With yet no proven cure in sight, effective HIV prevention remains the most compelling strategy for HIV/AIDS management in the coming years. Within the framework of HIV prevention, the medical male circumcision (MMC) is gaining momentum as an effective form of biomedical HIV prevention. This has been in part driven by World Health Organization (WHO) supported research that has shown that the risk of a medically circumcised man contracting HIV during vaginal sex is reduced by up to 60%, compared to that of an uncircumcised man. Since 2007, medical male circumcision has been promoted as part of a comprehensive strategy to prevent HIV. Resultantly, 14 Eastern and Southern African (ESA) countries have been identified by the WHO as priority for the roll out of MMC services. Prioritized due to their low circumcision rates yet high HIV prevalence, these countries exemplify where MMC would potentially have the most significant impact. With massive campaign, an impressive upturn in the number of male circumcisions performed occurred in 2013 with 2.7 million men in the 14 priority countries of ESA region. However, accompanying the concurrent deployment of national and international MMC services, several contentious issues have emerged. Amongst the issues raised regarding MMC, and potentially the single most important question to be answered relating to the MMC roll-out, centres on what has been termed risk-compensation. Risk compensation alludes to increases in risky behaviour sparked by decreases in perceived risk. Contextualized, this could include men forfeiting additional HIV prevention methods such as abstinence, being faithful or condom use, on account of false perceptions held over the protective benefit of MMC. It has been proposed that risk compensation threatens to undermine circumcision’s protective benefits through increasing a population’s aggregate risky sexual behaviour, and in turn, potentially increasing HIV prevalence. To prevent such an outcome, it is argued that MMC needs to be promoted not a standalone panacea but within a comprehensive HIV prevention package to ensure a full understanding of the risk-reduction benefits of the procedure and also to emphasize that this is not a ‘silver bullet’.
