Circumcision for HIV Prevention: Failure to Fully Account for Behavioral Risk Compensation
2007

Circumcision for HIV Prevention: Authors' Reply

publication Evidence: moderate

Author Information

Author(s): Seth Kalichman, Lisa Eaton, Steven Pinkerton

Primary Institution: University of Connecticut

Hypothesis

Does male circumcision lead to increased risk compensation behaviors that could offset its benefits in HIV prevention?

Conclusion

Circumcision may reduce HIV incidence among men but could increase it among women due to risk compensation behaviors.

Supporting Evidence

  • Three RCTs showed significant reductions in HIV infection among circumcised men.
  • Modeling suggests increased circumcision could prevent millions of HIV infections.
  • Risk compensation may offset the benefits of circumcision.
  • Counseling and free condoms in trials may not reflect real-world behaviors.

Takeaway

Getting circumcised might help men avoid HIV, but if they stop using condoms or have more partners, it could actually make things worse for women.

Methodology

The study discusses findings from randomized controlled trials and modeling studies regarding circumcision and HIV risk.

Potential Biases

Potential bias due to the controlled environment of trials not representing natural settings.

Limitations

The trials may not reflect real-world behaviors since participants received counseling and free condoms.

Participant Demographics

Men aged 15 to 24 in South Africa.

Digital Object Identifier (DOI)

10.1371/journal.pmed.0040138

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