Risk compensation among men in Zambia’s national program of voluntary medical male circumcision

Nicolas Grau, Paul Hewett, Shreemayi Samujjwala and Petra Todd
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Paul Hewett: U.S. NationalInstitutes of Health Center for Scientific Review
Shreemayi Samujjwala: University of Pennsylvania
Petra Todd: University of Pennsylvania

PIER Working Paper Archive from Penn Institute for Economic Research, Department of Economics, University of Pennsylvania

Abstract: After initial RCTs demonstrated the effectiveness of voluntary medical male circumcision (VMMC) in reducing HIV transmission, 14 eastern and southern African countries implemented VMMC programs on a broad scale. Zambia was one of the first countries to adopt VMMC as part of its HIV prevention strategy. However, the demand for VMMC fell short of initial projections and there were also concerns that men may have increased their risky sexual behaviors after getting the procedure, offsetting the HIV risk reduction benefits. This paper uses a new longitudinal dataset for Zambia to investigate the determinants of VMMC demand and to test for risk compensation in the context of Zambia’s largescale VMMC implementation. The results show that most men understand VMMC benefits but express concerns about potential discomfort and missing work. Also, VMMC demand depends significantly on clinic proximity. Using six different measures of risky behavior and a variety of econometric panel data estimators, including ones that allow for unobserved heterogeneity and endogeneity, we find robust evidence that men who obtain VMMC do not increase risky behavior.

Pages: 36 pages
Date: 2025-02-01
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