UGANDA: The Effectiveness of Male Circumcision for HIV Prevention and Effects on Risk Behaviors in a Posttrial Follow-Up Study



AIDS Vol. 26; No. 5: P. 609-615    (03.13.12):: Ron Gray; and others

Three randomized trials have demonstrated the efficacy of male circumcision for HIV prevention over two years, the authors wrote, “but the longer-term effectiveness of male circumcision is unknown.”

In Rakai, the researchers conducted a randomized trial of male circumcision in 4,996 HIV-negative men ages 15-49. After the trial, male circumcision was offered to control participants, and surveillance was maintained for up to 4.79 years. An as-treated analysis assessed HIV incidence per 100 person-years; Cox regression models, adjusted for sociodemographic and time-dependent sexual behaviors, were used to estimate the effectiveness of male circumcision. “For men uncircumcised at trial closure, sexual risk behaviors at the last trial and first posttrial visits were assessed by subsequent circumcision acceptance to detect behavioral risk compensation,” the authors wrote.

As of Dec. 15, 2010, 78.4 percent of the uncircumcised participants accepted male circumcision after the trial closed. During the posttrial surveillance period, overall HIV incidence was 0.50/100 person-years among the men who were circumcised and 1.93/100 person-years among the men who were not (adjusted effectiveness 73 percent [95 percent confidence interval 55 percent-84 percent]). Among participants of the control arm, posttrial HIV incidence was 0.54/100 person-years in circumcised men and 1.71/100 person-years in the uncircumcised men (adjusted effectiveness 67 percent [95 percent CI 38 percent-83 percent]). No significant differences were noted in sociodemographic characteristics and sexual behaviors between controls who accepted circumcision and those who did not.

“High effectiveness of male circumcision for HIV prevention was maintained for almost five years following trial closure,” the authors concluded. “There was no self-selection or evidence of behavioral risk compensation associated with posttrial male circumcision acceptance.”


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