Circumcision of Male Children for Reduction of Future Risk for HIV: Acceptability among HIV Serodiscordant Couples in Kampala, Uganda

Kenneth K Mugwanya,Jared M Baeten,Connie Celum,Edith Nakku-Joloba,Christopher Whalen,Elly Katabira

doi:10.1371/journal.pone.0022254

Abstract

IntroductionThe 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.MethodsWe 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.Results318 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.ConclusionsA 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.

Highlights

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
Perceptions about medical circumcision of male children for reduction of future risk for HIV acquisition have been largely unexplored, understanding parental preferences related to child circumcision may facilitate successful implementation of medical male circumcision [6]
Correlates of willingness to circumcise male children for reduction of future risk for HIV. Among both men and women, those who were knowledgeable that circumcision reduces adult men’s risk for becoming HIV infected and those who had discussed circumcision with their partner (APR = 1.08 for men, and APR = 1.08 for women) were significantly more likely to be interested in male child circumcision for HIV prevention (Table 1)

Summary

Introduction

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. WHO/UNAIDS recommends medical male circumcision as part of a comprehensive HIV prevention package in countries with high HIV prevalence where circumcision is uncommon [1], following clinical trial data demonstrating that circumcision of adult men reduces HIV-1 risk by ,60% [2,3,4]. The ultimate success of medical male circumcision for maximizing HIV prevention may depend on circumcising male infants and children before they reach adolescence, in addition to adults. Infant circumcision is technically easier than the adult procedure, can be conducted shortly after birth, carries a low risk of complications, and may be cost-effective, even in regions with low HIV prevalence [5]. Previous acceptability studies have demonstrated high interest in infant circumcision [7,8], but most of these studies were conducted prior to the completion of the randomized trials demonstrating the efficacy of circumcision for HIV prevention [2,3,4]

Methods

Results

Discussion

Conclusion