Sexual risk behaviors following circumcision among HIV-positive men in Rakai, Uganda

Edward Nelson Kankaka, Joseph Ssekasanvu, Jessica Prodger, Dorean Nabukalu, Hadijja Nakawooya, Anthony Ndyanabo, Godfrey Kigozi, Ronald H Gray

Research output: Contribution to journalArticle

Abstract

Objective: To determine whether circumcision of HIV-positive men is associated with increased subsequent sexual risk behaviors which may place their female partners at risk. Methods: Newly circumcised and uncircumcised HIV-positive men in the Rakai Community Cohort Study were followed from baseline (July 2013–January 2015) to determine trend in sexual risk behaviors and association of circumcision with subsequent sexual risk behaviors at follow up (February 2015–September 2016). Risk behaviors included sexual activity, alcohol before sex, transactional sex, multiple sex partners, casual sex partners, and inconsistent condom use with casual partners. The association was evaluated using modified Poisson regression, and sensitivity analyses were performed after multiple imputation with chained equations for missing data. Results: We identified 538 eligible men, of whom 113(21.0%) were circumcised at baseline and 425(79.0%) were uncircumcised. Men in fishing communities were more likely to be circumcised (p = 0.032) as well as those exposed to targeted HIV messaging (p < 0.001). Overall, 188(34.9%) men were lost to follow up and most were uncircumcised (p = 0.020). Among those followed up, behaviors remained largely unchanged with no differences by circumcision status. Transactional sex appeared to be associated with circumcision in unadjusted analyses (PR = 1.58, 95%CI = 1.01,2.48; p = 0.045, p = 0.05) and adjusted analyses (adj.PR = 1.54, 95%CI = 1.06,2.23; p = 0.022). However, the association was no longer significant in sensitivity analyses after accounting for loss to follow up (adj.PR = 1.43, 95%CI = 0.98,2.08; p = 0.066). No association with circumcision was observed for other sexual risk behaviors. Conclusion: We found no association between circumcision of HIV-positive men and subsequent sexual risk behavior.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalAIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV
DOIs
StateAccepted/In press - Feb 15 2018

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Uganda
Risk-Taking
risk behavior
Sexual Behavior
HIV
Sexual Partners
Lost to Follow-Up
Condoms
community
Cohort Studies
alcohol
Regression Analysis
Alcohols
regression
trend

Keywords

  • HIV-positive
  • male circumcision
  • Rakai
  • risk compensation
  • risky sexual behavior

ASJC Scopus subject areas

  • Health(social science)
  • Social Psychology
  • Public Health, Environmental and Occupational Health

Cite this

Sexual risk behaviors following circumcision among HIV-positive men in Rakai, Uganda. / Kankaka, Edward Nelson; Ssekasanvu, Joseph; Prodger, Jessica; Nabukalu, Dorean; Nakawooya, Hadijja; Ndyanabo, Anthony; Kigozi, Godfrey; Gray, Ronald H.

In: AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 15.02.2018, p. 1-7.

Research output: Contribution to journalArticle

Kankaka, Edward Nelson ; Ssekasanvu, Joseph ; Prodger, Jessica ; Nabukalu, Dorean ; Nakawooya, Hadijja ; Ndyanabo, Anthony ; Kigozi, Godfrey ; Gray, Ronald H. / Sexual risk behaviors following circumcision among HIV-positive men in Rakai, Uganda. In: AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV. 2018 ; pp. 1-7.
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abstract = "Objective: To determine whether circumcision of HIV-positive men is associated with increased subsequent sexual risk behaviors which may place their female partners at risk. Methods: Newly circumcised and uncircumcised HIV-positive men in the Rakai Community Cohort Study were followed from baseline (July 2013–January 2015) to determine trend in sexual risk behaviors and association of circumcision with subsequent sexual risk behaviors at follow up (February 2015–September 2016). Risk behaviors included sexual activity, alcohol before sex, transactional sex, multiple sex partners, casual sex partners, and inconsistent condom use with casual partners. The association was evaluated using modified Poisson regression, and sensitivity analyses were performed after multiple imputation with chained equations for missing data. Results: We identified 538 eligible men, of whom 113(21.0{\%}) were circumcised at baseline and 425(79.0{\%}) were uncircumcised. Men in fishing communities were more likely to be circumcised (p = 0.032) as well as those exposed to targeted HIV messaging (p < 0.001). Overall, 188(34.9{\%}) men were lost to follow up and most were uncircumcised (p = 0.020). Among those followed up, behaviors remained largely unchanged with no differences by circumcision status. Transactional sex appeared to be associated with circumcision in unadjusted analyses (PR = 1.58, 95{\%}CI = 1.01,2.48; p = 0.045, p = 0.05) and adjusted analyses (adj.PR = 1.54, 95{\%}CI = 1.06,2.23; p = 0.022). However, the association was no longer significant in sensitivity analyses after accounting for loss to follow up (adj.PR = 1.43, 95{\%}CI = 0.98,2.08; p = 0.066). No association with circumcision was observed for other sexual risk behaviors. Conclusion: We found no association between circumcision of HIV-positive men and subsequent sexual risk behavior.",
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T1 - Sexual risk behaviors following circumcision among HIV-positive men in Rakai, Uganda

