The Southern Africa Labour and Development Research Unit, University of Cape Town, Cape Town, Western Cape, South Africa.
PLoS One. 2012;7(7):e40753. doi: 10.1371/journal.pone.0040753. Epub 2012 Jul 19.
We examined whether knowledge of the HIV-protective benefits of male circumcision (MC) led to risk compensating behavior in a traditionally circumcising population in South Africa. We extend the current literature by examining risk compensation among women, which has hitherto been unexplored.
We used data on Xhosa men and women from the 2009 Cape Area Panel Study. Respondents were asked if they had heard that MC reduces a man's risk of contracting HIV, about their perceived risk of contracting HIV, and condom use. For each gender group we assessed whether risk perception and condom use differed by knowledge of the protective benefits of MC using bivariate and then multivariate models controlling for demographic characteristics, HIV knowledge/beliefs, and previous sexual behaviors. In a further check for confounding, we used data from the 2005 wave to assess whether individuals who would eventually become informed about the protective benefits of circumcision were already different in terms of HIV risk perception and condom use.
34% of men (n=453) and 27% of women (n=690) had heard that circumcision reduces a man's risk of HIV infection. Informed men perceived slightly higher risk of contracting HIV and were more likely to use condoms at last sex (p<0.10). Informed women perceived lower HIV risk (p<0.05), were less likely to use condoms both at last sex (p<0.10) and more generally (p<0.01), and more likely to forego condoms with partners of positive or unknown serostatus (p<0.01). The results were robust to covariate adjustment, excluding people living with HIV, and accounting for risk perceptions and condom use in 2005.
We find evidence consistent with risk compensation among women but not men. Further attention should be paid to the role of new information regarding MC, and drivers of HIV risk more broadly, in modulating sexual behavior among women.
我们考察了在南非一个传统行割礼的人群中，对艾滋病病毒保护效益的了解是否会导致风险补偿行为。我们通过考察女性的风险补偿，扩展了当前的文献，而此前这方面的研究尚未涉及。
我们使用了 2009 年开普敦地区小组研究中关于科萨男女的数据。受访者被问及是否听说过割礼可以降低男性感染艾滋病病毒的风险，以及他们对感染艾滋病病毒风险的认知，以及避孕套的使用情况。对于每个性别群体，我们通过单变量和多变量模型评估了对割礼保护效益的了解是否会影响风险认知和避孕套使用情况，控制了人口统计学特征、艾滋病病毒知识/信念和以往性行为。为了进一步检查混杂因素，我们使用了 2005 年的数据，评估了那些最终了解割礼保护效益的个体在艾滋病风险认知和避孕套使用方面是否已经存在差异。
34%的男性（n=453）和 27%的女性（n=690）听说过割礼可以降低男性感染艾滋病病毒的风险。知情男性对感染艾滋病病毒的风险感知略高，在上一次性行为中更有可能使用避孕套（p<0.10）。知情女性对艾滋病病毒风险的感知较低（p<0.05），在上一次性行为中更不可能使用避孕套（p<0.10），更普遍地（p<0.01），更有可能与阳性或未知血清学状况的伴侣不使用避孕套（p<0.01）。在调整了协变量、排除了艾滋病毒感染者，并考虑了 2005 年的风险认知和避孕套使用情况后，结果仍然稳健。
我们发现了女性存在风险补偿的证据，但男性没有。应进一步关注关于男性割礼的新信息以及更广泛的艾滋病病毒风险驱动因素，在调节女性性行为方面的作用。
