Women’s knowledge and perception of male circumcision before and after its roll-out in the South African township of Orange Farm from community-based cross-sectional surveys

<div><p>The roll-out of medical male circumcision (MC) is progressing in Southern and Eastern Africa. Little is known about the effect of this roll-out on women. The objective of this study was to assess the knowledge and perceptions of women regarding MC in a setting before and after the roll-out. This study was conducted in the South African township of Orange Farm where MC prevalence among men increased from 17% to 53% in the period 2008–2010. Data from three community-based cross sectional surveys conducted in 2007, 2010 and 2012 among 1258, 1197 and 2583 adult women, respectively were studied. In 2012, among 2583 women, 73.7% reported a preference for circumcised partners, and 87.9% knew that circumcised men could become infected with HIV. A total of 95.8% preferred to have their male children circumcised. These three proportions increased significantly during the roll-out. In 2007, the corresponding values were 64.4%, 82.9% and 80.4%, respectively. Among 2581 women having had sexual intercourse with circumcised and uncircumcised men, a majority (55.8%, 1440/2581) agreed that it was easier for a circumcised man to use a condom, 20.5% (530/2581) disagreed; and 23.07 (611/2581) did not know. However, some women incorrectly stated that they were fully (32/2579; 1.2%; 95%CI: 0.9% to 1.7%) or partially (233/2579; 9.0%; 95%CI: 8.0% to 10.2%) protected when having unprotected sex with a circumcised HIV-positive partner. This study shows that the favorable perception of women and relatively correct knowledge regarding VMMC had increased during the roll-out of VMMC. When possible, women should participate in the promotion of VMMC although further effort should be made to improve their knowledge.</p></div

Level of viral suppression and the cascade of HIV care in a South-African semi-urban setting in 2012

International audienceObjective: In 2012, seven years after the introduction of ART in the South-African townshipof Orange Farm, we measured the proportion of HIV-positive people who were virallysuppressed, especially among high risk groups (women 18-29y and men 25-34y).Design: A community-based cross-sectional representative survey was conducted among3293 men and 3473 women.Methods: Study procedures included a face-to-face interview and collection of blood samplesthat were tested for HIV, 11 antiretroviral drugs (ARVs) and HIV-Viral Load (VL).Results: HIV prevalence was 17.0%[95%CI: 15.7-18.3%] among men and 30.1%[28.5-31.6%] among women. Overall, 59.1%[57.4-60.8%] of men and 79.5%[78.2-80.9%] ofwomen had previously been tested for HIV. When controlling for age, circumcised men weremore likely to have been tested compared to uncircumcised men (66.1% vs 53.6%; p<0.001).Among HIV+, 21.0%[17.7-24.6%] of men and 30.5%[27.7-33.3%] of women tested positivefor on or more ARV. Using basic calculations we estimated that, between 2005 and 2012,ART programs prevented between 46%-63% of AIDS-related deaths in the community.Among ARV+, 91.9%[88.7-94.3%] had viral suppression (VL<400copies/mL). Theproportion of viral suppression among HIV+ was 27.0%[24.3-29.9%] among women and17.5%[14.4-20.9%] among men. These proportions were lower among the high risk groups:15.6%[12.1-19.7%] among women and 8.4%[5.0-13.1%] among men.Conclusion: In Orange Farm, between 2005 and 2012, ART programs were sub-optimal and,among those living with HIV, the proportion with viral suppression was still low, especiallyamong the young age groups. However, our study showed that in reality ARVs are highlyeffective in viral suppression at an individual level

Background characteristics of women from samples obtained in 2007, 2010 and 2012 in the South African township of Orange Farm.

<p>Background characteristics of women from samples obtained in 2007, 2010 and 2012 in the South African township of Orange Farm.</p

Sequential Cross-Sectional Surveys in Orange Farm, a Township of South Africa, Revealed a Constant Low Voluntary Medical Male Circumcision Uptake among Adults despite Demand Creation Campaigns and High Acceptability

International audienceWHO recommends a male circumcision (MC) prevalence rate higher than 80% to have a substantial impact on the HIV-AIDS epidemic in Eastern and Southern Africa. Orange Farm, a township in South Africa, has a free-for-service voluntary medical male circumcision (VMMC) clinic in operation since 2008. Following an intense campaign from 2008 to 2010, MC prevalence rate increased to 55.4% (ANRS-12126). Ongoing and past VMMC campaigns focused on youths, through school talks, and adults at a community level. The main objective of the study was to assess the change in MC prevalence rate among adults aged 18–19 and 18–49 years in the past 5 years

Main reason given by circumcised men for being circumcised.

<p>Main reason given by circumcised men for being circumcised.</p

Male circumcision (MC) prevalence rate among men aged 18–49 years obtained in three independent cross-sectional surveys conducted in Orange Farm in the years 2007–2008, 2010–2011 and 2015.

<p>Male circumcision (MC) prevalence rate among men aged 18–49 years obtained in three independent cross-sectional surveys conducted in Orange Farm in the years 2007–2008, 2010–2011 and 2015.</p

Background characteristics of the sample surveyed in 2015 and association with male circumcision status.

<p>Background characteristics of the sample surveyed in 2015 and association with male circumcision status.</p

Characteristics related to HIV and male circumcision of the sample surveyed in 2015 and association with male circumcision status.

<p>Characteristics related to HIV and male circumcision of the sample surveyed in 2015 and association with male circumcision status.</p

Main reason given by uncircumcised men for not being circumcised.

<p>Main reason given by uncircumcised men for not being circumcised.</p