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Open Access Research article

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

Pascale Lissouba1, Dirk Taljaard2, Dino Rech2, Veerle Dermaux-Msimang3, Camille Legeai1, David Lewis34, Beverley Singh3, Adrian Puren34 and Bertran Auvert156*

Author Affiliations

1 CESP INSERM-UVSQ UMRS 1018, Villejuif, France

2 Progressus, Johannesburg, South Africa

3 National Institute for Communicable Diseases (NICD) of the National Health Laboratory Services (NHLS), Johannesburg, South Africa

4 University of the Witwatersrand, Johannesburg, South Africa

5 Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne, France

6 Université Versailles Saint-Quentin-en-Yvelines, Versailles, France

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BMC Infectious Diseases 2011, 11:253  doi:10.1186/1471-2334-11-253

Published: 26 September 2011

Abstract

Background

To 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.

Methods

A 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.

Results

The 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%).

Conclusions

AMC 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.

Keywords:
male circumcision; foreskin; uptake; acceptability; HIV-AIDS