Male circumcision decreased risk for HIV, no risk compensation observed in Uganda
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.
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