HIV risk reduction intervention among medically circumcised young men in South Africa: a randomized controlled trial

Abstract

Medical male circumcision (MMC) is now considered one of the best available evidence-based biomedical HIV prevention interventions. However, there is some concern about risks for behavioural disinhibition, or risk compensation, following MMC. The aim of this study was to test a brief one-session (180 min) group culturally tailored HIV risk reduction counselling intervention among men undergoing medical circumcision in South Africa in order to limit behavioural disinhibition. A randomized controlled trial design was employed using a sample of 150 men, 75 in the experimental group and 75 in the control group. Comparisons between baseline and 3-month follow-up assessments on several key behavioural outcomes addressed by the intervention were done. Our study found that behavioural intentions and risk reduction skills significantly increased and sexual risk behaviour (reduction of the number of sexual partners and the number of unprotected vaginal sexual intercourse occasions) significantly decreased in the experimental compared to the control condition. However, male role norms did not change among the intervention conditions over time, while AIDS-related stigma beliefs significantly reduced in both conditions over time. Study findings show that a relatively brief (one session) and focused HIV risk reduction counselling can have at least short-term effects on reducing sexual risk behaviours in populations at high risk for behavioural disinhibition following medical male circumcision.