20th International AIDS Conference - Melbourne, Australia


MOPDC0105 - Poster Discussion Abstract

Assessing risk compensation post-male circumcision in Zambia's national program

Presented by Erica Soler-Hampesjek (United States).

P.C. Hewett1, P. Todd2, N. Grau2, K. Dzekedzeke3, E. Soler-Hampesjek4, N. Shiliya5, B.S. Mensch6

1Population Council, Lusaka Zambia, Zambia, 2University of Pennsylvania, Philadelphia, United States, 3Dzekedzeke, Inc., Lusaka, Zambia, 4Population Council, Poverty, Gender, and Youth, New York, United States, 5Society for Family Health, Lusaka, Zambia, 6Population Council, New York, United States

Background: Voluntary male medical circumcision (VMMC) is scaling up in eastern and southern-Africa. In Zambia, approximately 2.6 million HIV-negative men 15-49 are eligible. Since late 2008, Zambia has expanded its national program of medical male circumcision reaching over 500,000 men. While studies from the randomized trials of male circumcision in Kisumu, Kenya (Matson et al., 2008) and Rakai, Uganda (Grey et al., 2012) have not found evidence of risk compensation post circumcision, little information is available for national MC programs, which provide less intensive counseling and follow-up.
Methods: A prospective, population-based cohort study was initiated in Zambia to examine risk compensation post-MC. A total of 2,333 men aged 15−29 were interviewed in 2010-11 (baseline) and followed in 2011-12 (Round 2), and 2012-13 (Round 3); approximately 81% of Round1 participants were re-interviewed in Round3. Data collection for Round 4 will be completed in March 2014, providing over 3 years of observation. The study instruments included detailed questions about MC knowledge, attitudes and status, and an extensive module on sexual behavior, which was implemented via computerized self-interview. The data presented here are for Rounds 1-3, although the final analysis will include Round 4. In preliminary analysis, linear and logit fixed effects models were used to assess behavior change over time and to address potential endogeneity; propensity scoring methods will also be used in the final analysis.
Results: Data indicate that between Rounds 1 and 2 and Rounds 2 and 3, 7% and 8% of males were circumcised, respectively. A marginal increase in the prevalence of risky sexual behavior was observed; however, for only 1 of 6 indicators of risk behavior is the increase significant at the p < .05 level. Analysis reveals no consistent evidence of risk compensation post-MC. Indeed, some results suggest more protective behaviors among recently circumcised men.
Conclusions: The findings of this study will inform the male circumcision program in Zambia, provide valuable information for assessing the impact of the intervention regionally, and inform other HIV prevention efforts where risk compensation is a potential concern.

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