Poverty and InequalitySexual and Reproductive HealthFamily, Maternal & Child HealthMethodology

Sexual risk behaviors following circumcision among HIV-positive men in Rakai, Uganda

TitleSexual risk behaviors following circumcision among HIV-positive men in Rakai, Uganda
Publication TypeJournal Article
Year of Publication2018
AuthorsKankaka, EN, Ssekasanvu, J, Prodger, J, Nabukalu, D, Nakawooya, H, Ndyanabo, A, Kigozi, G, Gray, R
JournalAIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV
Type of ArticleArticle
ISBN Number09540121 (ISSN)
KeywordsAdult, alcohol consumption, article, casual sex, circumcision, concurrent sexual partnership, condom use, controlled study, follow up, HIV-positive, human, Human immunodeficiency virus infected patient, Human immunodeficiency virus infection, major clinical study, Male, male circumcision, priority journal, Rakai, risk compensation, Risky sexual behavior, Transactional sex, Uganda, Unsafe Sex

Objective: To determine whether circumcision of HIV-positive men is associated with increased subsequent sexual risk behaviors which may place their female partners at risk. Methods: Newly circumcised and uncircumcised HIV-positive men in the Rakai Community Cohort Study were followed from baseline (July 2013–January 2015) to determine trend in sexual risk behaviors and association of circumcision with subsequent sexual risk behaviors at follow up (February 2015–September 2016). Risk behaviors included sexual activity, alcohol before sex, transactional sex, multiple sex partners, casual sex partners, and inconsistent condom use with casual partners. The association was evaluated using modified Poisson regression, and sensitivity analyses were performed after multiple imputation with chained equations for missing data. Results: We identified 538 eligible men, of whom 113(21.0%) were circumcised at baseline and 425(79.0%) were uncircumcised. Men in fishing communities were more likely to be circumcised (p = 0.032) as well as those exposed to targeted HIV messaging (p < 0.001). Overall, 188(34.9%) men were lost to follow up and most were uncircumcised (p = 0.020). Among those followed up, behaviors remained largely unchanged with no differences by circumcision status. Transactional sex appeared to be associated with circumcision in unadjusted analyses (PR = 1.58, 95%CI = 1.01,2.48; p = 0.045, p = 0.05) and adjusted analyses (adj.PR = 1.54, 95%CI = 1.06,2.23; p = 0.022). However, the association was no longer significant in sensitivity analyses after accounting for loss to follow up (adj.PR = 1.43, 95%CI = 0.98,2.08; p = 0.066). No association with circumcision was observed for other sexual risk behaviors. Conclusion: We found no association between circumcision of HIV-positive men and subsequent sexual risk behavior. © 2018 Informa UK Limited, trading as Taylor & Francis Group.