Acceptability of male circumcision and predictors of circumcision preference among men and women in Nyanza Province, Kenya.

Numerous epidemiologic studies report significant associations between lack of male circumcision and HIV-1 infection, leading some to suggest that male circumcision be added to the limited armamentarium of HIV prevention strategies in areas where HIV prevalence is high and the mode of transmission is primarily heterosexual. This cross-sectional survey of 107 men and 110 women in Nyanza Province, Kenya, assesses the attitudes, beliefs, and predictors of circumcision preference among men and women in a traditionally non-circumcising region. Sixty per cent (n=64) of uncircumcised men and 69% (n=68) of women who had uncircumcised regular partners reported that they would prefer to be circumcised or their partners to be circumcised. Men's circumcision preference was associated with the belief that it is easier for uncircumcised men to get penile cancer, sexually transmitted diseases, and HIV/AIDS, and that circumcised men have more feeling in their penises, enjoy sex more, and confer more pleasure to their partners. Women with nine or more years of school were more likely to prefer circumcised partners. Men who preferred to remain uncircumcised were concerned about the pain and cost of the procedure, and pain was a significant deterrent for women to agree to circumcision for their sons. If clinical trials prove circumcision to be efficacious in reducing risk of HIV infection, it is likely that the procedure will be sought by a significant proportion of the population, especially if it is affordable and minimally painful.

Feasibility of medical male circumcision in Nyanza Province, Kenya.

BACKGROUND: Over forty observational studies have reported a protective effect of male circumcision against HIV-I acquisition, leading some to suggest that male circumcision be added to the limited armamentarium of HIV prevention strategies. OBJECTIVES: To evaluate the feasibility and requirements of implementing medical male circumcision in Nyanza Province of Kenya a quasi-experimental design was implemented to assess clinicians' knowledge of male circumcision and to assess the effectiveness of a one day educational intervention in one district. A cross sectional survey assessed the availability of necessary instruments and surgical supplies. RESULTS: None of the participating ten health facilities had all the necessary instruments and supplies to safely perform male circumcisions. Though most clinicians reported training about circumcision, most lacked sufficient knowledge to perform the procedure, and few were familiar with the process of informed consent. We demonstrated that a didactic educational workshop significantly improved providers' knowledge of male circumcision. CONCLUSIONS: Since increasing numbers of young men and parents are requesting male circumcision services in many parts of sub-Saharan Africa, health providers must undergo further training in the performance of the procedure and the process of informed consent. Many health facilities will have to be provided with the instruments and supplies necessary to perform male circumcision safely.

The acceptability of male circumcision to reduce HIV infections in Nyanza Province, Kenya.

Compelling epidemiological evidence showing a significant association between lack of male circumcision and HIV infection has prompted calls for consideration of male circumcision interventions as a strategy for reducing HIV prevalence in highly affected areas where circumcision is little practiced and transmission is predominantly heterosexual. Little is known about whether male circumcision interventions would be acceptable or feasible in traditionally non-circumcisng areas of Africa. This study assesses the acceptability of male circumcision in the Luo, a large, traditionally non-circumcising ethnic group in western Kenya. Separate focused group discussions with adult Luo men and women and semi-structured interviews with clinicians were conducted in Nyanza Province, Kenya. The primary barriers to acceptance of male circumcision were cultural identification, fear of pain and excessive bleeding and cost. The main facilitators were association of male circumcision with better hygiene and reduced risk of infection. Both men and women were eager for promotion of genital hygiene and male circumcision, and they desired availability of circumcision clinical services in the Province's health facilities. Clinicians lacked the knowledge and resources to offer safe circumcision counselling and services. If results from this study are valid for other areas of sub-Saharan Africa, acceptability of male circumcision as a means to reduce STDs and HIV is higher than previously suspected. Further studies are needed in other regions to assess the feasibility of introducing acceptable male circumcision information and services to reduce HIV transmission.