Long-term Effects of Male Circumcision on Risky Sexual Behaviors and STD Infections: Evidence from Malawian Schools

Abstract

The introduction of risk-reducing technology can lead to unintended consequences, especially when risk compensation can be one of potential operating mechanism to offset the positive impact. For male circumcision, its preventive effect against HIV infection might diminish if circumcised men engage in riskier sexual behaviors. The purpose of this study is to investigate risk-compensating behavior after medical male circumcision in the long run. We randomly provided free male circumcision surgery to 2,667 adolescent male students at secondary schools in Malawi and conducted long-term follow-up survey after about four years. We find that male students who received the offer more intensively were 35 percent more likely to be infected with HSV-2 than the other students, suggesting riskier sexual behavior after circumcision. Self-reported sexual behavior, meanwhile, are showing little-to-no evidence of practicing riskier sex after circumcision, except for the inconsistent use of condom.