Krieger JN, Bailey RC, Opeya J, et al. Adult male circumcision: results of a standardized procedure in Kisumu District, Kenya
ABSTRACT To develop a standard procedure for male circumcision in a resource-poor medical setting and prospectively evaluate the outcome in a randomized, controlled trial with the incidence of human immunodeficiency virus (HIV) as the main outcome, as studies suggest that circumcision is associated with a lower incidence of HIV and other sexually transmitted infections in high-risk populations.
Healthy, uncircumcised, HIV-seronegative men aged 18-24 years from Kisumu District, Kenya, were offered participation in a clinical trial using a standard circumcision procedure based on "usual" medical procedures in Western Kenya. The follow-up included visits at 3, 8 and 30 days after circumcision, with additional visits if necessary. Healing, satisfaction and resumption of activities were assessed at these visits and 3 months from randomization.
Overall, 17 (3.5%) of the 479 circumcisions were associated with adverse events judged definitely, probably or possibly related to the procedure. The most common adverse events were wound infections (1.3%), bleeding (0.8%), and delayed wound healing or suture line disruption (0.8%). After 30 days, 99% of participants reported being very satisfied with the procedure; approximately 23% reported having had sex and 15% reported that their partners had expressed an opinion, all of whom were very satisfied with the outcome. About 96% of the men resumed normal general activities within the first week after the procedure.
Safe and acceptable adult male circumcision services can be delivered in developing countries should male circumcision ultimately be advocated as a public-health measure.
- SourceAvailable from: Claudia Hanson
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- "It needs to be increased among youth and attempts should be made to transform it to a social norm-for all age groups – until the sexual partners have undergone testing. Male circumcision, for many years commonly performed in many urban areas (54) and in ethnic groups that traditionally do not circumcise, has only recently been recommended (19), after clear research evidence has been presented (18, 55). It is still of limited scale, but is likely to increase substantially, where it does not run into political problems. "
ABSTRACT: HIV control efforts in sub-Saharan Africa meet with difficulties. Incidence and prevalence remains high, and little behaviour change seems to have taken place. The focus on HIV control has shifted to anti-retroviral therapy (ART), although this is unlikely either to be cost-effective or the reduce the incidence of HIV. There is reason to change the current approach. Three questions arise: Is there a need to adjust the view on the determinants of the HIV epidemic in sub-Saharan Africa? Are the right things being done to control HIV? Are the things that are being done, done in the right way? We try to answer these questions. The determinants of the epidemic are reviewed and summarized in Figure 2. The need to adjust the view on the determinants and get rid of myths is stressed. A possible, locally adaptable intervention mix is outlined. Male circumcision is a key intervention where socially acceptable. Operationalisation and organisational changes are briefly discussed. Conclusively, the need for a "social revolution" through the opening up of a discussion on sexuality in the community, as well as a focus on cost-effective interventions and a slimmed down, more effective organisation is underlined. Such steps might make it possible to considerably reduce HIV-incidence, even in low-income countries.Global Health Action 10/2008; 1. DOI:10.3402/gha.v1i0.1837 · 1.93 Impact Factor
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- "These interpretations direct social and sexual interaction in this specific context, which can affect the health and well-being of adolescents. Literature on male circumcision, whether performed at clinics or at initiation schools, suggests a reduction in the incidence of sexually transmitted HIV, and circumcision should therefore be promoted (Agot, Ndinya- Achola, Kreiss, & Weiss, 2004; Gray et al., 2004; Krieger et al., 2005; Short, 2004). However, others have stressed that the previously documented positive outcomes of circumcision do not take into account confounding factors that might increase risk behaviors (Siegfried et al., 2003). "
ABSTRACT: This article is focused on young males' sexual identity and behaviors in rural South Africa. The study comprised 19 focus group discussions with adolescents aged 12 to 14 years. The informants depict male sexuality as biologically predetermined, where physical needs and practices such as circumcision legitimize early sexual debut. Furthermore, the construction of male sexual identity and power imbalances in relationships are already evident at an early age, and age and economics are pertinent factors affecting social relations. Violent behavior and sexual abuse are supported by constructed gender inequalities forming an often negative and nonsupportive environment for young people. We stress the importance of planned HIV and sexuality education for young adolescents with support structures that can help endorse individual actions and informed choices. This is especially important in resource-poor settings where young people are likely to be less empowered than is the case in more affluent settings.Qualitative Health Research 07/2008; 18(6):739-46. DOI:10.1177/1049732308318373 · 2.19 Impact Factor
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- "The attitude summary score consisted of the number of positive responses. The questionnaire was developed from a literature review (Bailey et al., 2002; Chabikuli and Obunbanjo, 2001; Kanta, 2004; Krieger et al., 2001; Meel, 2005; Mattson et al., 2004; Methar and Fass, 2001. A database of all traditional nurses and surgeons both trained and untrained was accessed from the Department of Health in the Eastern Province (male circumcision corcumcisionision programme). "
ABSTRACT: Training designed to improve circumcision knowledge, attitude and practice was delivered over 5 days to 34 traditional surgeons and 49 traditional nurses in the Eastern Cape, South Africa. Training included the following topics: initiation rites; statutory regulation of traditional male circumcision and initiation into Manhood (TCIM); structure and function of the male sex organs; procedure of safe circumcision, infection control; sexually transmitted infections (STIs); HIV/AIDS; infection control measures; aftercare of the initiate including after care of the circumcision wound and initiate as a whole; detection and early management of common complications of circumcision; nutrition and fluid management; code of conduct and ethics; and sexual health education. The evaluation of the training consisted of a prospective assessment of knowledge and attitude immediately prior to and after training. Significant improvement in knowledge and/or attitudes was observed in legal aspects, STI, HIV and environmental aspects, attitudes in terms of improved collaboration with biomedical health care providers, normal and abnormal anatomy and physiology, sexually transmitted infections and including HIV, circumcision practice and aftercare of initiates. We concluded that safer circumcision training can be successfully delivered to traditional surgeons and nurses.African Journal of Traditional, Complementary and Alternative Medicines 01/2008; 5(4):346-54. · 0.56 Impact Factor