Male circumcision, risk compensation and the role of intensive health education and VCT on HIV prevention in Rakai, Uganda
Observational studies and clinical trials show that male circumcision (MC) reduces HIV infection among men, and MC is recommended by WHO/UNAIDS as an important HIV prevention strategy. However, MC is not 100% protective against HIV, and risk compensation (i.e. engagement in increased risky sexual behaviors), may offset MC''s effectiveness. Thus behavioral risk reduction interventions need to be integrated into MC programs. Intensive risk reduction and monitoring of risk behaviors occurred during the trials prior to evidence of MC’s efficacy. However, there are no studies on within-individual changes in sexual behaviors among men following MC when it is provided as a service in the current era when MC''s preventive effect has been conclusively established. The MC trials and the ongoing post-trial surveillance conducted in Rakai, Uganda by the Rakai Health Sciences Program (RHSP) provide us a unique opportunity to assess sexual behavior changes among men both during and after the trial, and also allow us to evaluate the effects of intensity of preventive education that should accompany MC services. In addition, since one Rakai trial enrolled HIV-negative men who accepted voluntary HIV counseling and testing (VCT), and the other trial enrolled HIV-negative men who declined VCT, study of both trials will allow us to assess the importance of VCT uptake in preventing risk compensation following MC.
This study will focus on HIV-negative men and will provide critical information about MC''s impact on men''s sexual behaviors and the roles of intensive health education and VCT uptake for prevention of behavioral disinhibition. It will guide behavioral intervention strategies needed for MC scale-up programs and provide preliminary data for a planned R01 submission.