1
|
Luseno WK, Rennie S, Gilbertson A. A review of public health, social and ethical implications of voluntary medical male circumcision programs for HIV prevention in sub-Saharan Africa. Int J Impot Res 2023; 35:269-278. [PMID: 34702986 PMCID: PMC8545773 DOI: 10.1038/s41443-021-00484-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/06/2021] [Accepted: 10/13/2021] [Indexed: 12/22/2022]
Abstract
Ideally, the benefits of public health interventions should outweigh any associated harms, burdens, and adverse unintended consequences. The intended benefit of voluntary medical male circumcision (VMMC) programs in eastern and southern Africa (ESA) is the reduction of HIV infections. We review the literature for evidence of reductions in HIV incidence, evaluate the extent to which decreases in HIV incidence can be reasonably attributed to VMMC programs, and summarize social harms and ethical concerns associated with these programs. Review findings suggest that HIV incidence had been declining across ESA since before the large-scale rollout of VMMC as a public health intervention, and that this decline may be due to the combined effects of HIV prevention and treatment interventions, such as expanded antiretroviral therapy. The independent effect of VMMC programs in reducing HIV infections at the population level remains unknown. On the other hand, VMMC-associated evidence is increasing for the existence of negative social impacts such as stigmatization and/or discrimination, and ethically problematic practices, including lack of informed consent. We conclude that the relationship between the benefits and burdens of VMMC programs may be more unfavorable than what has been commonly suggested by proponents of global VMMC campaigns.
Collapse
Affiliation(s)
| | - Stuart Rennie
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, USA
- UNC Center for Bioethics, University of North Carolina, Chapel Hill, NC, USA
| | - Adam Gilbertson
- Pacific Institute for Research and Evaluation (PIRE), Chapel Hill, NC, USA
| |
Collapse
|
2
|
Risk Compensation in Voluntary Medical Male Circumcision Programs. Curr HIV/AIDS Rep 2022; 19:516-521. [PMID: 36350470 DOI: 10.1007/s11904-022-00635-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE OF REVIEW Evidence from clinical trials identified the effectiveness of voluntary medical male circumcision (VMMC) as an additional strategy to reduce the risk of HIV transmission from women to men. However, concerns about post-circumcision sexual risk compensation may hinder the scale-up of VMMC programs. We reviewed the evidence of changes in risky sexual behaviors after circumcision, including condomless sex, multiple sex partners, and early resumption of sex after surgery. RECENT FINDINGS Most clinical trial data indicate that condomless sex and multiple partners did not increase for men after circumcision, and early resumption of sex is rare. Only one post-trial surveillance reports that some circumcised men had more sex partners after surgery, but this did not offset the effect of VMMC. Conversely, qualitative studies report that a small number of circumcised men had increased risky sexual behaviors, and community-based research reports that more men resumed sex early after surgery. With the large-scale promotion and expansion of VMMC services, it may be challenging to maintain effective sexual health educations due to various restrictions. Misunderstandings of the effect of VMMC in preventing HIV infection are the main reason for increasing risky sexual behaviors after surgery. Systematic and practical sexual health counseling services should be in place on an ongoing basis to maximize the effect of VMMC.
Collapse
|
3
|
Association between medical male circumcision and HIV risk compensation among heterosexual men: a systematic review and meta-analysis. LANCET GLOBAL HEALTH 2021; 9:e932-e941. [PMID: 33939956 PMCID: PMC8690595 DOI: 10.1016/s2214-109x(21)00102-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/08/2021] [Accepted: 02/25/2021] [Indexed: 02/02/2023]
Abstract
Background Medical male circumcision (MMC) reduces HIV infection among heterosexual men. There are concerns MMC might prompt higher-risk sexual behaviours because of lower self-perceived risk of HIV infection. We reviewed the published literature to examine associations between MMC and both condom use and number of sex partners among heterosexual men. Methods In this systematic review and meta-analysis, we searched PubMed, Embase, and the Cochrane Library for studies published before Nov 15, 2020. Interventional and observational studies were included if they contained original quantitative data describing the association between MMC and condom use or number of sex partners among heterosexual men. We excluded data from men whose circumcisions were ritual or religious and data from men who have sex with men. We extracted odds ratios (ORs) and 95% CIs for the associations between MMC and condomless sex and MMC and multiple sex partners directly from the publications if available, selecting adjusted ORs when provided; when necessary, we calculated ORs and 95% CIs using original study data provided in the publication. We used the Mantel-Haenszel random effects model to calculate pooled ORs and 95% CIs. Findings Our search yielded 3035 results, of which 471 were duplicates and 2537 did not meet the inclusion criteria. From the remaining 27 eligible studies, we identified 99 292 men from 31 independent population samples. 24 studies were done in Africa. We found no statistically significant associations between MMC and condomless sex (OR 0·91, 95% CI 0·80–1·05; k=30; I2=88·7%) or multiple sex partners (1·02, 0·88–1·18; k=27; I2=90·1%). No associations between MMC and condomless sex or multiple sexual partners were found in any subgroup analyses by study design, income of country, age, recruitment setting, circumcision assessment, circumcision prevalence, and risk of publication bias. Interpretation The promotion of circumcision as an HIV preventive measure does not appear to increase higher-risk sexual behaviours in heterosexual men. Ongoing sexual health education should be maintained as a vital component of effective MMC programmes.
