Male circumcision and HIV in Zambia

Background: Over the last 10 years considerable interest has developed in male circumcision as a possible tool in reducing HIV transmission in high prevalence countries of sub-Saharan Africa. Statements from normative agencies, though cautious, have encouraged the introduction of safe hospital based circumcision practice where the demand for these services exists1. The anecdotal evidence has now been followed by one randomized control trial. The results of two further trials are awaited. In the interim , interest has grown in the question of how male circumcision can be operationalised in a real clinical setting should the two ongoing trials confirm the efficacy of male circumcision.Methods: The University Teaching Hospital Lusaka has been running an integrated dedicated male circumcision service for the last 2years. This site is, as far as we know, the only dedicated public service male circumcision service site in the region.Results: The site has performed 900 male circumcisions. The lessons learnt in relation to administration, cost, techniques, key operator and outcomes are reviewed. Comparison is drawn with the three research sites and public health strategies to reduce HIV transmission. Some conclusions are drawn about possible paths and pitfalls for future sites in the region

HIV sexual risk behaviors and perception of risk among college students: implications for planning interventions

<p>Abstract</p> <p>Background</p> <p>The college environment offers great opportunity for HIV high-risk behaviors, including unsafe sex and multiple partnerships. While the overall incidence of HIV infection has seen some decline in recent years, rates of HIV infection among young adults have not seen a proportionate decline. As in the general population, African American young adults have been disproportionately affected by the HIV/AIDS epidemic. This study examined the sexual risk behaviors and perception of HIV risk of students in a predominantly African American commuter urban university in the Midwest.</p> <p>Methods</p> <p>Students enrolled in randomly selected general education courses completed a paper and pencil survey. Data were collected in Fall 2007, and univariate, bivariate, and multivariate analyses were conducted using SPSS for Windows v.16.</p> <p>Results</p> <p>The sample included 390 students, the majority (83%) of whom were never married and 87% were sexually experienced. Among males reporting male partnerships those who used marijuana (OR = 17.5, p = 0.01) and those who used alcohol along with illegal drugs (OR = 8.8, p = 0.03) were significantly more likely to report multiple partnerships. Among females reporting male partnerships, those 30 years and older were significantly less likely (OR = 0.09, p = 0.03) to report having multiple male partners. There were significant differences in condom use last sex (p = 0.01) and consistent condom use (p = 0.002) among the different age groups. Older students were less likely to report condom use. Females age 30 years and older (OR = 3.74, p = 0.05) and respondents age 2029 years (OR = 2.41, p = 0.03) were more likely to report inconsistent condom use than those below 20 years. Marijuana use was correlated with inconsistent condom use (p = 0.02) and alcohol with not using condom last sex among females. Perception of HIV risk was generally poor with 54% of those age 30 years and older, 48.1% of 2029 year olds, and 57.9% of those below the age of 20 years perceived themselves as not having any chance of being infected with HIV. Predictors of moderate/good perception of HIV risk were drug and alcohol use, inconsistent condom use, and multiple partnerships.</p> <p>Conclusion</p> <p>Students in the study sample engaged in various HIV risk behaviors but have a poor appreciation of their risk of HIV infection. While low rates of condom use was a problem among older students (30 years and older), multiple partnerships were more common among younger students, and marijuana and alcohol use were related to low condom use among females. Our findings support the need for targeted HIV prevention interventions on college campuses.</p

Readability and test-retest reliability of a psychometric instrument designed to assess HIV/AIDS attitudes, beliefs, behaviours and sources of HIV prevention information of young adults

