Assessment of changes in risk behaviors during 3 years of posttrial follow-up of male circumcision trial participants uncircumcised at trial closure in Rakai, Uganda

Xiangrong Kong, Godfrey Kigozi, Fred Nalugoda, Richard Musoke, Joseph Kagaayi, Carl Latkin, Robert Ssekubugu, Tom Lutalo, Betty Nantume, Iga Boaz, Maria Wawer, David Serwadda, Ronald Gray

Research output: Contribution to journalArticle


Risk compensation associated with male circumcision has been a concern for male circumcision scale-up programs. Using posttrial data collected during 2007-2011 on 2,137 male circumcision trial participants who were uncircumcised at trial closure in Rakai, Uganda, the authors evaluated their sexual behavioral changes during approximately 3 years follow-up after trial closure. Eighty-one percent of the men self-selected for male circumcision during the period, and their sociodemographic and risk profiles were comparable to those of men remaining uncircumcised. Linear models for marginal probabilities of repeated outcomes estimate that 3.3 (P < 0.0001) of the male circumcision acceptors reduced their engagement in nonmarital relations, whereas there was no significant change among men remaining uncircumcised. Significant decreases in condom use occurred in both male circumcision acceptors (-9.2 with all partners and -7.0 with nonmarital partners) and nonacceptors (-12.4 and -13.5, respectively), and these were predominantly among younger men. However, the magnitudes of decrease in condom use were not significantly different between the 2 groups. Additionally, significant decreases in sex-related alcohol consumption were observed in both groups (-7.8 in male circumcision acceptors and -6.1 in nonacceptors), mainly among older men. In summary, there was no evidence of risk compensation associated with male circumcision among this cohort of men during 3 years of posttrial follow-up.

Original languageEnglish (US)
Pages (from-to)875-885
Number of pages11
JournalAmerican journal of epidemiology
Issue number10
StatePublished - Nov 1 2012



  • HIV prevention
  • Rakai
  • behavior changes
  • behavioral disinhibition
  • male circumcision
  • risk compensation

ASJC Scopus subject areas

  • Epidemiology

Cite this