Women's knowledge and perception of male circumcision before and after its roll-out in the South African township of Orange Farm from community-based cross-sectional surveys.

Barbara Maraux,Bertran Auvert,Julie Bouscaillou,Adrian Puren,Dirk Taljaard,Pascale Lissouba,David Lewis,Reathe Rain-Taljaard,Charlene S Dezzutti

doi:10.1371/journal.pone.0173595

Abstract

The roll-out of medical male circumcision (MC) is progressing in Southern and Eastern Africa. Little is known about the effect of this roll-out on women. The objective of this study was to assess the knowledge and perceptions of women regarding MC in a setting before and after the roll-out. This study was conducted in the South African township of Orange Farm where MC prevalence among men increased from 17% to 53% in the period 2008–2010. Data from three community-based cross sectional surveys conducted in 2007, 2010 and 2012 among 1258, 1197 and 2583 adult women, respectively were studied. In 2012, among 2583 women, 73.7% reported a preference for circumcised partners, and 87.9% knew that circumcised men could become infected with HIV. A total of 95.8% preferred to have their male children circumcised. These three proportions increased significantly during the roll-out. In 2007, the corresponding values were 64.4%, 82.9% and 80.4%, respectively. Among 2581 women having had sexual intercourse with circumcised and uncircumcised men, a majority (55.8%, 1440/2581) agreed that it was easier for a circumcised man to use a condom, 20.5% (530/2581) disagreed; and 23.07 (611/2581) did not know. However, some women incorrectly stated that they were fully (32/2579; 1.2%; 95%CI: 0.9% to 1.7%) or partially (233/2579; 9.0%; 95%CI: 8.0% to 10.2%) protected when having unprotected sex with a circumcised HIV-positive partner. This study shows that the favorable perception of women and relatively correct knowledge regarding VMMC had increased during the roll-out of VMMC. When possible, women should participate in the promotion of VMMC although further effort should be made to improve their knowledge.

Highlights

Three randomized controlled trials published in 2005 [1] and 2007 [2,3] demonstrated that the female-to-male transmission of HIV is reduced by male circumcision
As HIV transmission in sub-Saharan Africa is largely heterosexual [9], the roll-out of medical male circumcision (MC) is expected to have some effects on HIV among men [10] and will in turn affect the exposure of women to the virus
The information collected included the sexual preference of women, circumcision preference for their male children, the perception that circumcision increases sexual pleasure, the acceptability of circumcision for their partners and of circumcision at birth for their male newborns, support for male circumcision by their partners and family, knowledge about male circumcision, knowledge about the Bophelo Pele project, perception of what the community thought about men volunteering for circumcision and experience about male circumcision and condom use

Summary

Introduction

Three randomized controlled trials published in 2005 [1] and 2007 [2,3] demonstrated that the female-to-male transmission of HIV is reduced by male circumcision. Two years following the recommendation, the roll-out of Voluntary medical MC (VMMC) started in 14 priority countries of these two African regions [5] Such roll-outs, if successful, may yield a marked reduction of the HIV epidemic in Eastern and Southern Africa, which represents approximately 60% of new cases worldwide [6]. As HIV transmission in sub-Saharan Africa is largely heterosexual [9], the roll-out of medical MC is expected to have some effects on HIV among men [10] and will in turn affect the exposure of women to the virus. The proportion of women ever having sex with a circumcised man reached approximately 80% in 2012 and, as expected, increased with time

Objectives

Methods

Discussion

Conclusion