Adult male circumcision as an intervention against HIV: An operational study of uptake in a South African community (ANRS 12126)

Abstract

BackgroundTo evaluate the knowledge, attitudes and beliefs about adult male circumcision (AMC), assess the association of AMC with HIV incidence and prevalence, and estimate AMC uptake in a Southern African community.MethodsA cross-sectional biomedical survey (ANRS-12126) conducted in 2007-2008 among a random sample of 1198 men aged 15 to 49 from Orange Farm (South Africa). Face-to-face interviews were conducted by structured questionnaire. Recent HIV infections were evaluated using the BED incidence assay. Circumcision status was self-reported and clinically assessed. Adjusted HIV incidence rate ratios (aIRR) and prevalence ratios (aPR) were calculated using Poisson regression.ResultsThe response rate was 73.9%. Most respondents agreed that circumcised men could become HIV infected and needed to use condoms, although 19.3% (95%CI: 17.1% to 21.6%) asserted that AMC protected fully against HIV. Among self-reported circumcised men, 44.9% (95%CI: 39.6% to 50.3%) had intact foreskins. Men without foreskins had lower HIV incidence and prevalence than men with foreskins (aIRR = 0.35; 95%CI: 0.14 to 0.88; aPR = 0.45, 95%CI: 0.26 to 0.79). No significant difference was found between self-reported circumcised men with foreskins and other uncircumcised men. Intention to undergo AMC was associated with ethnic group and partner and family support of AMC. Uptake of AMC was 58.8% (95%CI: 55.4% to 62.0%).ConclusionsAMC uptake in this community is high but communication and counseling should emphasize what clinical AMC is and its effect on HIV acquisition. These findings suggest that AMC roll-out is promising but requires careful implementation strategies to be successful against the African HIV epidemic.

Overcoming Barriers to Uptake of Voluntary Medical Male Circumcision in a Traditionally Circumcising Community in Machinga District, Malawi

“…Without such confirmation, a false rate of circumcision could have been registered as some men could report that they were circumcised when in actual fact they were not. Such discrepancies were also noted in an operational study of uptake of medical male circumcision in a South African community where almost half of self-reported circumcised men had in fact an intact foreskin [8].…”

“…In addition, VMMC is considered to be a significant life-and cost-saving intervention as it has been projected that up to two million new HIV infections and 300,000 AIDS-related deaths could be averted in the next 10 years in SubSaharan Africa [8] [9]. This is why the World Health Organisation (WHO) and the Joint United Nations Program on HIV and AIDS (UNAIDS) endorsed medical male circumcision as part of a comprehensive package for HIV prevention, mainly in high HIV prevalence and low male circumcision countries [10].…”

The Proportion of Human Immunodeficiency Virus Patients in Circumcised and Uncircumcised Men with Unsafe Sexual Practices in Special Care Center in General Hospital Center Haji Adam Malik Hospital Medan

“…13 The result which stated that circumcision could decrease the risk of sexual transmitted infections is still controversial (Lissouba, 2011).…”

Simian-Human Immunodeficiency Viruses and Their Impact on Non-Human Primate Models for AIDS

“…Limited preclinical research is available regarding the penile mode of transmission and an emphasis has been placed on vaginal and rectal transmission studies. The presence of foreskin has been associated with an approximately 50% increase in risk of acquisition of HIV [173][174][175]. The human penis, foreskin has potential HIV target cells such as CD4+ T cells, Langerhans cells, macrophages, and submucosal lymphoidal aggregates that are rich in CD3+ and CD4+ cells [176,177].…”