Multiple trials have demonstrated that voluntary medical male circumcision (VMMC) has a protective effect against HIV infection. These studies have been conducted in sub-Saharan Africa, however, leading some to question whether the same effects would be observed elsewhere, and one frequently raised concern is that circumcision may lead men to adopt riskier behaviours out of a false sense of security. At IDWeek 2015, Maximo Brito of the University of Illinois College of Medicine and colleagues presented data from a study conducted in the Dominican Republic. This study involved 454 men who underwent VMMC, 80% of whom returned for a follow-up visit 6–8 months after their surgery, at which time data about their sexual behaviour, penile trauma after intercourse and their satisfaction with the circumcision were collected and compared with data gathered prior to the surgery. After circumcision, no changes in condom use or the number of female partners in the past 6 months were reported, and there was a significant decrease in the number of men who reported having sex with a woman they met on the same day. Thus, there was no evidence of risk compensation. In addition, 98% of men reported they were either ‘very satisfied’ or ‘somewhat satisfied’ with their circumcision, and the prevalence of penile trauma after intercourse significantly decreased. Brito concludes, ‘The big takeaway from this study is that VMMC programs can be exported to settings outside of Africa, men's satisfaction with their sexual life after the procedure is quite high, and it dramatically improves penile trauma’. Noting the relatively large sample size, he also points out that the study shows that men in this community are willing to be circumcised if the benefits and risks are clearly presented.
Emmanuel Njeuhmeli of USAID explains that although policymakers have been concerned about the possibility of risk compensation, especially because the WHO and UNAIDS now recommend that VMMC be incorporated into the HIV prevention portfolio of countries with a high prevalence of HIV and a low prevalence of male circumcision, the findings from the Dominican Republic are consistent with the results of multiple studies from eastern and southern Africa. ‘For me, this study from the Dominican Republic just confirms the trend that we’ve seen before in the literature in other country contexts’, he says. Ronald Gray of the Johns Hopkins Bloomberg School of Public Health agrees that these findings are reassuring and consistent with African studies on VMMC and risk compensation.
What's next? Brito says that his team will be studying issues of masculinity in circumcised men and are also evaluating the acceptability of VMMC to men's female partners.
Conflicts of interest
There are no conflicts of interest.