Grund Jonathan M, Hennink Monique M
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
AIDS Care. 2012;24(2):245-51. doi: 10.1080/09540121.2011.596516. Epub 2011 Jul 21.
Male circumcision has been shown to reduce the risk of heterosexual transmission of HIV infection in men by up to 60% in three randomized controlled trials. Less is known, however, about sexual behavior change in men who have been circumcised and whether male circumcision's protective effect leads to riskier sexual behaviors. This study used qualitative in-depth interviews to understand men's sexual behavior after circumcision and to determine whether and how men participated in riskier sexual behaviors following male circumcision. Men in urban Swaziland, circumcised in the previous 12 months, were recruited and asked about their perceptions of sexual risk and sexual behavior post-circumcision. Results showed that following circumcision, men experience changes in both their sexual attitudes and behavior, which can be considered both protective and risky for HIV transmission. Most of them described protective changes (e.g., more responsible attitudes towards safe sex, reducing sexual temptation and partners, easier condom use). A minority, however, experienced increased sexual risk-taking, typically during a brief period of sexual experimentation shortly after circumcision. HIV counseling and counseling throughout the circumcision process is shown to be critical in influencing protective behaviors. Findings in this study confirm the existence of risk compensation following circumcision; however, this study adds important contextual insight about precisely when and why such risk-taking occurs. Nevertheless this study suggests that male circumcision scale-up as an HIV prevention strategy is likely to foster protective behavior change among men. The integration of HIV counseling with circumcision provision remains critical for effectively mitigating HIV risk behavior as male circumcision gains momentum as a viable HIV prevention tool.
在三项随机对照试验中，男性包皮环切术已被证明可将男性通过异性传播感染艾滋病毒的风险降低多达60%。然而，对于接受包皮环切术的男性的性行为变化以及男性包皮环切术的保护作用是否会导致更危险的性行为，人们了解得较少。本研究采用定性深入访谈，以了解男性包皮环切术后的性行为，并确定男性在包皮环切术后是否以及如何参与更危险的性行为。招募了斯威士兰城市中在过去12个月内接受包皮环切术的男性，并询问他们对性风险的看法以及包皮环切术后的性行为。结果表明，包皮环切术后，男性的性态度和行为都会发生变化，这对艾滋病毒传播既可能有保护作用，也可能有风险。他们中的大多数人描述了具有保护作用的变化（例如，对安全性行为的态度更负责，减少性诱惑和性伴侣，更容易使用避孕套）。然而，少数人在包皮环切术后短期内进行性尝试时，性冒险行为有所增加。研究表明，在整个包皮环切过程中提供艾滋病毒咨询和辅导对于影响保护行为至关重要。本研究结果证实了包皮环切术后存在风险补偿现象；然而，这项研究增加了关于这种冒险行为何时以及为何发生的确切背景见解。尽管如此，这项研究表明，扩大男性包皮环切术作为一种艾滋病毒预防策略，可能会促使男性形成保护性的行为改变。随着男性包皮环切术作为一种可行的艾滋病毒预防工具的推广，将艾滋病毒咨询与包皮环切术相结合对于有效减轻艾滋病毒风险行为仍然至关重要。
