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Background: Voluntary medical male circumcision (VMMC) in young men is an important component of national HIV prevention programmes, given its protective effect in the heterosexual transmission of HIV. Concerns have been raised that circumcised men will increase their sexual risk behaviours following circumcision as a result of lowered perceptions of HIV-risk. This possibility of risk compensation has the potential to reverse the public health benefit of VMMC. Accordingly, this study documented sexual practices of circumcised (n= 616) and uncircumcised (n=589) learners in 42 mixed sex secondary schools over a 12 month period in Vulindlela, KwaZulu-Natal who were targeted by a national department of health VMMC campaign.
Methods: During the VMMC campaign (March 2011 To February 2013) 5165 learners were circumcised and 5923 refused to be circumcised. We randomly selected participants for each cohort from March 2012 until May 2013. Study participants aged 16 to 24 years were interviewed at baseline, 6 months after baseline and at 12 months. Mixed effect models were used to account for the longitudinal data and the clustering of learners in schools.
Results: The uncircumcised cohort was slightly older than the circumcised group (17.4 vs 17.7 years, p < .01). In terms of sexual behaviours, the uncircumcised cohort was more likely to be sexually active at the baseline interview (54 vs. 41%; p < .01). There were no statistically significant differences between the circumcised and uncircumcised cohort in terms of number of sexual acts in the previous 6 months (p=.32) and the number of sexual partners in the previous 6 months (p = .77). Further, perceptions of HIV risk were significantly lower in the circumcised cohort than in the uncircumcised cohort at study endpoint (p = .01). The uncircumcised group reported higher incidence of transactional sex than the circumcised group (7% vs. 2%, p < .01).
Conclusions: There was no evidence of risk compensation in this study. Early involvement of young men in VMMC is optimal for HIV prevention, however the intensification of prevention activities needs to be addressed for high risk young men such as those who engage in transactional sex and refuse circumcision.

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