What do people actually learn from public health education campaigns? Incorrect inferences about male circumcision and female HIV infection risk in a cluster randomized trial in Malawi

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dc.contributor.author Maughan-Brown, Brendan
dc.contributor.author Godlonton, Susan
dc.contributor.author Thornton, Rebecca
dc.contributor.author Venkataramani, Atheendar
dc.date.accessioned 2013-08-22T14:41:23Z
dc.date.available 2013-08-22T14:41:23Z
dc.date.issued 2013-08
dc.identifier.isbn 978-1-920517-45-8
dc.identifier.uri http://hdl.handle.net/11090/620
dc.description.abstract Objective: To examine whether individuals who learn that voluntary medical male circumcision (VMMC) partially reduces female-to-male HIV transmission erroneously infer a reduction in male-to-female HIV transmission risk. Design: Cluster randomised controlled trial. Methods: In 2008, information that VMMC reduces female-to-male HIV transmission risk was randomly disseminated to men in rural Malawi, with follow-up in 2009 (n=917). Data was collected on perceived male and female HIV-transmission risks. We assessed whether beliefs about male circumcision and female HIV-risk varied by receipt of VMMC information and by whether or not individuals believed that VMMC partially protects men from HIV-infection. Results: Men informed about VMMC were more likely to believe that sex with a circumcised male would confer lower transmission risk for women vis-à-vis sex with an uncircumcised male (38% versus 50%, p<0.01). Multivariate regression analyses showed that incorrect inferences were most likely to be made by those who believed that circumcised men were partially protected from contracting HIV. Consistent with this, instrumental variable analyses indicated that those individuals who received information about VMMC, and consequently believed it, were 82 percentage points more likely to believe that male circumcision also protects women (p<0.01). The inferred reduction in direct HIV infection risk for women due to male circumcision was approximately 50%. Conclusions: Our results suggest the need for VMMC campaigns to make explicit that male circumcision does not directly protect women from HIV-infection. It is also important to assess whether incorrect inferences lead to updated self-perceived HIV-risk and the adoption of riskier sexual behaviours. en_US
dc.description.sponsorship Brendan Maughan-Brown is grateful for funding from the National Research Foundation (NRF) Research Chair in Poverty and Inequality Research for his Postdoctoral Research Fellowship. Atheendar S. Venkataramani is grateful to the Massachusetts General Hospital Global Primary Care Program for travel and research support. Opinions expressed and conclusions arrived at, are those of the authors and are not necessarily to be attributed to the NRF. Sources of Funding: Funding for this study was provided by Michigan Center for Demography of Aging (MiCDA), OVPR and Rackham at the University of Michigan as well as the Institute for Research on Women and Gender. Godlonton and Thornton gratefully acknowledge use of the services and facilities of the Population Studies Center at the University of Michigan, funded by NICHD Center Grant R24 HD041028. The funders had no role in the collection, analysis, and interpretation of data, manuscript preparation, and in the decision to submit the article for publication. en_US
dc.language.iso en en_US
dc.relation.ispartofseries Working Paper;104
dc.subject Male circumcision en_US
dc.subject Female HIV risk en_US
dc.subject Risk compensation en_US
dc.subject Southern Africa en_US
dc.subject HIV/AIDS en_US
dc.subject Prevention en_US
dc.subject Information campaigns en_US
dc.title What do people actually learn from public health education campaigns? Incorrect inferences about male circumcision and female HIV infection risk in a cluster randomized trial in Malawi en_US
dc.type Working Paper en_US

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