Male circumcision, sexual behavior, and HIV status in Uganda

Abstract

After a series of studies that revealed the protective effect of male circumcision against HIV infection, WHO/UNAIDS in 2007 recommended the adoption of safe male circumcision as one of the effective strategies in reducing heterosexually acquired HIV. To this effect, in 2010 the Ministry of Health in Uganda developed a circumcision policy, and circumcision was added to the strategy of abstinence, being faithful, and condom use (ABC) to protect against AIDS. Especially after the implementation of the safe male circumcision (SMC) policy, however, there has been a concern that some circumcised men may lead a more risky sexual lifestyle than noncircumcised men. This paper, therefore, examines the associations among circumcision status, age at circumcision, risky sexual behaviors, and HIV serostatus among men. The paper uses data from the 2011 Uganda AIDS Indicator Survey, focusing on a subsample of 7,969 weighted cases of men age 15-59 who have ever had sex and who have received their HIV test results. The paper examines associations between risky sexual behaviors and circumcision status among all men, and associations between risky sexual behaviors and age at circumcision among circumcised men. At the multivariate level, the paper establishes the independent relationships between circumcision status and age at circumcision, risky sexual behaviors, and HIV serostatus. Results show that 28% of men in Uganda have been circumcised, and the majority were circumcised before age 10. At the bivariate level, circumcision status is not independent of risky sexual behaviors. Results from the logistic regression models show that circumcised men are more likely to engage in risky sexual behaviors, while age at circumcision is not significantly associated with these behaviors. Circumcised men are also less likely to be HIV-positive. The findings suggest a need to repackage the circumcision messages to account for the increased risky sexual behaviors among men who have been circumcised. Intensified, individual tailored counseling before and after SMC procedures may help to reduce these risky behaviors. Furthermore, qualitative research should explore the reasons for circumcision and the drivers for risky sexual behavior.