BOSTON — Five-year post-trial data indicated male circumcision
reduced more than half of all new HIV infections when compared with
uncircumcised men in Uganda. Yet, surveillance suggested an increase in "risky
sexual behaviors" among both circumcised and uncircumcised men, according to
Xiangrong Kong, PhD.
Although previous findings from randomized trials have suggested male
circumcision was associated with the prevention of HIV during 2 years
follow-up, the long-term effect on HIV-risk behaviors is unknown.
For the original randomized trial, 4,996 HIV-positive men aged 15 to 49
years residing in Rakai, Uganda, were either assigned to a circumcision
intervention arm or to a control arm where they were offered circumcision after
2 years; 80.4% of men accepted circumcision after the trial.
Men who were circumcised were then compared with men who were not. All
study participants were comparable in age, education, marital status, number of
sexual partners, and use of alcohol and condoms with sex, she said.
During post-trial surveillance, those who were circumcised had a 73%
lower risk for HIV-infection when compared with men who remained uncircumcised,
according to Kong. Compared with an overall HIV incidence of 1.93 per 100
person-years in uncircumcised men (n=372), the overall incidence for HIV was
0.50 per 100 person-years in circumcised men (n=2,750) within 4.28 years
post-surveillance follow-up.
“There have been concerns that some circumcised men might think
they are well protected against HIV, so they may engage in riskier sexual
behaviors," Kong said during a press conference. "We found no increase in the
number of non-marital sexual partners among circumcised men, and although there
was a reduction in condom use after the trial, the reduction was observed in
both circumcised men and men remaining uncircumcised. Thus circumcision itself
did not lead to increased risky behaviors. The reduction in condom use may be
due to less availability of free condoms and reduced intensive education and
counseling after the trial.” – by Jennifer Henry
For more information:
- Kong X. #36. Presented at: 18th Conference on Retroviruses and
Opportunistic Infections; Feb. 27-March 3, 2011; Boston.