Mattson, C., Campbell, R., Baily, R.C., et al. PLOS ONE (June 2008), 3(6): e2443.
This study assessed whether about 1,000 18–24-year-old men, participants in a randomized, controlled trial in Kisumu, Kenya on male circumcision (MC), adopted risky sexual behaviors after being circumcised. Participants received counseling that research about MC's protective effect against HIV was inconclusive. This study included a comprehensive, 18-point scale that was validated with serologic text results for sexually transmitted infections. Detailed sexual histories were collected at baseline, 6 months, and 12 months after randomization, with individualized HIV risk reduction counseling taking place at this time. The researchers found that sexual risk behaviors decreased one year after being randomized to either MC or control. There was no difference between circumcised and uncircumcised men after one year of follow-up in propensity for sexual risk, or in incidence of gonorrhea, chlamydia, and trichomoniasis. While this study indicated that risk compensation may not be an issue with MC, study participants had risk reduction counseling and the support of a clinical trial—counseling and support that will be difficult to replicate when MC becomes widely available. Furthermore, changes in sexual behavior may take place more than one year after MC.