The Effectiveness of Male Circumcision for HIV Prevention and Effects on Risk Behaviors in a Post-Trial Follow-Up Study

Gray, R., Kigozi G., Kong, X., et al. AIDS (March 2012), 26(5): 609–615, doi: 10.1097/QAD.0b013e3283504a3f.

This article reported on a post-trial observational study of the effectiveness of medical male circumcision (MMC) for HIV prevention in longer-term follow-up of a clinical trial population over five years in Rakai, Uganda. It also looked at any impact that self-selection or behavioral risk compensation may have on longer-term effectiveness. The initial trial was stopped after it had demonstrated that MMC reduced the risk of HIV acquisition in heterosexual men by approximately 59 percent. Researchers continued to follow the study population, and trial participants who had not been circumcised were offered MMC, with 78.4 percent accepting. There were no sociodemographic differences found between those who chose circumcision and those who declined. The study showed that overall effectiveness was maintained over five years, with rates similar to or higher than in the randomized trial. There was no statistically significant evidence of risk compensation or self-selection. The authors concluded that MMC offers long-term protection from HIV acquisition in men.