ASSESSING RISK COMPENSATION POST-VOLUNTARY MEDICAL MALE CIRCUMCISION IN ZAMBIA Paul C. Hewett a, Petra Todd b, Nicolas Grau c, Erica Soler- Hampejsek c,

Slides:

Advertisements

Similar presentations

What women think about male circumcision: Perceptions of the female partners of recently circumcised men in Nyanza Province, Kenya Timothy Okeyo 1, Nelli.

Advertisements

South African National HIV Prevalence, Incidence and Behaviour Survey, 2012 Presenter: Prof LC Simbayi Executive Director, HAST Programme, Human Sciences.

A cluster randomized trial of the impact of an intimate partner violence (IPV) and HIV prevention intervention on emotional, physical and sexual abuse,

Research activities in Orange Farm Bertran Auvert INSERM University of Versailles, France Country update meeting on scaling - up of male circumcision programmes.

Male Circumcision in Swaziland: Demographics, Behaviors and HIV Prevalence Findings from the Swaziland HIV Incidence Measurement Survey (SHIMS) Abstract#

Increased routine screening for syphilis and falling syphilis incidence in HIV positive and HIV negative men who have sex with men: implications for syphilis.

Unmet need for family planning and low rates of dual method protection among men and women attending HIV care and treatment services in Kenya, Namibia.

K. Jean, P. Lissouba, D. Taljaard, R. Rain-Taljaard, B. Singh, J. Bouscaillou, G. Peytavin, R. Sitta, S.G. Mahiane, D. Lewis, A. Puren, B. Auvert Inserm.

MCUTS Trial: A sport-based intervention to increase uptake of voluntary medical male circumcision among adult male football players: results from a cluster-

Journal Club Alcohol, Other Drugs, and Health: Current Evidence July–August 2013.

HIV Risk Behaviors and Alcohol Intoxication among Injection Drug Users in Puerto Rico Tomás D. Matos, MS Center for Addiction Studies Universidad Central.

Who Gets AIDS and How? Education and Sexual Behaviors in Burkina Faso, Cameroon, Ghana, Kenya and Tanzania Damien de Walque The World Bank Development.

Sexual Risk Behaviors of Self- identified and Behaviorally Bisexual HIV+ Men. By: Matt G. Mutchler, PhD; Miguel Chion, MD, MPH; Nancy Wongvipat, MPH; Lee.

School-Based HIV Prevention Lessons from Impact Evaluation.

Patterns of Age Mixing and Sexually Transmitted Infections Julie Kraut-Becher University of Pennsylvania Sevgi O. Aral Division of STD Prevention, CDC.

Monitoring the effects of ARV treatment programmes on prevention Gabriel Mwaluko 1, Mark Urassa,2, John Changalucha,2, Ties Boerma 3 1 TANESA Project,

Uptake of antiretrovirals in a cohort of women involved in high risk sexual behaviour in Kampala, Uganda J.Bukenya, M. Kwikiriza, O. Musana, J. Ssensamba,

Perceived HIV risks, types of sexually transmitted diseases, and discordant infection status among low-tier female sex workers in China (Roundtable Presentation)

A random household survey of male circumcision and HIV in Kisumu, Kenya Circumcision Impact Study (CIRCIS) Matthew Westercamp University of Illinois at.

N ORTHWEST AIDS E DUCATION AND T RAINING C ENTER PrEP 201: Beyond the Basics Joanne Stekler, MD MPH Associate Professor of Medicine University of Washington.

Summarising Male Circumcision Efficacy: Results of the three randomised clinical trials Neil A Martinson Perinatal HIV Research Unit.

Impact Evaluation in the Real World One non-experimental design for evaluating behavioral HIV prevention campaigns.

HIV/AIDS BI-ANNUAL REVIEW 2008 Prevention -Goal, Indicators and Targets TACAIDS.

Forging Pathways to an AIDS-Free Generation Young People and VMMC 11 th November 2014.

Rebecca Thornton University of Michigan and J-PAL.

HIV Prevention in Kenya: Lessons Learned from the 2007 Kenya AIDS Indicator Survey Carol Ngare KAIS TWG Member, NASCOP-MOH Prevention Summit 2008 HIV Prevention.

PSI ■■ 13 calle 3-40 Ed. Atlantis, zona 10 GUATEMALA, 1010 ASOCIACIONPASMO.ORG PASMO ■■ th STREET, NW I SUITE 600 WASHINGTON, DC PSI.ORG PSI.

HIV and STI Department, Health Protection Agency - Colindale HIV and AIDS Reporting System HIV in the United Kingdom: 2012 Overview.

Cost-effectiveness of male circumcision in reducing the spread of HIV in the general population in sub-Saharan Africa Jim Kahn & Elliot Marseille, UCSF.

