Westercamp, N., Agot, K., Jaoko, W., et al. AIDS and Behavior (September 2014), 18(9): 1764–1775, doi: 10.1007/s10461-014-0846–4.
This article reported on the first program-based longitudinal study of reported HIV risk behaviors before and after voluntary medical male circumcision (VMMC). Diverse stakeholders have expressed concern that risk compensation—increase in risk behavior due to perception that an intervention like MMC reduces risk—could negate VMMC’s effects at individual and population levels. Previous research showed little evidence of risk compensation but was conducted in trial settings with intensive support. Newly circumcised men (1,588) were matched on age and community of residence with uncircumcised controls (1,598) in urban and rural Nyanza Province, Kenya. Participants were asked about their risk behavior using audio computer-assisted self-interview or paper at baseline and every six months for 24 months. No difference was found in specific reported risk behaviors between circumcised and uncircumcised men; all behaviors decreased over time in both groups. Reported condom use increased in both groups, more among circumcised men. Circumcised men reported significant decline in perceived HIV risk but with no differential effect on reported behavior. The authors recommended that models of VMMC impact and cost-effectiveness reflect this evidence, and said that concerns about risk compensation should not pose a barrier to widespread implementation of VMMC for HIV prevention.