Collapse
|
4
|
Korenromp EL, Bershteyn A, Mudimu E, Weiner R, Bonecwe C, Loykissoonlal D, Manuhwa C, Pretorius C, Teng Y, Stover J, Johnson LF. The impact of the program for medical male circumcision on HIV in South Africa: analysis using three epidemiological models. Gates Open Res 2021; 5:15. [PMID: 33615145 PMCID: PMC7878969 DOI: 10.12688/gatesopenres.13220.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 12/24/2022] Open
Abstract
Background: South Africa began offering medical male circumcision (MMC) in 2010. We evaluated the current and future impact of this program to see if it is effective in preventing new HIV infections. Methods: The Thembisa, Goals and Epidemiological Modeling Software (EMOD) HIV transmission models were calibrated to South Africa's HIV epidemic, fitting to household survey data on HIV prevalence, risk behaviors, and proportions of men circumcised, and to programmatic data on intervention roll-out including program-reported MMCs over 2009-2017. We compared the actual program accomplishments through 2017 and program targets through 2021 with a counterfactual scenario of no MMC program. Results: The MMC program averted 71,000-83,000 new HIV infections from 2010 to 2017. The future benefit of the circumcision already conducted will grow to 496,000-518,000 infections (6-7% of all new infections) by 2030. If program targets are met by 2021 the benefits will increase to 723,000-760,000 infections averted by 2030. The cost would be $1,070-1,220 per infection averted relative to no MMC. The savings from averted treatment needs would become larger than the costs of the MMC program around 2034-2039. In the Thembisa model, when modelling South Africa's 9 provinces individually, the 9-provinces-aggregate results were similar to those of the single national model. Across provinces, projected long-term impacts were largest in Free State, KwaZulu-Natal and Mpumalanga (23-27% reduction over 2017-2030), reflecting these provinces' greater MMC scale-up. Conclusions: MMC has already had a modest impact on HIV incidence in South Africa and can substantially impact South Africa's HIV epidemic in the coming years.
Collapse
Affiliation(s)
| | - Anna Bershteyn
- Department of Population and Health, NYU Langone Medical Center, New York, NY, 11016, USA
| | - Edina Mudimu
- Department of Decision Sciences, University of South Africa (UNISA), Pretoria, 0003, South Africa
| | - Renay Weiner
- Research and Training for Health and Development, Johannesburg, 2196, South Africa
| | | | | | - Clarence Manuhwa
- FHI 360, Pretoria, 0083, South Africa
- Independent Consultant, Pretoria, 0083, South Africa
| | - Carel Pretorius
- Center for Modeling and Analysis, Avenir Health, Glastonbury, CT, 06033, USA
| | - Yu Teng
- Center for Modeling and Analysis, Avenir Health, Glastonbury, CT, 06033, USA
| | - John Stover
- Center for Modeling and Analysis, Avenir Health, Glastonbury, CT, 06033, USA
| | - Leigh F. Johnson
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
5
|
Spees LP, Wirth KE, Mawandia S, Bazghina-Werq S, Ledikwe JH. Sexual risk compensation following voluntary medical male circumcision: Results from a prospective cohort study amongst human immunodeficiency virus-negative adult men in Botswana. South Afr J HIV Med 2021; 21:1157. [PMID: 33391832 PMCID: PMC7756904 DOI: 10.4102/sajhivmed.v21i1.1157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background Circumcised men may increase sexual risk-taking following voluntary medical male circumcision (VMMC) because of decreased perceptions of risk, which may negate the beneficial impact of VMMC in preventing new human immunodeficiency virus (HIV) infections. Objectives We evaluated changes in sexual behaviour following VMMC. Method We conducted a prospective cohort study amongst sexually active, HIV-negative adult men undergoing VMMC in Gaborone, Botswana, during 2013–2015. Risky sexual behaviour, defined as the number of sexual partners in the previous month and ≥ 1 concurrent sexual partnerships during the previous 3 months, was assessed at baseline (prior to VMMC) and 3 months post-VMMC. Change over time was assessed by using inverse probability weighted linear and conditional logistic regression models. Results We enrolled 523 men; 509 (97%) provided sexual behaviour information at baseline. At 3 months post-VMMC, 368 (72%) completed the follow-up questionnaire. At baseline, the mean (95% confidence interval) number of sexual