Knowledge and Attitudes About Male Circumcision for HIV-1 Prevention among Heterosexual HIV-1 Serodiscordant Partnerships in Kampala, Uganda

Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
AIDS and Behavior (Impact Factor: 3.49). 04/2010; 14(5):1190-7. DOI: 10.1007/s10461-010-9696-x
Source: PubMed


Male circumcision for HIV-1 prevention will require high uptake among at-risk populations. 318 HIV-1 serodiscordant couples in Kampala, Uganda [155 (48.7%) with HIV-1 uninfected male partners] were interviewed about male circumcision for HIV-1 prevention. 77.1% of men and 89.6% of women were aware that circumcision reduces men's risk for HIV-1 acquisition. Almost all understood the partial protective efficacy of circumcision for HIV-1 acquisition and lack of reduced HIV-1 transmission from circumcising HIV-1 infected men. Among couples with uncircumcised HIV-1 negative men (n = 92), 53.3% of men and 88.1% of female partners expressed interest in male circumcision. Previous discussion within the couple about circumcision for HIV-1 prevention was significantly associated with interest in the procedure. HIV-1 serodiscordant couples in Uganda demonstrated a high level of understanding of the partial protective effect of male circumcision for HIV-1 prevention, but only half of HIV-1 uninfected uncircumcised men expressed interest in the procedure.

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    ABSTRACT: Most new HIV infections in sub-Saharan Africa now occur in married and cohabiting couples, many of whom do not realize that only one of them may be infected with HIV. HIV-negative individuals living in stable HIV-discordant partnerships (in which one partner is HIV-infected while the other one is not) are twice as likely to get infected with HIV as those living in concordant HIV-negative relationships. Since HIV transmission occurs mainly from HIV-infected persons who are unaware of their status, a combination of interventions including behavioral and biomedical interventions is urgently needed to increase knowledge of HIV status as well as reduce the risk of HIV transmission within married and cohabiting couples. Behavioral interventions include promotion of couples' counseling, testing and disclosure; condom promotion as well as alcohol risk-reduction, while biomedical interventions include provision of antiretroviral treatment to the HIV-infected partner, medical male circumcision and treatment of sexually transmitted infections. Since no single intervention can turn around the current HIV tide in married and cohabiting couples, we argue for the inclusion of these interventions in a combination prevention package for married and cohabiting HIV-discordant couples in sub-Saharan Africa.
    No preview · Article · Jul 2010 · Current HIV research
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    ABSTRACT: The ultimate success of medical male circumcision for HIV prevention may depend on targeting male infants and children as well as adults, in order to maximally reduce new HIV infections into the future. We conducted a cross-sectional study among heterosexual HIV serodiscordant couples (a population at high risk for HIV transmission) attending a research clinic in Kampala, Uganda on perceptions and attitudes about medical circumcision for male children for HIV prevention. Correlates of willingness to circumcise male children were assessed using generalized estimating equations methods. 318 HIV serodiscordant couples were interviewed, 51.3% in which the female partner was HIV uninfected. Most couples were married and cohabiting, and almost 50% had at least one uncircumcised male child of ≤18 years of age. Overall, 90.2% of male partners and 94.6% of female partners expressed interest in medical circumcision for their male children for reduction of future risk for HIV infection, including 79.9% of men and 87.6% of women who had an uncircumcised male child. Among both men and women, those who were knowledgeable that circumcision reduces men's risk for HIV (adjusted prevalence ratio [APR] 1.34 and 1.14) and those who had discussed the HIV prevention effects of medical circumcision with their partner (APR 1.08 and 1.07) were significantly (p≤0.05) more likely to be interested in male child circumcision for HIV prevention. Among men, those who were circumcised (APR 1.09, p = 0.004) and those who were HIV seropositive (APR 1.09, p = 0.03) were also more likely to be interested in child circumcision for HIV prevention. A high proportion of men and women in Ugandan heterosexual HIV serodiscordant partnerships were willing to have their male children circumcised for eventual HIV prevention benefits. Engaging both parents may increase interest in medical male circumcision for HIV prevention.
    Full-text · Article · Jul 2011 · PLoS ONE
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    ABSTRACT: Adult male circumcision has been shown to reduce the transmission of HIV. Women's acceptability of male circumcision is important in Papua New Guinea's preparedness to introduce male circumcision, and in ethical considerations of its use as a biomedical technology for HIV prevention. We conducted 21 focus group discussions and 18 in-depth interviews with women in all four regions of Papua New Guinea. The majority of women objected to the introduction of male circumcision for three main reasons: circumcision would result in sexual risk compensation; circumcision goes against Christian faith; and circumcision is a new practice that is culturally inappropriate. A minority of women accepted male circumcision for the prevention of HIV and other sexually transmitted infections, and for the benefit of penile hygiene and health. Women's objections to circumcision as a biomedical method of preventing HIV reemphasize the importance of sociocultural and behavioral interventions in Papua New Guinea.
    No preview · Article · Nov 2012 · Qualitative Health Research
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