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Male Circumcision for HIV Prevention: The “Disinhibition Effect”

Male Circumcision for HIV Prevention: The “Disinhibition Effect”. Willard Cates, Jr., MD, MPH Family Health International September 18, 2002. “Disinhibition” – Historical Odyssey. 1987 - VCT findings of increases in unsafe behaviors regardless of results in low proportion

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Male Circumcision for HIV Prevention: The “Disinhibition Effect”

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  1. Male Circumcision for HIV Prevention: The “Disinhibition Effect” Willard Cates, Jr., MD, MPH Family Health International September 18, 2002

  2. “Disinhibition” – Historical Odyssey 1987 - VCT findings of increases in unsafe behaviors regardless of results in low proportion • if uninfected “immune” • If infected “vengeance” 1994 - Vaccine trial responses 1998 - HAART’s counter effect 2002 - Microbicide trial in Cameroon

  3. “Disinhibition” – Definition • An increase in unsafe behaviors in response to perceptions caused by introduction of a preventive or therapeutic intervention • Applies to any field of public health, not just HIV - seat belts/reckless driving - chest x-ray/tobacco use - anesthesia for childbirth/sexual activity

  4. Rate Ratio of STI Acquisition, by Study Group -- Cameroon, 1998-2001 Source: Roddy (JAMA, 2002)

  5. Cameroon N-9/STI Trial Percentage of Sex Acts in Which Condoms and/or Gel are Used Source: Roddy (JAMA, 2002)

  6. “Disinhibition” – Conclusion • Disinhibition a measurable risk of preventive/curable interventions • Risk/benefit ratio modeling with all new interventions • Emphasis on both pre- and post-intervention counseling with follow up reinforcement at individual/population level

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