Evidence of Behavioural Compensation in Internal Replication Study of Male Circumcision Trial to Reduce HIV Acquisition in Kisumu, Kenya

Abstract

We replicated the study ‘Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial’ using an epidemiological approach as well as an econometric approach. Both approaches confirmed the 60 per cent protective effect of circumcision reported in the original paper. Similar to the original paper, we found no evidence of heterogeneous treatment effects by age. Contrary to the original study, we found evidence of risk compensation, with circumcised men less likely to stay abstinent (odds ratio 0.79 [95% CI: 0.64, 0.99]) and more likely to have had unprotected intercourse (OR 1.2 [1.1, 1.4]). These findings reinforce the impact of circumcision but highlight behavioural risk.