Office of Global Health and HIV (OGHH) Office of Overseas Programming & Training Support (OPATS) Session: Voluntary Medical Male Circumcision (VMMC)

HIV Communication Programs, Condom Use at Sexual Debut, and Protection from HIV in South Africa 2005 Stella Babalola April 30 th, 2014.

Human Sexuality Sexually Transmitted Infections. STIs/STDs Sexually Transmitted Infections: More accurate than “STDs” A less judgmental term?

1 Celtel Uganda Limited 2 Increasing utilization of HIV Counseling & Testing services - Innovative approaches for Celtel Uganda Ltd. By Pius Kasajja.

FBO Engagement in Male Circumcision May 25, 2009 CCIH Annual Conference.

The Relationship Between Psychotropic Medication Use and STI Infections Among Detained Youth Dexter R. Voisin Professor.

AFRICA HIV/AIDS AIDS DATA SOURCE: UNAIDS 2007 REPORT WORLD HEALTH ORGANIZATION.

Country gallery Maldives. Basic socio-demographic indicators, Total population (thousands)306 Annual population growth rate2.4 Population aged.

Amphetamine-type stimulant use increases HIV risk among young women engaged in sex work in Phnom Penh, Cambodia M-C Couture, N Sansothy, ES Stein, J Evans,

Sexually Transmitted Disease (STD) Surveillance Report, 2008 Minnesota Department of Health STD Surveillance System Minnesota Department of Health STD.

Drug users in Amsterdam: are they still at risk for HIV? Nienke van der Knaap, Bart Grady, Maarten Schim van der Loeff, Titia Heijman, Arjen Speksnijder,

HIV and AIDS Data Hub for Asia-Pacific Review in slides Maldives Last updated: December 2014.

1 HIV and AIDS Data Hub for Asia-Pacific Review in slides Maldives.

A prospective study of risk compensation following male circumcision as an HIV prevention method in Nyanza Province, Kenya: interim results Presented by:

Stephen Nkansah-Amankra, PhD, MPH, MA 1, Abdoulaye Diedhiou, MD, PHD, H.L.K. Agbanu, MPhil, Curtis Harrod, MPH, Ashish Dhawan, MD, MSPH 1 University of.

Acceptability of Voluntary Medical Male Circumcision (VMMC) among M-F+ HIV Serodiscordant Couples Kilembe William, Rachel Parker, Kalonde Malama, Hanzunga.

Status of HIV in Kenya DR Nicholas Muraguri MBChB, MPH, PGC epidemiology Head, National Aids and STI Control Program.

Background  Substance abusers are at risk for HIV and other STIs.  Anal intercourse (AI) is riskier than vaginal intercourse.  Studies of AI have focused.

HIV and STI Prevalence among Men who Have Sex with Men in 3 Major Cities in Nigeria Sylvia Adebajo 1,2, Waimar Tun 2, Andrew Karlyn 2, Lung Vu 2, Idogho.

Results from the STEAM Survey Elizabeth Barash, MPH.

Beliefs about Male Circumcision among Men from a Traditionally Non- Circumcising Community in Rural Western Kenya, Adega, A, Burmen, B, Mutai,

HIV Prevalence and Incidence Estimates Among Women with High Risk Indicators in Addis Ababa, Ethiopia Asfawesen G-Yohanes 1, Stephanie Combes 2, Abraham.

Determinants of Family Planning uptake among Female Sex Workers Enrolled in a HIV incidence study in Eldoret Kenya. Authors: J. Kipyego, E. Kaguiri, G.

Evaluating the Impact of the Voluntary Medical Male Circumcision Program in Kenya Francis Ndwiga Benson 1, Mathews Onyango 2, John Stover 3 1 National.

Correlates of HIV testing among youth in three high prevalence Caribbean Countries Beverly E. Andrews, Doctoral Candidate University.

Elijah Odoyo-June 1,3, John Rogers 2, Walter Jaoko 1,3, Robert C. Bailey 1, 2 1 Nyanza Reproductive Health Society 2 University of Illinois at Chicago.

Kawango Agot, Omanga E, Kabare M, Ayieko B, Odeny R, Ohaga S. Impact Research & Development Organization, Kisumu, Kenya We too are shareholders: Why Women.

Associations Between Recent Gender- Based Violence and Pregnancy, Sexually Transmitted Infections, Condom Use Practices, and Negotiation of Sexual Practices.

Why don’t Key Populations Access HIV

HPTN 071 (PopART): Have we reached the targets after two years of the PopART intervention IAS Paris July 2017 Richard Hayes.

