She said, “The connection between male circumcision and HIV has been detected in a number of observational studies since [the] 1990s. However, the scientific inquiry on this topic culminated when three clinical control trials in Kenya, Uganda and South Africa found that male circumcision reduces the risk of female to male transmission by about 60-percent.”

Despite the risk reduction, Westercamp said male circumcision should not be used alone to prevent HIV infection.

“It’s supposed to be implemented as a package of interventions altogether – male circumcision, condom promotion, HIV testing and counseling and so on,” she said.

Some feared that if circumcision was promoted as a prevention measure, circumcised men might think it was all right to engage in risky sexual behavior.

Westercamp said, “If men who become circumcised believe that they are fully protected against HIV, and engage in higher sexual risk taking behaviors as a result of this belief, this could reduce or even negate the protective effect of male circumcision against HIV.”

Between 2008 and 2010, nearly 3200 uncircumcised men from Nyanza Province took part in the study. Half underwent medical circumcision, while the other half did not. At the beginning of the study, those who chose to have the procedure actually thought they would be at a greater risk of infection than those who chose not to have it done. That perception declined significantly over time.

Researchers then monitored the participants. Westercamp said fears of increased risky sexual behavior among circumcised men were unfounded.

“Looking at sexual behaviors, we saw that the overall level of sexual activity increased equally in both groups – mostly driven by the youngest age group. That’s 18 to 24 year olds. However, despite this decrease in the risk perception among circumcised men – and an increase in sexual activity in both groups – all other risk behaviors decreased in both groups. And some protective behaviors -- such as condom use -- increased, particularly among circumcised men,” she said.

Westercamp said, “Countries that have been holding back on implementing medical circumcision programs…should have no concerns about scaling-up those programs.”