"Voluntary medical male circumcision (VMMC) has emerged as one of the most effective means of preventing HIV transmission in countries of Eastern and Southern Africa . Based on the results of three clinical trials demonstrating the efficacy of male circumcision in reducing HIV transmission (by approximately 60%), the World Health Organization and the Joint United National Programme on HIV/AIDS (UNAIDS) issued recommendations in 2007 that countries should include medical MC as part of HIV prevention interventions and that implementation should be prioritized to areas with low MC and high HIV prevalence . "
[Show abstract][Hide abstract] ABSTRACT: Background
Despite the importance of male circumcision (MC) prevalence to HIV prevention efforts in Eastern and Southern Africa, there has been no systematic analysis on the correlates of male circumcision. This analysis identifies correlates of MC in 12 countries in the region with available data.
Data from the male questionnaire of DHS surveys collected between 2006–2011 in Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe were analyzed. The dependent variable was self-reported male circumcision status. Independent variables included age, education, wealth quintile, place of residence, ethnicity, religion and region. Bivariate and multivariate analyses were conducted separately for each country.
MC prevalence ranged from 8.2 percent in Swaziland to 92.2 percent in Ethiopia. Bivariate analyses showed a consistent positive association between age (being older) and male circumcision. Education, wealth quintile, and place of residence were either not significantly related or differed in the direction of the relationship by country. Multivariate logistic regression showed three variables consistently associated with MC status: age (being older), religion (being Muslim) and ethnicity.
These data were collected prior to the scale-up of voluntary medical male circumcision (VMMC) programs in 11 of the 12 countries. As the VMMC scale-up intensifies in countries across Eastern and Southern Africa, the correlates of VMMC are likely to change, with (younger) age and education emerging as key correlates of VMMC performed in medical settings. The centuries-long tradition among Muslims to circumcise should continue to favor MC among this group. Non-circumcising ethnicities may become more open to MC if promoted as a health practice for decreasing HIV risk.
PLoS ONE 06/2014; 9(6):e100775. DOI:10.1371/journal.pone.0100775 · 3.23 Impact Factor
"A textbook on meta-analyses  and a review of methods and techniques in meta-analyses  use this meta-analysis as an illustrative example of how Simpson's paradox can lead to incorrect results. Subsequent, correctly performed, metaanalyses found male circumcision to have a strong protective effect against HIV infection  . "
[Show abstract][Hide abstract] ABSTRACT: We critically evaluate a recent article by Van Howe involving 12 meta-analyses that concludes, contrary to current evidence, that male circumcision increases the risk of various common sexually transmitted infections (STIs). Our detailed scrutiny reveals that these meta-analyses (1) failed to include results of all relevant studies, especially data from randomized controlled trials, (2) introduced bias through use of inappropriate control groups, (3) altered original data, in the case of human papillomavirus (HPV), by questionable adjustments for "sampling bias," (4) failed to control for confounders through use of crude odds ratios, and (5) used unnecessarily complicated methods without adequate explanation, so impeding replication by others. Interventions that can reduce the prevalence of STIs are important to international health. Of major concern is the global epidemic of oncogenic types of HPV that contribute to the burden of genital cancers. Meta-analyses, when well conducted, can better inform public health policy and medical practice, but when seriously flawed can have detrimental consequences. Our critical evaluation leads us to reject the findings and conclusions of Van Howe on multiple grounds. Our timely analysis thus reaffirms the medical evidence supporting male circumcision as a desirable intervention for STI prevention.
"They also point out that campaigners encourage the mutilation of the male body without sufficient reliable scientific evidence (Boyle et al. 2002; Goldman 1997). Most recent controversies centre on two main issues: public health implications of scaling-up adult male circumcision due to the 'conclusive evidence that male circumcision offers significant protection for men from HIV infection' (Weiss et al. 2008) and the relevance of enforcing routine neonatal and child circumcision (Xu et al. 2009, 79) as a 'longer-term HIV prevention strategy' (UNAIDS 2010, 5–6). Despite the American Academy of Paediatrics having newly released guidelines on the health benefits of infant circumcision, 'especially with regard to a decrease in risk of acquiring a sexually transmitted infection' (The Lancet 2012), the procedure has not been universally recommended . "
[Show abstract][Hide abstract] ABSTRACT: In-depth repeat interviews with 14 male Japanese urologists and plastic surgeons are analysed to shed light on male circumcision: a procedure largely conducted at beauty clinics to deal with gender and sexual matters. The urologists strongly oppose male circumcision because it is a surgery promoted by plastic surgeons without any prophylactic benefit and which works only as a placebo. This suggests a critical public health matter within current international debates on adult and paediatric male circumcision. Urologists encourage the practice of the ‘informed parent’ to challenge male circumcision and promote penile hygiene. Plastic surgeons, in comparison, argue that male circumcision can be effectively used to deal with issues concerning male’s self-confidence, erectile dysfunction and premature ejaculation. Despite urologist and plastic surgeons exhibiting clear divergent positions, their viewpoint converge on the sexual script that sexuality arises from the genitals and the master narrative that the penis is central in the construction of masculinity.
Critical Public Health 12/2013; 23(4). DOI:10.1080/09581596.2012.753409 · 0.88 Impact Factor
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