partners was 1.60 (1.48, 1.65), and 111 (31% of 353 with data) men reported engaging in concurrent partnerships. At 3 months post-VMMC, 70 (23% of 311 with data) reported fewer partners and 19% had more partners. Amongst 111 men with a concurrent partnership at baseline, 52% reported none post-VMMC. Amongst the 242 (69%) without a concurrent partnership at baseline, 19% reported initiating one post-VMMC. After adjustment for loss to follow-up, risky sexual behaviour post-VMMC (measured as mean changes in a number of partners and proportion engaging in concurrency) was similar to baseline levels. Conclusion We found no evidence of sexual risk compensation in the 3 months following VMMC.
Collapse
Affiliation(s)
- Lisa P Spees
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States of America
| | - Kathleen E Wirth
- Department of Biostatistics, Faculty of Health Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America.,Botswana International Training and Education Center for Health (I-TECH), Gaborone, Botswana
| | - Shreshth Mawandia
- Department of Health Policy and Management, Faculty of Medicine, Botswana International Training and Education Center for Health, Gaborone, Botswana.,Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Semo Bazghina-Werq
- Department of Global Health, University of Washington, Seattle, WA, United States of America.,Independent Global Health Consultant, Washington, DC, United States of America
| | - Jenny H Ledikwe
- Department of Health Policy and Management, Faculty of Medicine, Botswana International Training and Education Center for Health, Gaborone, Botswana.,Department of Global Health, University of Washington, Seattle, WA, United States of America
| |
Collapse
|
6
|
Atkins K, Yeh PT, Kennedy CE, Fonner VA, Sweat MD, O’Reilly KR, Baggaley R, Rutherford GW, Samuelson J. Service delivery interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review. PLoS One 2020; 15:e0227755. [PMID: 31929587 PMCID: PMC6957297 DOI: 10.1371/journal.pone.0227755] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 12/27/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Voluntary medical male circumcision (VMMC) remains an essential component of combination HIV prevention services, particularly in priority countries in sub-Saharan Africa. As VMMC programs seek to maximize impact and efficiency, and to support World Health Organization guidance, specific uptake-enhancing strategies are critical to identify. METHODS We systematically reviewed the literature to evaluate the impact of service delivery interventions (e.g., facility layout, service co-location, mobile outreach) on VMMC uptake among adolescent and adult men. For the main effectiveness review, we searched for publications or conference abstracts that measured VMMC uptake or uptake of HIV testing or risk reduction counselling within VMMC services. We synthesized data by coding categories and outcomes. We also reviewed studies assessing acceptability, values/preferences, costs, and feasibility. RESULTS Four randomized controlled trials and five observational studies were included in the effectiveness review. Studies took place in South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. They assessed a range of service delivery innovations, including community-, school-, and facility-based interventions. Overall, interventions increased VMMC uptake; some successfully improved uptake among age-specific subpopulations, but urban-rural stratification showed no clear trends. Interventions that increased adult men's uptake included mobile services (compared to static facilities), home-based testing with active referral follow-up, and facility-based HIV testing with enhanced comprehensive sexual education. Six acceptability studies suggested interventions were generally perceived to help men choose to get circumcised. Eleven cost studies suggested interventions create economies-of-scale and efficiencies. Three studies suggested such interventions were feasible, improving facility preparedness, service quality and quantity, and efficiencies. CONCLUSIONS Innovative changes in male-centered VMMC services can improve adult men's and adolescent boys' VMMC uptake. Limited evidence on interventions that enhance access and acceptability show promising results, but evidence gaps persist due to inconsistent intervention definition and delivery, due in part to contextual relevance and limited age disaggregation.
