Traditional Male Circumcision is Associated with Sexual Risk Behaviors in Sub-Saharan Countries Prioritized for Male Circumcision

AIDS Behav. 2020 Mar;24(3):951-959. doi: 10.1007/s10461-019-02473-0.


To understand the sexual risk behavior of men with traditional male circumcision and medical male circumcision in the context of the World Health Organization's (WHO) campaign for voluntary medical male circumcision (VMMC) scale-up, we investigated ten countries prioritized for the scale-up from the Demographic and Health Surveys. Male respondents aged 15-49 were selected. Ordinal regression was used to analyze the relationship between three sexual risk behaviors-condom use with non-cohabiting partners, number of non-cohabiting partners, and partner type-and circumcision status (traditionally circumcised before and after the VMMC scale-up, medically circumcised before and after the scale-up, and not circumcised), while controlling for social demographic covariates. We found evidence that some sexual risky behavior, specifically lower condom use and higher number of sexual partners, was associated with traditional circumcision. This finding suggests that messages about the protective effect of male circumcision may not have reached men with traditional circumcision. We suggest that WHO's VMMC campaign should include communities where traditional male circumcision is popular. We looked for, but did not find, evidence of differences between groups circumcised at different times, which could have indicated sexual risk compensation.

Keywords: Demographic health survey; HIV; Male circumcision; Sexual risk behavior; Sexual risk compensation.

MeSH terms

  • Adolescent
  • Adult
  • Africa South of the Sahara
  • Circumcision, Male / statistics & numerical data*
  • Condoms / statistics & numerical data
  • HIV Infections / prevention & control*
  • Health Promotion
  • Humans
  • Male
  • Middle Aged
  • Risk-Taking
  • Safe Sex
  • Sexual Behavior / statistics & numerical data*
  • Sexual Partners
  • Unsafe Sex / statistics & numerical data
  • Young Adult