Objective: This comparative study evaluated the readability and test-retest reliability of a questionnaire designed to assess the attitudes, beliefs behaviours and sources of information about HIV/AIDS among young adults recruited from universities in the United States of America (USA), Turkey and South Africa. Design/Setting: The instrument was administered on two occasions, within a two week interval, to 219 university students in the USA (n = 66), Turkey (n = 53) and South Africa (n = 100). Method: The psychometric instrument developed has five major subscales: demographic, HIV/AIDS attitudes and beliefs, HIV risk sexual behaviour, alcohol and drug use, and HIV sources of information. Results: The instrument’s readability evaluation revealed a Flesch-Kincaid score (literacy difficulty level of the questionnaire) of 8.4, indicating that respondents would need an eighth grade reading level to understand the survey. The overall test-retest reliability coefficients for the items on the demographic subscale were generally high (0.893–0.997). Similarly, high test-retest reliability was obtained for the HIV risk sexual behaviour (0.738–0.996) and the alcohol and drug use (0.562–1.000) subscales. Much lower test-retest reliability was obtained for the HIV/AIDS attitudes and beliefs (0.32–0.80), and sources of information about HIV/AIDS (0.370–0.892) subscales. Conclusion: We found no discernible difference in the reliability data among the respondents from the three countries. The instrument should be of interest to clinicians and researchers investigating the HIV risk behaviours of young adults and older age groups with an eighth grade reading level. The availability of this instrument may enhance HIV population and intervention studies internationally.Web of Scienc

Voluntary Medical Male Circumcision: Matching Demand and Supply with Quality and Efficiency in a High-Volume Campaign in Iringa Region, Tanzania

Hally Mahler and colleagues evaluate a six-week voluntary medical male circumcision campaign in Iringa province of Tanzania, providing a model for matching supply with demand for services and showing that high-volume circumcisions can be performed without compromising client safety

Determinants of circumcision and willingness to be circumcised by Rwandan men, 2010

<p>Abstract</p> <p>Background</p> <p>Male Circumcision (MC) has been recommended as one of the preventive measures against sexual HIV transmission by the World Health Organization (WHO). Rwanda has adopted MC as recommended but the country is a non-traditionally circumcising society. The objective was to explore knowledge and perception of Rwandan men on Male Circumcision (MC) and to determine the factors associated with the willingness to be circumcised and to circumcise their sons.</p> <p>Methods</p> <p>This cross sectional study was conducted in 29 districts of Rwanda between January and March 2010. Data were collected using a structured questionnaire among men aged 15-59 years. The rate of MC was measured and its perception from respondents, and then the factors associated with the willingness to go for MC were analysed using multiple logistic regressions.</p> <p>Results</p> <p>A total of 1098 men were interviewed. Among respondents 17% (95% CI 14-19%) reported being circumcised. About three-quarter (72%) could define MC, but 37% of adolescent could not. Half of the participants were willing to get circumcised and 79% of men would accept circumcision for their sons. The main motivators for MC were its benefits in HIV/STI prevention (69%) and improving hygiene (49%). Being too old was the main reason (32%) reported by men reluctant to undergo MC and younger men were afraid of pain in particular those less than 19 years old (42%). The willingness to circumcise was significantly associated with younger age, living in the Eastern Province, marital status, and the knowledge of the preventive role of circumcision.</p> <p>Conclusions</p> <p>Adolescents and young adults were more willing to be circumcised. It is critical to ensure the availability of pain free services in order to satisfy the increasing demand for the scale up of MC in Rwanda.</p

"Now we are in a different time; various bad diseases have come." understanding men's acceptability of male circumcision for HIV prevention in a moderate prevalence setting

Background: Adult male surgical circumcision (MC) has been shown to reduce HIV acquisition in men and is recommended by the WHO for inclusion in comprehensive national HIV prevention programs in high prevalence settings. Only limited research to date has been conducted in countries experiencing moderate burden epidemics, where the acceptability, operational feasibility and potential epidemiological impact of MC remain unclear. Methods. A multi-method qualitative research study was conducted at four sites in Papua New Guinea (PNG), with 24 focus group discussions and 65 in-depth interviews carried out among 276 men. Results: The majority of men were in favour of MC being introduced for HIV prevention in PNG and considered improved genital hygiene, enhanced sexual pleasure and culturally appropriateness key factors in the acceptability of a future intervention. A minority of men were against the introduction of MC, primarily due to concerns regarding sexual risk compensation and that the intervention went against prevailing cultural and religious beliefs. Conclusion: This is one of the first community-based MC acceptability studies conducted in a moderate prevalence setting outside of Africa. Research findings from this study suggest that a future MC program for HIV prevention would be widely accepted by men in PNG