Of the 35.3 million people living with HIV worldwide, 71% reside in Sub-Saharan Africa. But could this number be reduced if more African men were circumcised? According to a new study conducted in Kenya by researchers at the University of Illinois at Chicago, circumcision among young African men reduces engagement in sexual behavior that increases HIV risk.
According to the research team, led by Nelli Westercamp, PhD, a former research project coordinator at the University of Illinois at Chicago (UIC), past research has suggested that male circumcision reduces the risk of acquiring HIV (human immunodeficiency syndrome).
As reported by Medical News Today in 2012, such research has led to calls for voluntary medical male circumcision to be promoted as a form of HIV prevention.
But the team points out that some health experts believe that if circumcision is encouraged in this way, it could result in reduced condom use or increased promiscuity, offsetting any benefits for HIV prevention.
For this latest study, published in the journal AIDS and Behavior, researchers conducted what they say is the first population-level longitudinal analysis of how adult male circumcision impacts risky sexual behavior.
Between 2008 and 2010 - during the rollout of the national, voluntary medical circumcision program in Kenya - the UIC team assessed 3,186 uncircumcised men between the ages of 18 and 35 from Nyanza Province in the east African country. During the 2-year follow-up, half of the participants were circumcised.
'Countries should not be worried about scaling-up medical circumcision programs'
At study baseline and every 6 months thereafter, all men were questioned about their sexual behaviors, use of condoms and their perceived risk of contracting HIV. During the study period, all participants were also encouraged to attend clinics for HIV testing and counseling services, where HIV educational videos were shown in waiting areas. The researchers note that the men did not undergo direct HIV risk-reduction counseling during these visits.
The investigators found that sexual activity increased at the same level among both circumcised and uncircumcised men during the study period. However, they also found that condom use increased among both groups, while engagement in risky sexual behaviors - such as having multiple sex partners or having sex in exchange for money - declined.
- Of the 35.3 million people living with HIV worldwide, 3.2 million are children
- Last year, approximately 2.1 million people worldwide were newly infected with HIV
- HIV is the strongest risk factor for developing tuberculosis. In 2012, approximately 320,000 people with HIV died from tuberculosis.
In addition, the researchers found that men who had been circumcised believed the procedure had reduced their risk of contracting HIV. Prior to undergoing circumcision, 30% of men believed they were at high risk of HIV. This reduced to 14% after circumcision.
Among men who were not circumcised, 25% believed they were at high risk of HIV at study baseline, while 21% believed they were still at high risk when the study ceased. But the researchers note that these particular findings did not have any impact on whether participants engaged in risky sexual behavior during the study period.
According to Westercamp, the team's findings should alleviate concerns among countries that have been holding back on promotion of medical circumcision programs due to lack of evidence that it helps HIV prevention.
Senior study author Robert Bailey, professor of epidemiology at UIC adds that the "study provides the best evidence to date that concerns about risk compensation should not impede widespread implementation of voluntary male medical circumcision programs."
Medical News Today recently reported on a study published in JAMA, which revealed that annual HIV diagnosis rates in the US have decreased by more than 30% over the past decade.