Abstract
Background: New cases of HIV are increasing among young adults in Zambia; yet voluntary medical male circumcision (VMMC) coverage as an HIV prevention measure remains low. Despite having the highest HIV burden in the province, Ndola district had a VMMC coverage of 23% in 2015 compared to the national target of 80% among high-risk groups. Objectives: To determine predictive factors associated with circumcision status among male students in Ndola district. Methods: We conducted a cross-sectional study in May 2016 among students aged 18–35 years enrolled in five conveniently sampled colleges. We administered a structured questionnaire to assess the knowledge, attitudes and perceptions about VMMC. We used multivariable logistic regression to determine factors associated with male circumcision (MC) status. Results: Of 136 students interviewed, 63% were circumcised, and of those, 96% were medically circumcised. Half of all students were aged 21–24 years. Those who perceived the circumcision procedure to be ‘safe’ (adjusted odds ratio [aOR] = 5.13; 95% CI: 2.09–14.82), and knew that it reduced female to male HIV transmission risk (aOR = 3.65; 95% CI: 3.12–11.67), were more likely to be circumcised. The perception that MC promotes ‘promiscuous behaviour’ (aOR = 0.20; 95% CI: 0.07–0.61), and that sexual sensitivity is the ‘same’ regardless of circumcision status, were associated with not being circumcised (aOR = 0.13; 95% CI: 0.02–0.80). Conclusion: Students had adequate knowledge about the safety of medical circumcision, and the subsequent risk reduction of HIV infection. Interventions aimed at addressing negative sexual perceptions about circumcision may increase VMMC coverage among college students.
Highlights
In Zambia, HIV prevalence remains high, with a prevalence of 12.3% and an overall HIV annual incidence among men and women aged 15–49 years of 70 per 10 000 population.[1]
In an effort to combat the high HIV burden, Zambia initiated programmes to expand the provision of voluntary medical male circumcision (VMMC) in 2007.2 This policy change was based on evidence from three randomised controlled trials conducted in Kenya, Uganda and South Africa, which showed that male circumcision (MC) reduced the risk of sexual transmission of HIV from women to men by approximately 60%
Consistent with other studies in African nations, this study showed that most male college students in Ndola district of Zambia had knowledge about the benefits of MC
Summary
In Zambia, HIV prevalence remains high, with a prevalence of 12.3% and an overall HIV annual incidence among men and women aged 15–49 years of 70 per 10 000 population.[1]. An assessment of the potential impact and costs of scaling-up MC in Zambia found that if the government had expanded MC coverage to 80% of all adolescent and adult males by 2015, it would have averted an estimated 486 000 new HIV infections (approximately 50% of all new infections) and would result in substantial cumulative net savings for the public health sector. For these reasons, a national programme to make high-quality and safe MC services available and accessible on a voluntary basis to all HIV-negative men aged 15–49 years was implemented.[4]. Despite having the highest HIV burden in the province, Ndola district had a VMMC coverage of 23% in 2015 compared to the national target of 80% among high-risk groups
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