ArticleJournal of acquired immune deficiency syndromes (1999)2019
Does Incident Circumcision Lead to Risk Compensation? Evidence From a Population Cohort in KwaZulu-Natal, South Africa.
Article in Journal of acquired immune deficiency syndromes (1999), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 3 of them syntheses that pooled it.
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Who cites it
13 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Association between medical male circumcision and HIV risk compensation among heterosexual men: a systematic review and meta-analysis.The Lancet. Global health · 2021Pooled it
- Impact of male circumcision on risk of HIV infection in men in a changing epidemic context - systematic review and meta-analysis.Journal of the International AIDS Society · 2020Pooled it
- Service delivery interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review.PloS one · 2020Pooled it
- The impact of male circumcision on risk of HIV infection in sub-Saharan Africa: a household fixed-effects analysis of 279,351 men from 29 countries.Frontiers in public health · 2026Article
- The real-world association between male circumcision and risk of HIV infection in sub-Saharan Africa: a household fixed-effects analysis of 279,351 men from 29 countries.medRxiv : the preprint server for health sciences · 2025Article
- Deficits and opportunities, pivots and shifts for scaling-up voluntary medical male circumcision in Uganda: a qualitative reflexive thematic analysis study.BMC public health · 2024Article
- Understanding the Evolving Role of Voluntary Medical Male Circumcision as a Public Health Strategy in Eastern and Southern Africa: Opportunities and Challenges.Current HIV/AIDS reports · 2022Review
- Risk compensation after HIV-1 vaccination may accelerate viral adaptation and reduce cost-effectiveness: a modeling study.Scientific reports · 2021Article
- Cohort Profile Update: Africa Centre Demographic Information System (ACDIS) and population-based HIV survey.International journal of epidemiology · 2021Article
- The impact of the program for medical male circumcision on HIV in South Africa: analysis using three epidemiological models.Gates open research · 2021Article
- No Evidence of Sexual Risk Compensation Following PrEP Initiation Among Heterosexual HIV Serodiscordant Couples in Kenya and Uganda.AIDS and behavior · 2020Article
- Sexual risk compensation following voluntary medical male circumcision: Results from a prospective cohort study amongst human immunodeficiency virus-negative adult men in Botswana.Southern African journal of HIV medicine · 2020Article
- Give PrEP a chance: moving on from the "risk compensation" concept.Journal of the International AIDS Society · 2019Article
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Authors and funding
6 authors.
Funding
Abstract
backgroundVoluntary medical male circumcision reduces men's risk of HIV acquisition and may thus increase HIV risk-related sexual behaviors through risk compensation. We analyze longitudinal data from one of Africa's largest population cohorts using fixed-effects panel estimation to measure the effect of incident circumcision on sexual behaviors.
settingKwaZulu-Natal, South Africa.
methodsAn open population cohort of men was followed from 2009 to 2015. Men self-reported their circumcision status and sexual behavior annually. We used linear regression models with individual-level fixed effects to measure the effect of incident circumcision on recent sex (past 12 months) and sexual behaviors that increase HIV risk (not using a condom at last sex, never using condoms with the most recent sexual partner, concurrent sexual partners at present, and multiple sexual partners in the past 12 months). We controlled for potential time-varying confounders: calendar year, age, education, and sexual debut.
resultsThe 5127 men in the cohort had a median age of 18 years (interquartile range 16-24) at cohort entry. Over the study period, almost 1 in 5 of these men (19.4%) became newly circumcised. Incident circumcision affected neither recent sex [percentage point (PP) change 0.0, 95% confidence interval: -1.2 to 1.3] nor sexual behaviors that increase HIV risk (PP -1.6, 95% confidence interval: -4.5 to 1.4).
conclusionsThe data from this study strongly reject the hypothesis that circumcision affects sexual risk-taking. Risk compensation should not serve as an argument against increased and accelerated scale-up of circumcision in this and similar communities in South Africa.
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