Medically circumcised men are no more likely to engage in risky sexual behaviour than their uncircumcised peers, according to new research from South Africa and Zimbabwe.
Major studies have shown that medical male circumcision reduces a man's chances of contracting HIV through vaginal sex by about 60%. The World Health Organisation now recommends the procedure as an HIV prevention method.
But many people have wondered whether telling circumcised men they were partially protected from HIV infection would lead them to take chances with their health by, for example, ditching condoms and having sex with more people. Scientists often describe this kind of disinhibition as "risk compensation"
Now, new studies from South Africa and Zimbabwe conducted among almost 17000 men found that those who had been medically circumcised were no less likely to use condoms than their uncircumcised peers.
Researchers from the universities of Harvard, Seattle and Washington in the United States also discovered that circumcised men also did not have more partners and were no more likely to have more than one partner at a time, both of which are risk factors for HIV infection. Both studies were recently presented at the Conference on Retroviruses and Opportunistic Infections in Seattle, Washington.
Harvard University HIV prevention researcher Katrina Ortblad says that the new data should erase any doubts about medical male circumcision's benefits:
"A study like this could convince circumcision sceptics that fears of risk compensation are unsubstantiated, encouraging more clinics and physicians to begin encouraging the intervention," Ortbald told Bhekisisa.
South African health advocacy organisation Brothers for Life says the new findings strengthen calls for men to undergo the procedure, which can be done by a number of health workers and does not require hospitalisation.
Brothers for Life program manager Mogale Mashiapata says he hopes the new research will encourage more men to line up for the procedure. He says that men – and their partners – stand to benefit from voluntary medical male circumcision.
Mashiapata says men who undergo "the snip" enjoy an easier-to-clean penis following the removal of the foreskin – and their female partners may be at a lower risk of cervical cancer.
A 2011 study published in the medical journal The Lancet found that the female partners of medically circumcised men were less likely to contract the human papillomavirus and those who did were more likely to naturally clear the infection. Strains of the human papillomavirus are known to cause cervical cancer in women.
In 2010, the health department set a national target to have 80% of HIV-negative men between 15 and 49 — or about 4.3-mllion people — undergo voluntary medical male circumcision by 2015. As of 2014, the country was estimated to fall short of this target, according to a report by the South African National Aids Council.
Ortbald says that she hopes that her study will help dispel some health workers' fears that encouraging men to line up for "the snip" will lead to risky moves in the bedroom – and help clinicians better advocate for the service in South Africa and globally.
She explains: "Evidence that risk compensation does not exist could also increase global enthusiasm for circumcision, resulting in increased funding for the intervention."
If 11.7-million African men were medically circumcised by 2025, the continent could avert 335 000 new HIV infections, argues WHO research. The body notes that while countries such as Kenya, Tanzania and Zambia have been able to reach national circumcision goals, Southern Africa continues to fall short as a region because of a lack of funding.
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Bhekisisa means "to scrutinise" in Zulu
In South Africa, Zulu patients who would like to be thoroughly assessed by a doctor, would ask the physician to "bhekisisa" them.