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Estimating the uptake of safe and free male circumcision in a South African community
Presented by Bertran Auvert, France.
D. Taljaard1, D. Rech1, S. Doyle1, D. Lewis2, C. Legeai3, P. Lissouba3, F. Lert3, B. Auvert4
1Progressus, Johannesburg, South Africa, 2National Institute for Communicable Diseases, Johannesburg, South Africa, 3INSERM U687, Villejuif, France, 4INSERM U687, Assistance Publique-Hôpitaux de Paris, University Versailles Saint-Quentin, Villejuif, Boulogne, Versailles, France
Background: WHO has recommended male circumcision (MC) for the prevention of heterosexually acquired HIV infection in men, in regions where HIV prevalence is “high” and MC prevalence is “low”. Since the success of a MC intervention depends on its uptake, defined here as the proportion of uncircumcised men to whom circumcision has been proposed and who effectively undergo the procedure, this study was designed to estimate the uptake of safe and free MC in a South African community.
Methods: In 2007, in the township of Orange Farm, HIV prevalence among the 15-49 years old was about 22% and self-reported MC prevalence was 27.8%. A representative sample of 1680 households was selected from the community and all residing males of this age group were offered an HIV risk reduction counselling session and given condoms, treated free of charge for symptomatic STIs and encouraged to follow VCT (ANRS-12126-study). Furthermore, all self-reported uncircumcised men were offered free medicalised circumcision. Two months later, those willing to be circumcised were recontacted, given additional counselling regarding MC and, if ready, allocated an appointment for MC surgery. Circumcisions were performed by doctors under local anesthesia according to WHO recommendations.
Results: Most uncircumcised participants (82.6%) were willing to be circumcised and preliminary findings indicate that 79.0% of those willing also accepted to be circumcised. Therefore uptake estimation among self-reported uncircumcised men was 65.3% (CI: 50.3%-80.4%). This is more than twice the prevalence of circumcised males in this community.
Conclusion: In a South African community where most males are uncircumcised, relatively high uptake of medicalised MC can be obtained by simply offering it for free. Similar studies should be conducted in African countries where HIV prevalence is “high” and MC prevalence is “low”. The authors also suggest intensifying the promotion of safe and free male circumcision to increase uptake.