Male Circumcision in Siaya and Bondo Districts, Kenya Prospective Cohort Study to Assess Behavioral DisinhibitionFollowing Circumcision

Abstract

Background: Evidence for efficacy of male circumcision as an HIV prevention measure is increasing, but there is serious concern that men who are circumcised may subsequently adopt more risky sexual behaviors. Methods: Using a prospective cohort study, we compared sexual behaviorsof324recentlycircumcisedand324uncircumcisedmenat 1, 3, 6, 9, and 12 months after circumcision/study enrollment. The main outcome indicators were incidence of sexual behaviors known to place men at increased risk of acquiring HIV, namely, having sex with partners other than their wife/wives for married men or other than ‘‘regular’’ girlfriends for unmarried men. Results: During the first month following circumcision, men were 63%and61%lesslikelytoreporthaving0to0.5and.0.5riskysex acts/week, respectively,than menwhoremained uncircumcised. This difference disappeared during the remainder of follow-up, with no excess of reported risky sex acts among circumcised men. Similar resultswere observed for riskyunprotected sex acts, number of risky sex partners, and condom use. Discussion: During the first year postcircumcision, men did not engage in more risky sexual behaviors than uncircumcised men, suggesting that any protective effect of male circumcision on HIV acquisition is unlikely to be offset by an adverse behavioral impact.