Abstract
BackgroundSafe male circumcision (SMC) is a known efficacious intervention in the prevention of heterosexual HIV acquisition. However, there are perceptions that SMC may lead to behavior disinhibition towards risky sexual behaviors. We assessed the association between male circumcision, risky sexual behaviors and HIV prevalence among men in a nationally representative sample.MethodsData was extracted from the Uganda AIDS Indicator Survey (2011), a stratified two-stage cluster sample, with a total of 7,969 ever sexually active men aged 15–59 years. The association between risky sexual behaviors (non- marital/non-cohabiting sexual relations, non-use of condoms, transactional sex, multiple (4+) lifetime partners) and male circumcision status were determined using odds ratios (OR) and their 95% confidence intervals, through logistic regression models. All analyses were conducted in Stata version 12.ResultsOverall, the prevalence of male circumcision was 28%; higher among men aged 25–34 years, 32%, and lowest among those aged 45–59 years, 18%. HIV prevalence was significantly lower among the circumcised, 4.8% compared to the uncircumcised men, 7.8% (p < 0.001). The commonest risky sexual behaviors were multiple life-time sexual partners (4+), 59%; non-use of condoms with non-marital sexual partners, 55%; and having non-marital sex, 33%. In comparison with the uncircumcised, circumcised men had higher odds of engaging in non-marital sex AOR = 1.26 (95% CI: 1.05-1.52), reporting multiple (4+) life-time partners, AOR = 1.46 (95% CI: 1.27-1.67). The odds of non-use of condoms with a non-marital partner were also significantly lower among the circumcised compared to the uncircumcised men, AOR = 0.79 (95% CI: 0.63-0.98).ConclusionsAlthough risky sexual behaviors were more common among circumcised men, HIV prevalence was lower among the circumcised men relative to the uncircumcised. These observations suggest a need to promote the already known HIV intervention strategies especially among the circumcised men.
Highlights
Safe male circumcision (SMC) is a known efficacious intervention in the prevention of heterosexual Human Immunodeficiency Virus (HIV) acquisition
Despite evidence of higher risky sexual behavior (RSB) among the circumcised men, we found lower HIV prevalence in this group compared to their uncircumcised counterparts
In a Zimbabwe study [20], circumcision was not associated with RSBs, but instead uncircumcised men who were willing to be circumcised had more risky behaviors, while in a post trial study in Rakai-Uganda [21], there was no evidence of risk compensation as well
Summary
Safe male circumcision (SMC) is a known efficacious intervention in the prevention of heterosexual HIV acquisition. Male circumcision was primarily practiced for religious and cultural reasons in Uganda, a safe male circumcision (SMC) policy was launched in 2010 as part of the comprehensive strategy on HIV prevention to complement the “ABC” strategy (abstinence, being faithful to one partner and condom use). The goal of the SMC policy is to contribute to the reduction of HIV and other STIs [2], and to establish a research agenda focusing on male circumcision services towards HIV prevention as one of the key objectives. This policy recommends the integration of SMC services in the HIV prevention and sexual and reproductive health care services, while targeting all males including neonates whose parents and/or guardians consent to the procedure
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