Abstract
BackgroundAlthough male circumcision reduces the heterosexual HIV transmission risk, its effect may be attenuated if circumcised men increase sexual risk behaviours (SRB) due to perceived low risk. In Uganda information about the protective effects of circumcision has been publicly disseminated since 2007. If increased awareness of the protection increases SRB among circumcised men, it is likely that differences in prevalence of SRB among circumcised versus uncircumcised men will change over time. This study aimed at comparing SRBs and HIV sero-status of circumcised and uncircumcised men before and after the launch of the safe male circumcision programme.MethodsData from the 2004 and 2011 Uganda AIDS Indicator Surveys (UAIS) were used. The analyses were based on generalized linear models, obtaining prevalence ratios (PR) as measures of association between circumcision status and multiple sexual partners, transactional sex, sex with non-marital partners, condom use at last non-marital sex, and HIV infection. In addition we conducted multivariate analyses adjusted for sociodemographic characteristics, and the multivariate models for HIV status were also adjusted for SRB.ResultsTwenty six percent of men were circumcised in 2004 and 28 % in 2011. Prevalence of SRB was higher among circumcised men in both surveys. In the unadjusted analysis, circumcision was associated with having multiple sexual partners and non-marital partners. Condom use was not associated with circumcision in 2004, but in 2011 circumcised men were less likely to report condom use with the last non-marital partner. The associations between the other sexual risk behaviours and circumcision status were stable across the two surveys.” In both surveys, circumcised men were less likely to be HIV positive (Adj PR 0.55; CI: 0.41–0.73 in 2004 and Adj PR 0.64; CI: 0.49–0.83 in 2011).ConclusionsThere was higher prevalence of SRBs among circumcised men in both surveys, but the only significant change from 2004 to 2011 was a lower prevalence of condom use among the circumcised. Nevertheless, HIV prevalence was lower among circumcised men. Targeted messages for circumcised men and their sexual partners to continue using condoms even after circumcision should be enhanced to avoid risk compensation.
Highlights
Male circumcision reduces the heterosexual HIV transmission risk, its effect may be attenuated if circumcised men increase sexual risk behaviours (SRB) due to perceived low risk
HIV prevalence was lower among circumcised men
The 2004 Uganda AIDS Indicator Surveys (UAIS) was conducted before the implementation of the safe male circumcision (SMC) programme while the 2011 UAIS was conducted after the SMC programme implementation was underway in the country
Summary
Male circumcision reduces the heterosexual HIV transmission risk, its effect may be attenuated if circumcised men increase sexual risk behaviours (SRB) due to perceived low risk. In 2011, there were further social marketing efforts to increase demand, such as the “stand proud, get circumcised” campaign using a provocative approach that spoke to men through women. This was designed to convince men who had intentions of circumcision to get SMC services while encouraging women to support their partners to get circumcised and encouraging adherence to post circumcision practices that promote healing. Between 2009 and September 2013, over 1.4 million adult men were circumcised [18, 19]
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