“I changed my mind and became convinced that circumcision will never help in controlling HIV/AIDS”

By contrast, the men in the clinical trials had sessions before and after circumcision, and every six months during the 21-month follow-up period. Some public-health advocates argue that the protocols used in the trials should be replicated closely in the campaigns, otherwise they will not be as effective.

Studies of this phenomenon — known as risk compensation — are just starting to shed light on how circumcision alters behaviour,...

...that one-fifth of men and women they interviewed said that condom use is less necessary and that HIV is a less serious threat because male circumcision is available.

As one woman who was interviewed for the study put it: “Circumcised men who are HIV-positive can have sex with women and the women will not get the infection easily.”

“There is evidence in South Africa, Kenya and Tanzania that shows that generally women are overstating the benefits of circumcision and believe the risk to be lower than it actually is,” she says.

“Why bother with the procedure if you have to continue to use condoms?” he asks. “The whole point is, 'if I have the procedure I don't need to'.”

...even if some women are placed at greater risk in the short term.

..do whatever it takes to get men in and out that door

So circumcision providers are coming up with innovative ways to recruit more men

“There's a lot of pressure right now in this country because of PEPFAR and others,”

In Kenya, some service providers are even offering 'moonlight circumcisions' at night, or financial incentives for referrals. More money is also being invested, but this has put significant pressure on local service providers to operate on more men. The Bill & Melinda Gates Foundation, based in Seattle, Washington, has implemented a pay-for-performance model in Zambia, for instance, in which organizations are reimbursed on the basis of their ability to reach a target number of circumcisions.