Collapse
Affiliation(s)
- Kaitlyn Atkins
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Ping Teresa Yeh
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Caitlin E. Kennedy
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Virginia A. Fonner
- Division of Global and Community Health, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Michael D. Sweat
- Division of Global and Community Health, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Kevin R. O’Reilly
- Division of Global and Community Health, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Rachel Baggaley
- Department of HIV, World Health Organization, Geneva, Switzerland
| | - George W. Rutherford
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Julia Samuelson
- Department of HIV, World Health Organization, Geneva, Switzerland
| |
Collapse
|
7
|
Luseno WK, Field SH, Iritani BJ, Rennie S, Gilbertson A, Odongo FS, Kwaro D, Ongili B, Hallfors DD. Consent Challenges and Psychosocial Distress in the Scale-up of Voluntary Medical Male Circumcision Among Adolescents in Western Kenya. AIDS Behav 2019; 23:3460-3470. [PMID: 31375957 PMCID: PMC6854308 DOI: 10.1007/s10461-019-02620-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In priority sub-Saharan African countries, on the ground observations suggest that the success of voluntary medical male circumcision (VMMC) programs should not be based solely on numbers of males circumcised. We identify gaps in the consent process and poor psychosocial outcomes among a key target group: male adolescents. We assessed compliance with consent and assent requirements for VMMC in western Kenya among males aged 15-19 (N = 1939). We also examined differences in quality of life, depression, and anticipated HIV stigma between uncircumcised and circumcised adolescents. A substantial proportion reported receiving VMMC services as minors without parent/guardian consent. In addition, uncircumcised males were significantly more likely than their circumcised peers to have poor quality of life and symptoms of depression. Careful monitoring of male adolescents' well-being is needed in large-scale VMMC programs. There is also urgent need for research to identify effective strategies to address gaps in the delivery of VMMC services.
Collapse
Affiliation(s)
- Winnie K Luseno
- Pacific Institute for Research and Evaluation (PIRE), 101 Conner Dr., Suite 200, Chapel Hill, NC, USA.
| | - Samuel H Field
- Independent Statistical Consultant, Chapel Hill, NC, USA
| | - Bonita J Iritani
- Pacific Institute for Research and Evaluation (PIRE), 101 Conner Dr., Suite 200, Chapel Hill, NC, USA
| | - Stuart Rennie
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adam Gilbertson
- Pacific Institute for Research and Evaluation (PIRE), 101 Conner Dr., Suite 200, Chapel Hill, NC, USA
| | - Fredrick S Odongo
- Kenya Medical Research Institute (KEMRI), Centre for Global Health Research, Kisumu, Kenya
| | - Daniel Kwaro
- Kenya Medical Research Institute (KEMRI), Centre for Global Health Research, Kisumu, Kenya
| | - Barrack Ongili
- Kenya Medical Research Institute (KEMRI), Centre for Global Health Research, Kisumu, Kenya
| | - Denise D Hallfors
- Pacific Institute for Research and Evaluation (PIRE), 101 Conner Dr., Suite 200, Chapel Hill, NC, USA
| |
Collapse
|
8
|
Kaufman MR, Dam KH, Sharma K, Van Lith LM, Hatzold K, Marcell AV, Mavhu W, Kahabuka C, Mahlasela L, Patel EU, Njeuhmeli E, Seifert Ahanda K, Ncube G, Lija G, Bonnecwe C, Tobian AAR. Females' Peer Influence and Support for Adolescent Males Receiving Voluntary Medical Male Circumcision Services. Clin Infect Dis 2019; 66:S183-S188. [PMID: 29617773 PMCID: PMC5888916 DOI: 10.1093/cid/cix1057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background While female involvement in voluntary medical male circumcision (VMMC) has been studied among adults, little is known about the influence of adolescent females on their male counterparts. This study explored adolescent females’ involvement in VMMC decision making and the postoperative wound healing process in South Africa, Tanzania, and Zimbabwe. Methods Across 3 countries, 12 focus group discussions were conducted with a total of 90 adolescent females (aged 16–19 years). Individual in-depth interviews were conducted 6–10 weeks post-VMMC with 92 adolescent males (aged 10–19 years). Transcribed and translated qualitative data were coded into categories and subcategories by 2 independent coders. Results Adolescent female participants reported being supportive of male peers’ decisions to seek VMMC, with the caveat that some thought VMMC gives males a chance to be promiscuous. Regardless, females from all countries expressed preference for circumcised over uncircumcised sexual partners. Adolescent females believed VMMC to be beneficial for the sexual health of both partners, viewed males with a circumcised penis as more attractive than uncircumcised males, used their romantic relationships with males or the potential for sex as leveraging points to convince males to become circumcised, and demonstrated supportive attitudes in the wound-healing period. Interviews with males confirmed that encouragement from females was a motivating factor in seeking VMMC. Conclusions Adolescent female participants played a role in convincing young males to seek VMMC and remained supportive of the decision postprocedure. Programs aiming to increase uptake of VMMC and other health-related initiatives for adolescent males should consider the perspective and influence of adolescent females.
