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Citation Information

Type Thesis or Dissertation - Doctor of Philosophy in Public Health Sciences
Title Sexual behavior, health, and medical male circumcision in Nyanza province, Kenya
Publication (Day/Month/Year) 2013
URL http://gradworks.umi.com/36/04/3604104.html
Three randomized controlled trials (RCTs) in Africa have demonstrated the efficacy of male
circumcision (MC) in reducing the risk of female-to-male HIV transmission by approximately 60%.
Following these results, the United Nations Joint Programme on HIV/AIDS (UNAIDS) and the
World Health Organization (WHO) recommended MC as an important additional strategy for the
prevention of heterosexually acquired HIV infection in men. Kenya was one of the first priority
countries to initiate national male circumcision scale-up.
However, questions remain about whether the promotion of MC as an HIV prevention
intervention will translate into a decline in HIV incidence in the general population. Risk
compensation—defined as an increase in risky behavior in response to the perceived risk
reduction following an intervention—is one important possible mechanism that could negatively
impact the effectiveness of MC programs.
To assess the concerns about risk compensation, we conducted a prospective observational
study to monitor the sexual risk behavior of circumcised men before and after circumcision and
compare it to the behavior of uncircumcised controls over 24 months of follow-up. As a secondary
objective, we also aimed to evaluate the impact of circumcision on sexual health, function, and
satisfaction. Finally, we sought to conduct an in-depth investigation of one of the least understood
HIV risk behaviors—sexual partner concurrency—among circumcised and uncircumcised men,
based on an earlier study of risk compensation embedded in the MC RTC in Kisumu, Kenya.
Designed to complement operations research accompanying the scale-up of the national
MC program in Kenya, our study produced results that enabled policy makers throughout the
region to make evidence-based decisions about MC implementation.

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