Male circumcision reduces HIV risk behaviour, says study

Men who opt for circumcision are more likely to engage in responsible sexual behaviour than their uncircumcised counterparts, a new study shows.

The study was published in the current July issue of the prestigious AIDS and Behaviour Journal titled Risk Compensation Following Male Circumcision: Results from a Two-Year Prospective Cohort Study of Recently Circumcised and Uncircumcised Men in Nyanza Province, Kenya.

The long term study compared the behaviours of 1, 588 newly circumcised men with 1,598 uncircumcised men for a period of 24 months in Nyanza province.

Researchers found that condom use among the newly circumcised men increased by 30 percent compared to the uncircumcised group where the use rose by only 6 percent.

This is consistent with earlier research which found that circumcised men consider condoms more comfortable and easier to use.

Dr Robert Bailey, Principal Investigator of the study from the University of Illinois stated that the results of the study also showed that circumcised men reported declines in other HIV risk behaviours.

They included less frequent casual sex, reduced incidence of transactional (paid) sex and fewer sexual partners.

There have been concerns from some policy makers and stakeholders that VMMC could increase the spread of HIV by encouraging risky behaviours - such as indulgence in unprotected sex - among circumcised men who believe that the ‘cut’ offers them immunity against the disease.

“We hope that these findings will convince all those who’ve been sceptical about Voluntary Medical Male Circumcision (VMMC) to finally embrace it,” noted Professor Walter Jaoko, Chair of the University Of Nairobi Medical Microbiology Department and the Deputy Director of the Kenya Aids Vaccine Initiative (KAVI), who participated in the study.

He noted that the new study has significantly reinforced the effectiveness of VMMC with regards to it reducing HIV transmission.

Mr James Macharia, Cabinet Secretary of Health stated that the government will continue rolling out VMMC programmes in regions where male circumcision has historically been low, especially in Nyanza province.

He noted that advocacy and sensitisation on the significance of VMMC is crucial to reduce stigma linked to the practice (mainly due to cultural beliefs) and promote its acceptance.

“We are also encouraging parents to circumcise their children while they are still young as it’s easier and beneficial to do so then,” he said.

Nyanza suffers the highest HIV prevalence in Kenya (15.1 percent) and contributes approximately one third of the nation’s new infections.

It is also the region with lowest rate of male circumcision (66 percent), based on the current Kenya Aids Indicator Survey (KAIS).

The VMMC approach has been proven to reduce the risk of female-to-male sexual transmission of HIV by approximately 60 percent.

Consequently, the World Health Organisation and UNAIDS have recommended the uptake of VMMC in 14 priority countries – including Kenya – with high HIV prevalence and historically low levels of male circumcision.

Other nations include Tanzania, Uganda, Rwanda, Ethiopia, Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe.

The WHO projects that reaching 80 percent VMMC coverage in these 14 priority countries - within five years and maintaining this for another 10 years – will save more than US$16 billion in future healthcare costs that would have been needed for HIV treatment.

Yet, experts at the 2014 AIDS conference warned of a major funding short fall. Of the $ 1.5 billion needed by 2016 for the 80 percent coverage in these countries, only $790 million is available. “This means that close to half ($710 million) of what we need is not there,” they noted.

With minimal budgetary allocation to the health sector, Kenya could be among the affected countries as the government largely relies on donor and other external financial resources to fund its VMMC programme scale-up.