Reasons for the low uptake of adult male circumcision for the prevention of HIV transmission in Swaziland

Swaziland is currently experiencing the worst impact of HIV and AIDS of any country in the world. In an effort to curb further spread of the virus; the country adopted mass male circumcision (MC) as recommended by the World Health Organization in 2007. Despite intense campaigns to promote the procedure over the past three years; the uptake of circumcision remains very low for reasons that are not very clear. The purpose of this study was to explore the reasons for the low uptake of MC in Swaziland despite the massive national MC campaigns. A qualitative research design was used; in which all men who were targeted by the mass MC campaign were eligible. Participants were identified as they came for sexual and reproductive health services at the Family Life Association of Swaziland (FLAS) Clinic; Mbabane. In-depth; individual face-to-face unstructured interviews were conducted to elicit the reasons why men were not going for circumcision. A total of 17 men were interviewed. Results showed that these reasons include fear of the procedure and the possible outcome; perception of no significant benefit of the procedure; impatience about waiting for the procedure or the healing process; religious/cultural beliefs; and worries about the fate of the foreskin. These reasons were attributed to misconceptions and lack of accurate and specific information about some aspects of the circumcision strategy of HIV preventions. Physiological changes and economic activities associated with adulthood were also found to be hindrances to MC uptake. The study recommended that a comprehensive description of the procedure and more precise facts and scientific bases of the MC strategy be incorporated and emphasised in the MC campaigns. Involvement of religious leaders will also facilitate clarification of religious or cultural misunderstandings or misconceptions. A focus on neonatal MC would also help

Attitudes towards male circumcision among attendees at a sexually transmitted Infection Clinic in Kingston, Jamaica / Actitudes hacia la circuncisión masculina entre los asistentes a la Clínica de Infecciones transmitidas sexualmente en Kingston, Jamaica

OBJECTIVE: To describe the attitudes of Sexually Transmitted Infection (STI) clinic attendees towards male circumcision. DESIGN AND METHODS: A convenience sample of attendees at the main STI clinic in Kingston was interviewed using a structured questionnaire in June 2008. RESULTS: One-hundred men and 98 women were interviewed. Over 90% of the men were not circumcised. Although 60% of men and 67% of women reported that they had heard of circumcision, the research nurse assessed that 28% of men and 40% of women actually understood what circumcision was. When asked about the benefits of circumcision, 32% of men and 41.8% of women said that circumcision makes it easier to clean the penis while 13% of men and 20.4% of women said that circumcision lessens the likelihood of STI. Twenty-two per cent of men and 13.3% of women said that the foreskin offers protection while 18% of men and 10.2% of women said that the penis looks more attractive when uncircumcised. When informed that research showed that circumcision reduced the risk of HIV, 35% of men said that they were willing to be circumcised and 67.3% of women said that they would encourage their spouse to be circumcised (p < 0.001) while 54% of men and 72.4% of women said that they would circumcise their sons (p = 0.057). CONCLUSION: Knowledge of circumcision and its benefits were limited among STI clinic attendees. Significantly more women than men were in favour of circumcision when informed that it reduced the risk of HIV infection.

OBJETIVO: Describir las actitudes de los asistentes a la clínica de infecciones de transmisión sexual (ITS) hacia la circuncisión masculina. DISEÑO Y MÉTODOS: Una muestra de conveniencia de asistentes a la clínica principal de ITS en Kingston fue encuestada mediante un cuestionario estructurado en junio de 2008. RESULTADOS: Se entrevistaron 100 hombres y 98 mujeres. Más del 90% de los hombres no estaban circuncidados. Aunque el 60% de los hombres y el 67% de las mujeres informaron que habían oído hablar de la circuncisión, la enfermera de la investigación evaluó que el 28% de los hombres y el 40% de las mujeres realmente entendían que era la circuncisión. Cuando se les preguntó acerca de los beneficios de la circuncisión, el 32% de los hombres y el 41.8% de las mujeres dijeron que la circuncisión facilita la limpieza del pene, mientras que el 13% de los hombres y el 20.4% de las mujeres dijeron que la circuncisión disminuye la probabilidad de ITS. El veintidós por ciento de los hombres y el 13.3% de las mujeres dijo que elprepucio ofreceprotección, mientras que el 18% de los hombres y el 10.2% de las mujeres dijeron que el pene parece más atractivo cuando está incircunciso. Cuando se les informó que las investigaciones mostraban que la circuncisión reducía el riesgo de VIH, el 35% de los hombres dijeron que querían ser circuncidados y el 67.3% de las mujeres dijeron que estimularían a sus esposos a quefueran circuncidados (p < 0.001), mientras que el 54% de los hombres y el 72.4% de las mujeres dijeron que harían circuncidar a sus hijos (p = 0.057). CONCLUSIÓN: El conocimiento de la circuncisión y sus beneficios eran limitados entre los asistentes a la clínica de ITS. Un número significativamente mayor de mujeres en comparación con los hombres, estuvieron a favor de la circuncisión cuando se dio la información de que reducía el riesgo de infección de VIH.

Parental Concerns on the Circumcision for Elementary School Boys: A Questionnaire Study

To evaluate the parental concerns for elementary school boys (7-12 yr) on the circumcision, a randomly selected cross-sectional survey was performed in each elementary school from 16 urban wards in Busan. We asked 10,861 parents to answer the questionnaires on the circumcision such as the benefits and fallbacks of circumcision, proper time and knowledge of the surgery, and neonatal circumcison. The overall response rate to the questionnaire was 38.9%. The overall circumcision rate of elementary school boys was 43.2%, which increased from 18.7% at 7 yr old to 64.8% at 12 yr old. The significant reason for and against circumcison was 'hygiene benefits (88.1%)' and 'unreliable medical benefits (38.5%)', respectively. 74.9% of parents thought that elementary school age is the optimal time of circumcision. Only 11.2% of boys were circumcised during neonatal period. The main reason for parents to oppose neonatal circumcision was 'their babies feel pain (35.8%)'. About 50% of parents thought that circumcision will prevent medical diseases. Besides the medical basis, the circumcision is emerging as a kind of social custom in Busan. For parents making the decisions on the circumcision of their boys, physician or health care providers should provide helpful and honest facts about circumcision.