An in-Depth Evaluation of Behavioral Disinhibition Associated with Male Circumcision in Kisumu, Kenya: A Nested Longitudinal Analysis

The results of three randomized controlled trials have now confirmed compelling observational evidence that male circumcision significantly reduces transmission of heterosexually acquired HIV-1 infection among men. However, concern remains as to whether circumcised men will engage in increased risk behavior after the procedure. The purpose of this study was to perform an in-depth evaluation of the sexual behavior among a sub-set of men participating in the RCT in Kenya. Participants were prospectively recruited from the RCT of MC in Kenya to undergo additional in-depth interviews about their sexual behavior within 10 days of enrollment in the RCT and then 6 and 12 months after enrollment. In a prior study we used non-parametric Item Response Theory to develop an 18-item scale to characterize sexual risk behavior. These scores served as the primary outcome variable for this longitudinal analysis of sexual risk behavior. Secondary outcome variables included: number of sexual partners in the last 6 months, number of partners with whom men did not always use a condom with in the last 6 months, and incident infections gonorrhea, chlamydia or trichomonas. Random effects regression models were used to assess changes in sexual risk behavior through time and between circumcised and uncircumcised men. Between March 2004 and September 2005, 1780 men in the parent RCT of MC were eligible to enroll in this study. Of these, 1319 enrolled, yielding an overall response rate of 74%. Seventy-six percent of men returned for the 6 month and 77% returned for the 12 month follow-up visit.