Systematic review: Safety of surgical male circumcision in context of HIV prevention public health programmes [version 2; peer review: 2 approved]

Background: Since the recommendation of voluntary medical male circumcision (VMMC) to reduce the risk of heterosexually acquired HIV, a number of adolescent boys and men in 15 priority countries in Africa have been circumcised. Our primary goal was to identify the incidence of adverse events (AEs) associated with VMMC and to assess the safety profile among adolescent boys 10 – 14 years. Methods: We searched the databases MEDLINE and Embase, WHO, and conference abstracts from 2005 to 2019. The incidence of AEs was estimated by type of AE, size of study and age. Results: We retained 40 studies. Severe and moderate AEs overall were estimated at 0.30 per 100 VMMC clients with wide variability per study type. A higher rate was noted in small and moderate scale programmes and device method research studies compared with larger scale programmes. There was a limited number of studies reporting AEs among younger adolescent boys and they had higher infection-related AEs than those aged 20 years and older. Case studies noted rare AEs such as necrotizing fasciitis, tetanus, and glans injury. Conclusions: AE rates were comparable to those from the randomized controlled trials (RCTs) that led to recommendations and implementation of VMMC in high HIV burden countries, despite being implemented in low resource settings. Clients over time have increasingly included adolescents under the age of 15 years. Studies suggest potentially higher risks in this age group. As VMMC services are sustained, patient safety surveillance systems and promoting a patient safety culture are crucial to identify and mitigate potential harms from medical male circumcision

Male contraceptive prevalence and factors associated with contraceptive use among men in Ngara, Tanzania

This is a study to explore the knowledge, attitude and practice of family planning among men in Ngara district Tanzania. The first objective of the study was to assess the knowledge of different contraceptive methods and the magnitude of contraceptive use among men. The second objective was to assess the level of contraceptive availability and reasons for using/not using contraceptive methods as well as the men's reproductive preferences. It is a cross-sectional study conducted in August-December 2000, including 275 men aged 15-59 years who were randomly selected from 18 villages. Men who had no sexual experience or were mentally ill and those who did not consent were excluded from the research. The data were collected using structured questionnaire, in addition focus group discussions were done and the association between different factors and contraception use was calculated. The male contraceptive prevalence was low (18%), with periodic abstinence as a common method in use (9%). The knowledge of male methods was limited. Though a majority of men has heard about condoms (96%), only 70% have seen one and a majority reporting to have seen condoms only in packets during focus group discussions. Few men knew of vasectomy (48%), associating the method with "castration of animals". Desiring more children (25%), poor knowledge of male methods (20%) and difficulties in using the methods (10%) were the most frequent reasons given by non-users. Men desired a large family size and preferred boys rather than girls. Contraceptive approval among men was high and men believed to be the prime contraception discussion initiators in their families. We conclude that low knowledge and misconception about male methods, large desired family size may have been associated with low male contraceptive prevalence. Therefore, there is a need to find better ways to reach men especially in rural areas, to provide access to appropriate and adequate information regarding a range of family planning services