A Systematic Review of Evidence: Male Circumcision, HIV Transmission and Risky Sexual Behaviour in Sub Saharan Africa.
Griffin, B. (2013) A Systematic Review of Evidence: Male Circumcision, HIV Transmission and Risky Sexual Behaviour in Sub Saharan Africa., no. 48.
he protective effects of male circumcision (MC) for female to male transmission have been endorsed by international health authorities and subsequent upscaling of MC programs have been aggressively pursued. In light of rapid upscaling, evidence has arisen suggesting the protective effects of MC are exaggerated or misconceived among lay understandings; leading to an increase in risky sexual behaviour post circumcision. The aim of the following systematic review is to establish whether changes in risky sexual behaviour are observed in relation to MC for HIV transmission reduction in SSA, and to evaluate studies reporting thereon for the purposes of informing policy and MC programs. Fourteen studies investigating changes in HIV risk behaviour and perceived risk of HIV acquisition in relation to MC were included for analysis. The average robustness score among studies was 63.1% with a range of 42.5% to 87.1%. Eight out of 14 studies found no indication of increased risky sexual behaviour; however, inconsistencies within and between studies; confounding variables such as HIV counseling, participant sampling, relationship status and social desirability bias; and follow-up time made definitive conclusions around risk compensation unrealistic. The identification of inconsistencies and confounding variables within this review should serve as grounds to question the safety and validity of ongoing MC programs and studies. As such, the speed of upscaling MC programs should, at the very least, be slowed to investigate evidentiary and programatic issues identified here.