Background: Male medical circumcision (MMC) is known to reduce the risk of HIV acquisition in men by 50-60%, with no direct HIV benefit to women. There is concern that knowledge of MMC efficacy could influence sexual risk behaviours among women. This study investigated whether women with circumcised partners displayed riskier sexual behaviour compared to women with uncircumcised partners.
Methods: This secondary analysis from the Vaginal and Oral Interventions to Control the Epidemic (VOICE) trial enrolled 5029 HIV uninfected women, aged 18 to 45 years, at 15 sites in Africa. Participants underwent monthly pregnancy and HIV testing and sexually transmitted infections (STI) testing at baseline and quarterly visits. Socio- demographic and sexual behaviour data were collected. Impact of partner circumcision awareness on participant STI outcomes was assessed using Cox regression models. Impact of circumcision awareness on condom usage and frequency of sex was analysed using GEE models with a logit link. Participant age, education, study site and marital status were adjusted for in all analyses.
Results: There were 4982 participants with a baseline response, 1561 (31%) reported having circumcised partners, 2863 (57%) having uncircumcised partners and 558 (11%) did not know the circumcision status of their partner. Partner circumcision rate varied by country: South Africa (33%), Uganda (51%) and Zimbabwe (10%).Women with circumcised partners had a significantly reduced risk of syphilis acquisition compared to all other women, [Hazard ratio 0.51 (0.26, 1.00), p-value=0.05)]. A trend toward significance remained in the adjusted model (adjusted (adj) p-value=0.06). Participants with circumcised partners tended to have significantly fewer sex acts in the past 7 days than participants with uncircumcised partners (6% less likely to have ≥1 act of sex, adjusted p-value= 0.0005). Participants with uncircumcised partners were significantly less likely to have used a condom at the last sex act compared to the other two groups, [adjusted relative risk 0.86 (0.80, 0.92), adj p-value< 0.0001].
Conclusions: This study found no evidence of sexual risk compensation in women with circumcised partners. Risky sexual behaviour in women with uncircumcised partners was noted. Ongoing education of couples on the benefits of MMC is essential to HIV prevention efforts.

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