Three randomized controlled trials (RCT) showed that voluntary medical male circumcision (VMMC) reduces the risk of female to male HIV transmission by approximately 60%. However, data from communities where VMMC programs have been implemented are needed to assess changes in circumcision prevalence and whether men and women compensate for perceived reductions in risk by increasing their HIV risk behaviors.
Scale-up of free VMMC began in Kisumu, Kenya in 2008. Between 2009 and 2013 a sequence of three unlinked cross-sectional surveys was conducted. All individuals 15-49 years of age residing in randomly selected households were interviewed and offered HIV testing. MC status was confirmed by examination. Design adjusted bivariate comparisons and multivariable analyses were used for statistical inference.
The prevalence of male circumcision increased from 32% (95% CI: 26-38%) in 2009 to 60% (95% CI: 56-63%) in 2013. The aPR of HIV and genital ulcer disease (GUD) in circumcised compared to uncircumcised men was 0.48 (95% CI: 0.36-0.66) and 0.51 (95% CI: 0.37-0.69), respectively. There was no association between circumcision status and sexual behaviors, HIV knowledge, or indicators of risk perception.
The conditions necessary for the VMMC program to have a significant public health impact are present in Kisumu, Kenya. Between 2009 and 2013, circumcision prevalence increased from 30% to 60%; HIV prevalence in circumcised men was half that of uncircumcised men, and there was no or minimal sexual risk compensation.