Male circumcision has been shown to reduce the transmission of HIV from women to menA

Male circumcision has been shown to reduce the transmission of HIV from women to men through vaginal sex by approximately 60%. There is concern that men may engage in risk compensation after becoming circumcised, diminishing the benefits of male circumcision. Reiss and colleagues conducted qualitative interviews with 30 sexually active circumcised men in Kisumu, Kenya from March to November 2008. Most respondents reported no behaviour change or increasing protective sexual behaviours including increasing condom use and reducing the number of sexual partners. A minority of men reported engaging in higher risk behaviours either not using condoms or increasing the number of sex partners. Circumcised respondents described being able to perform more rounds of sex, easier condom use, and fewer cuts on the penis during sex. The results illustrate that information about male circumcision’s protection against HIV has disseminated into the larger community and male circumcision accompanied by counselling and HIV testing can foster positive behaviour change and maintain sexual behaviour.

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Editors’ note: This first published qualitative study exploring male circumcision and risk compensation gives us rich insights into young men’s motivations for changing or maintaining sexual behaviour following circumcision. The term ‘risk compensation’ refers to people modifying their behaviour in an ‘offsetting’ way in response to real or perceived changes in risk. In the case of male circumcision, there have been concerns that men who become circumcised might stop using condoms, increase their number of sexual partners, or choose higher risk sexual partners. This study of 30 circumcised men makes for an interesting read and is a solid contribution to our understanding of how young men perceive the partial protection that male circumcision affords against HIV. Of the five men who reported risk compensation in this study, one stopped using condoms temporarily with his wife and four increased the number of sexual partners but reported using condoms with their new partners. The remainder either maintained their previous behaviour (n=17) or reduced their risk (n=8) by either decreasing their number of partners or increasing condom use. Nine of the men had not received counselling at the time of circumcision and yet they reported no increase in risky behaviour, underscoring the widespread penetration of the partial protection message in the general community in Kisumu. Those who did receive counselling and HIV testing in the context of the surgery, reported it as influential in their subsequent sexual behaviour choices. This gives added fuel to the argument that male circumcision services are best conceived and delivered as male sexual and reproductive health programmes.