AU - Kankaka, Edward Nelson

AU - Ssekasanvu, Joseph

AU - Prodger, Jessica

AU - Nabukalu, Dorean

AU - Nakawooya, Hadijja

AU - Ndyanabo, Anthony

AU - Kigozi, Godfrey

AU - Gray, Ronald H

PY - 2018/2/15

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N2 - Objective: To determine whether circumcision of HIV-positive men is associated with increased subsequent sexual risk behaviors which may place their female partners at risk. Methods: Newly circumcised and uncircumcised HIV-positive men in the Rakai Community Cohort Study were followed from baseline (July 2013–January 2015) to determine trend in sexual risk behaviors and association of circumcision with subsequent sexual risk behaviors at follow up (February 2015–September 2016). Risk behaviors included sexual activity, alcohol before sex, transactional sex, multiple sex partners, casual sex partners, and inconsistent condom use with casual partners. The association was evaluated using modified Poisson regression, and sensitivity analyses were performed after multiple imputation with chained equations for missing data. Results: We identified 538 eligible men, of whom 113(21.0%) were circumcised at baseline and 425(79.0%) were uncircumcised. Men in fishing communities were more likely to be circumcised (p = 0.032) as well as those exposed to targeted HIV messaging (p < 0.001). Overall, 188(34.9%) men were lost to follow up and most were uncircumcised (p = 0.020). Among those followed up, behaviors remained largely unchanged with no differences by circumcision status. Transactional sex appeared to be associated with circumcision in unadjusted analyses (PR = 1.58, 95%CI = 1.01,2.48; p = 0.045, p = 0.05) and adjusted analyses (adj.PR = 1.54, 95%CI = 1.06,2.23; p = 0.022). However, the association was no longer significant in sensitivity analyses after accounting for loss to follow up (adj.PR = 1.43, 95%CI = 0.98,2.08; p = 0.066). No association with circumcision was observed for other sexual risk behaviors. Conclusion: We found no association between circumcision of HIV-positive men and subsequent sexual risk behavior.

AB - Objective: To determine whether circumcision of HIV-positive men is associated with increased subsequent sexual risk behaviors which may place their female partners at risk. Methods: Newly circumcised and uncircumcised HIV-positive men in the Rakai Community Cohort Study were followed from baseline (July 2013–January 2015) to determine trend in sexual risk behaviors and association of circumcision with subsequent sexual risk behaviors at follow up (February 2015–September 2016). Risk behaviors included sexual activity, alcohol before sex, transactional sex, multiple sex partners, casual sex partners, and inconsistent condom use with casual partners. The association was evaluated using modified Poisson regression, and sensitivity analyses were performed after multiple imputation with chained equations for missing data. Results: We identified 538 eligible men, of whom 113(21.0%) were circumcised at baseline and 425(79.0%) were uncircumcised. Men in fishing communities were more likely to be circumcised (p = 0.032) as well as those exposed to targeted HIV messaging (p < 0.001). Overall, 188(34.9%) men were lost to follow up and most were uncircumcised (p = 0.020). Among those followed up, behaviors remained largely unchanged with no differences by circumcision status. Transactional sex appeared to be associated with circumcision in unadjusted analyses (PR = 1.58, 95%CI = 1.01,2.48; p = 0.045, p = 0.05) and adjusted analyses (adj.PR = 1.54, 95%CI = 1.06,2.23; p = 0.022). However, the association was no longer significant in sensitivity analyses after accounting for loss to follow up (adj.PR = 1.43, 95%CI = 0.98,2.08; p = 0.066). No association with circumcision was observed for other sexual risk behaviors. Conclusion: We found no association between circumcision of HIV-positive men and subsequent sexual risk behavior.

KW - HIV-positive

KW - male circumcision

KW - Rakai

KW - risk compensation

KW - risky sexual behavior

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