Background Incorrect inferences drawn from large-scale HIV prevention messages may hinder their efficacy. We examined whether individuals who are told that medical male circumcision (MMC) partially reduces female-to-male HIV transmission also erroneously infer a reduction in male-to-female HIV transmission risk.
Methods In 2008, nearly 1,000 men in rural Malawi were randomised to receive the information that MMC reduces female-to-male HIV transmission risk, with follow-up in 2009. Data was collected on perceived HIV transmission risks faced by men and women by the circumcision status of the male partner. Descriptive and multivariate variable regression analyses were used to assess whether beliefs about male circumcision and female HIV risk varied by receipt of information about MMC and by whether individuals believed that that MMC partially protects men from HIV infection.
Results Men randomised to information about MMC were more likely to believe that circumcised men faced reduced HIV transmission risks relative to uncircumcised men (50% versus 65%, p < 0.01). They were also more likely to believe that sex with a circumcised male would confer lower transmission risks for women vis-à-vis sex with an uncircumcised male (38% versus 50%, p < 0.01). Multivariate Ordinary Least Squares (OLS) regression analyses supported these findings and demonstrated that those who internalised beliefs about the risk reduction benefits accruing to men believed, on average, that circumcision conferred a 22 percentage point greater risk reduction (p < 0.01) in the probability of HIV transmission from men to women than men who did not believe that MMC protects men. Moreover, instrumental variable analyses indicated that the result from the OLS regression were an underestimation of the true effect.
Conclusions Our results point toward the need for male circumcision campaigns to make explicit that male circumcision does not directly protect women from HIV infection.
- HIV Prevention
- HIV risk perceptions
- Male Circumcision
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