IAS Satellite Session 25th July 2017 Daniel Were, PhD

1University of Kentucky, Lexington, Kentucky

School-Based HIV Prevention

Psychosocial and behavioral predictors of partner notification for STD and HIV exposure among MSM Matthew J. Mimiaga, ScD, MPH, Sari L. Reisner, MA,

Project START Intervention Increases HIV Testing Uptake and Decreases HIV Risk Behavior among Men Released from Prison: a Randomized Controlled Study.

Bruce Armstrong, DSW Debra Kalmuss, PhD

Preparé et Presenté par : Sidikiba SIDIBE

Peter Godfrey-Faussett for Charlotte Watts

Progress on Voluntary Medical Male Circumcision for HIV prevention and How VMMC fits into UNAIDS ' ' target Julia Samuelson, Nurse epidemiologist.

Trends in the HIV incidence rate following ART scale-up in a rural and hyper-endemic South Africa population (2004–2015) Alain Vandormael, PhD School of.

Response to HIV in Next Decade Definitive way to measure client centered approach to prevention and treatment services Ambassador Deborah Birx, MD PEPFAR.

Presentation transcript:

ASSESSING RISK COMPENSATION POST-VOLUNTARY MEDICAL MALE CIRCUMCISION IN ZAMBIA Paul C. Hewett a, Petra Todd b, Nicolas Grau c, Erica Soler- Hampejsek c, Kumbutso Dzekedzeke d, Barbara S. Mensch c a Population Council, Zambia, b University of Pennsylvania, c Universidad de Chile, d Population Council, New York, e Dzekedzeke, Inc.

Background Government of the Republic of Zambia has set ambitious targets for scaling up voluntary medical male circumcision (VMMC) services. Target: MC 2.0 million HIV negative men aged 15−49, approximately 80% of the eligible population by Objectives of this analysis: Assess risk compensatory behaviors post MC Focus on men in a population based cohort Across 2 years of observation Assessing 6 indictors of risk behavior Estimation methods account of selectivity of uptake of circumcision

Kisumu, Kenya : Mattson et al., 2008 (sub-study) Propensity score of 18 risk behaviors Incident infections of gonorrhea, chlamydia, trich No stat sign. differences: MC, not MC; all declined HIV testing and counseling: 1m, 3m, 6m, 12m Rakia, Uganda: Gray et al., 2012 Post-trial FU for 2-years (control, MC) - 22% no MC No observable self-selection MC, ~MC Sex active 12m, # partners, condom use, alcohol No stat. sign. differences MC & non-MC HIV testing & health education : Enroll, 6m, 12m, 24m Risk compensation: Evidence

Question What about risk compensation in a program with national scale and less intensive counseling and follow-up? Example: Zambia Over 725,000 circumcisions conducted since 2008.

Methods Since 2010, PC has been annually following a representative cohort of men & women in Zambia. Primary objective: To assess the prevalence of risk compensation post-VMMC. Information collected: Demographics VMMC Knowledge, beliefs and attitudes VMMC status and timing Sexual behavior and experiences of STIs Perceptions of HIV risk

Methods (cont.) To-date, the study has collected three rounds of data within a 24 month timeframe Round 1 Nov 2010 to Apr 2011 Round 2 Sep 2011 to Dec 2011 Round 3 Sep 2012 to Jan 2013 Round 4 Oct 2013 to Feb 2014 Round 1Round 2Round 3 N R1-R2R1-R3 Response rate Attrition rate--1618

Methods (cont.) Indicators assessing risk compensation Sex with 2+ partner in last year Unprotected sex Sex after alcohol use Experience of STI symptom in last year Paid for sex in last year Statistical Analysis Instrumental variables GMM regression Logit regression with fixed effects Difference-in-difference matching Estimation approaches addresses endogeneity of circumcision uptake

Results – MC Uptake Since 2008 through early 2013… 21% of sample men were recently circumcised 16% between R1 (2010) & R3 (2013). 5% 12% 21%

Results – Risk Compensation IV GMM Logit FE Diff-Diff ATT Sex w/2+ partners Circumcised-1.2 (.67) †.05 (.03) †.05 (.05) Unprotected sex Circumcised-.85 (.57)-.07 (.03)*-.03 (.06) Sex & alcohol use Circumcised1.61 (1.06).02 (.03)-.07 (.07) STI symptom Circumcised-.08 (.27).01 (.02)-.06 (.03)* Paid for Sex Circumcised-1.39 (.65)*.03 (.02).09 (.04)* † p <.10; * P <.05 Note: models includes covariate controls

Conclusions 10 Source: Hallet et al., 2008 – Southern Africa MC men may be less risky than uncircumcised No evidence of risk compensation in 2-years Controlling for endogeneity of circumcision uptake…

The Population Council conducts research and delivers solutions that improve lives around the world. Big ideas supported by evidence: It’s our model for global change. Ideas. Evidence. Impact.