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Protective sexual behaviours and risk compensation related to male circumcision among men and women in Kisumu, Kenya
Presented by Thomas Horton Riess (United States).
T.H. Riess1, M.M. Achieng'2, S. Otieno2, J.O. Ndinya-Achola3, R.C. Bailey4
1University of Illinois at Chicago, Division of Commuity Health Sciences, Chicago, United States, 2UNIM Project, Kisumu, Kenya, 3University of Nairobi, Department of Medical Microbiology, Nairobi, Kenya, 4University of Illinois at Chicago, Division of Epidemiology and Biostatistics, Chicago, United States
Background: Following findings that male circumcision (MC) reduces HIV transmission from women to men during vaginal intercourse by approximately 60%, there is concern that people will engage in risk compensation, i.e. reduce HIV prevention efforts and engage in higher risk sex due to feeling protected by circumcision. This study was conducted to explore men's and women's sexual risk behaviors and perceptions of sexual risk related to MC status.
Methods: Qualitative in-depth interviews were conducted from March to November 2008 with 30 women, 30 circumcised men, and 10 uncircumcised men 18-35 years old who were sexually active. Participants were recruited in Kisumu, Kenya using convenience and snowball sampling methods. Interviews were conducted in English, Kiswahili, and Dholuo, transcribed verbatim, and translated into English.
Results: Most participants reported adopting safer sex practices or making no changes in sexual behaviours, rather than engaging in risk compensation. MC was recognized as providing partial protection against HIV and was seen as part of a prevention plan that incorporated condom use, partner reduction, monogamy, and HIV testing. Pre-circumcision counseling and testing influenced circumcised men's decision to maintain safe HIV prevention practices, increase condom use, or reduce the number of sexual partners. A few men reported increasing the number of rounds of sex and engaging in unprotected sex after being circumcised to “test” sexual sensation. More women reported a desire for circumcised sexual partners because they were assumed to be more hygienic and have reduced chances of being infected with STIs or HIV.
Conclusions: HIV counseling and testing provided with MC programs, and for the general public, which properly explains the partial protective effects of MC and the need for accompanying HIV prevention strategies, helps to mitigate risk compensation and facilitate increases in protective behaviours.
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