Collapse
Affiliation(s)
| | - Kim H Dam
- Johns Hopkins Center for Communication Programs, Baltimore, Maryland
| | - Kriti Sharma
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lynn M Van Lith
- Johns Hopkins Center for Communication Programs, Baltimore, Maryland
| | | | - Arik V Marcell
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Webster Mavhu
- Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe
| | | | | | - Eshan U Patel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Emmanuel Njeuhmeli
- Office of HIV/AIDS, Global Health Bureau, United States Agency for International Development, Washington, District of Columbia
| | - Kim Seifert Ahanda
- Office of HIV/AIDS, Global Health Bureau, United States Agency for International Development, Washington, District of Columbia
| | | | - Gissenge Lija
- Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | | | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
9
|
Govender K, Masebo WGB, Nyamaruze P, Cowden RG, Schunter BT, Bains A. HIV Prevention in Adolescents and Young People in the Eastern and Southern African Region: A Review of Key Challenges Impeding Actions for an Effective Response. Open AIDS J 2018; 12:53-67. [PMID: 30123385 PMCID: PMC6062910 DOI: 10.2174/1874613601812010053] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/27/2018] [Accepted: 05/07/2018] [Indexed: 11/22/2022] Open
Abstract
The global commitment to ending the AIDS epidemic by 2030 places HIV prevention at the centre of the response. With the disease continuing to disproportionately affect young populations in the Eastern and Southern African Region (ESAR), particularly adolescent girls and young women, reducing HIV infections in this group is integral to achieving this ambitious target. This paper examines epidemiological patterns of the HIV epidemic among adolescents and young people, indicating where HIV prevention efforts need to be focused (i.e., adolescent girls and young women, adolescent boys and young men and young key populations). Key innovations in the science of HIV prevention and strategies for dealing with programme implementation are reviewed. The paper also discusses the value of processes to mitigate HIV vulnerability and recommends actions needed to sustain the HIV prevention response. Stemming the tide of new HIV infections among young people in the ESAR requires an amplification of efforts across all sectors, which will safeguard past achievements and advance actions towards eliminating AIDS as a public health threat.
Collapse
Affiliation(s)
- Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Wilfred G B Masebo
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Patrick Nyamaruze
- School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Richard G Cowden
- Department of Psychology, Middle Tennessee State University, Murfreesboro, United States of America
| | | | - Anurita Bains
- UNICEF, Eastern and Southern Africa Regional Office, Nairobi, Kenya
| |
Collapse
|
10
|
Kabwama SN, Ssewanyana D, Berg-Beckhoff G. The Association Between Male Circumcision and Condom Use Behavior - a Meta-Analysis. Mater Sociomed 2018; 30:62-66. [PMID: 29670480 PMCID: PMC5857052 DOI: 10.5455/msm.2018.30.62-66] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Introduction The protective benefit of male circumcision against spreading HIV is well established. Aim The objective of this Meta-analysis was to investigate behavioral risk compensation measured as the change in condom use behavior in light of knowledge of the benefits of circumcision. Material and Methods A systematic search was conducted from 6 bibliographic databases for studies that quantitatively assessed a link between male circumcision and condom use behavior. Pooled odd ratios (OR) of condom use during any sexual activity were generated from three cohort studies and two Randomized Control Trails (RCT) that were included in the review. Results The pooled effects from cohort and RCTs were not statistically significant at 6 months follow-up (OR=0.91, 95% CI: 0.57-1.45), at 12 months (OR=1.08, 95% CI=0.87-1.34) and 24 or more months (OR=1.11, 95% CI: 0.85, 1.45). Conclusion Male circumcision does not influence condom use behavior in the medium and short term.
Collapse
|