Male circumcision for HIV prevention

Male circumcision

Male circumcision for HIV prevention - a cross-sectional study on awareness among young people and adults in rural Uganda.

Medical male circumcision is now part of a comprehensive approach to HIV prevention. It has been shown that awareness of the protective effect of male circumcision leads to high acceptability towards the introduction of medical male circumcision services within countries. The objective of this survey was to identify factors determining awareness of male circumcision for HIV prevention. The authors interviewed 452 participants (267 adults >24 years of age; 185 youths 14-24 years) living in three rural Ugandan districts in 2008. Using a standardized questionnaire, they assessed socio-demographic parameters, awareness of male circumcision for HIV prevention, general beliefs/attitudes regarding male circumcision and male circumcision status. Determinants for awareness of male circumcision for HIV prevention were examined with multiple logistic regression models. Out of all adults, 52.1% were male (mean+/-SD age 39.8+/-11 years), of whom 39.1% reported to be circumcised. Out of all youths, 58.4% were male (18.4+/-2.5), 35.0% circumcised. Adults were more aware of male circumcision for HIV prevention than youths (87.1% vs. 76.5%; p=0.004). In adults, awareness was increased with higher educational level compared to no school: primary school (adjusted OR 9.32; 95%CI 1.80-48.11), secondary (5.04; 1.01-25.25), tertiary (9.91; 0.76-129.18), university education (8.03; 0.59-109.95). Younger age and male sex were further significant determinants of increased awareness, but not marital status, religion, district, ethnicity, employment status, and circumcision status. In youths, they found a borderline statistically significant decrease of awareness of male circumcision for HIV prevention with higher educational level, but not with any other socio-demographic factors. Particularly Ugandans with low education, youths, and women, playing an important role in decision-making of male circumcision for their partners and sons, should be increasingly targeted by information campaigns about positive health effects of male circumcision.

Ugandans wait for a clear endorsement by the government and community leaders of male circumcision for HIV prevention, information from the media and from nongovernmental and community-based organizations is increasing the understanding of those who will make the decisions at family level about male circumcision. Women are involved as mothers and sexual partners in such decisions, fathers can discuss male circumcision with their sons, and community advocates can raise the call for safe male circumcision services. As this study demonstrates, there is already a high level of awareness in rural Uganda. In such situations, the risk often increases that unsafe circumcision by untrained, poorly equipped operators working in unsanitary conditions will result in avoidable morbidity, mutilations, and mortality.