Abstract
BackgroundThere has been substantial demand for safe male circumcision (SMC) in Uganda in the early programme scale-up phase. Research indicates that early adopters of new interventions often differ from later adopters in relation to a range of behaviours. However, there is limited knowledge about the risk profile of men who were willing to be circumcised at the time of launching the SMC programme, i.e., potential early adopters, compared to those who were reluctant. The aim of this study was to address this gap to provide indications on whether it is likely that potential early adopters of male circumcision were more in need of this new prevention measure than others.MethodsData were from the 2011 Uganda AIDS Indictor Survey (UAIS), with a nationally representative sample of men 15 to 59 years. The analysis was based on generalized linear models, obtaining prevalence risk ratios (PRR) with 95% confidence intervals (CI) as measures of association between willingness to be circumcised and multiple sexual partners, transactional sex, non-marital sex and non-use of condoms at last non-marital sex.ResultsOf the 5,776 men in the survey, 44% expressed willingness to be circumcised. Willingness to be circumcised was higher among the younger, urban and educated men. In the unadjusted analyses, all the sexual risk behaviours were associated with willingness to be circumcised, while in the adjusted analysis, non-marital sex (Adj PRR 1.27; CI: 1.16–1.40) and non-use of condoms at last such sex (Adj PRR 1.18; CI: 1.07–1.29) were associated with higher willingness to be circumcised.ConclusionWillingness to be circumcised was relatively high at the launch of the SMC programme and was more common among uncircumcised men reporting sexual risk behaviours. This indicates that the early adopters of SMC were likely to be in particular need of such additional HIV protective measures.
Highlights
There are several biomedical and behavioural interventions available to reduce the impact of the HIV epidemics in sub Saharan Africa, and partly as a result of this, incidence is declining in most of the region [1]
Willingness to be circumcised was relatively high at the launch of the safe male circumcision (SMC) programme and was more common among uncircumcised men reporting sexual risk behaviours
This indicates that the early adopters of SMC were likely to be in particular need of such additional HIV protective measures
Summary
There are several biomedical and behavioural interventions available to reduce the impact of the HIV epidemics in sub Saharan Africa, and partly as a result of this, incidence is declining in most of the region [1]. The foreskin is one of the prime sites for HIV entry [2] and male circumcision reduces heterosexual HIV transmission risk from infected women to men as indicated in several observational studies [3,4,5] and randomised controlled trials in Uganda [6], Kenya [7], and South Africa [8]. It reduces the prevalence of high risk human papilloma virus that is most associated with cervical cancer [9] and incidence of herpes simplex virus infection among men [10], and genital ulcers in female partners of circumcised HIV negative men [11].
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