Male Circumcision (MC) is effective in reducing the risk of HIV acquisition. A clinical trial to introduce MC was conducted in the Dominican Republic (DR). Behavioral disinhibition (BD) is the increase in risky behaviors from a perceived risk reduction after an intervention. BD may negatively impact the effectiveness of MC programs. The objective of this study was to compare sexual behaviors before and after MC to determine whether BD occurred
This is a cohort study comparing sexual risk behaviors before and after MC. McNemar’s test was used to assess differences in proportions of men with certain sexual risk behaviors before and after MC. Log binomial regression was used to explore baseline characteristics associated with an increase in sex partners 30 days prior to the interview.
Out of 454 circumcised men, 362 (80%) returned for a follow up visit. 98% were very or somewhat satisfied with their MC. Compared to prior to MC there was a decrease in the proportion of men having sex with women they met the same day (p<0.01) and of men having sex while drinking alcohol (p<0.01). There was an insignificant decrease in condom use at last sexual encounter post MC (p=0.08), but 95% of these unprotected encounters were with participant’s wife or regular partner. Seventy men increased the number of sex partners in the previous 30 days from less than 2 to 2 or more when compared to baseline. The proportion of these men who consistently used condoms with non-regular partners (highest risk encounters) was statistically similar than before MC (p=0.06). In multivariate analysis, having sex with a woman they met the same day (RR=1.6, 95% CI: 0.7-1.3) and number of female sex partners at baseline (RR=0.5, 95% CI: 0.3-0.8) were the only variables associated with any increase in the number of sex partners after MC.
There are differences in sexual behaviors before and after MC in this cohort of men. Although there was an increase in the proportion of men who had multiple sex partners after MC, there was no statistically significant difference in condom use during high risk encounters when compared to baseline. Behavioral disinhibition should be monitored and evaluated during the implementation phase of MC programs.
L. Lerebours, None
P. Fleming, None
Y. Donastorg, None
M. Brito, None
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