Acceptability Of Circumcision Research Articles

Acceptability of male circumcision for HIV prevention among men who have sex with men in China: a short report

ABSTRACT Recent evidence shows that circumcision is associated with lower HIV prevalence among MSM. We assessed the acceptability of circumcision for preventing HIV and that of Shang Ring circumcision (SRC) among men who have sex with men (MSM) in China. 538 adult MSM were recruited from six cities in China between January and March 2019. Participants were surveyed by an online, self-administered questionnaire. The acceptability of circumcision was assessed before and after the potential protective effect of circumcision against HIV was informed, and subsequently men’s willingness to undergo SRC was assessed. The level of circumcision was 16.4%. Of 450 uncircumcised MSM, their willingness to be circumcised in the following six months increased significantly from 32.2% to 55.6% after the information session. Three quarters of men who were willing to undergo circumcision accepted SRC. MSM who perceived that circumcision could maintain genital hygiene were more likely to accept circumcision after the information session, whereas those who regarded circumcision as an embarrassing surgery were disinclined to be circumcised. The low circumcision rate, along with its high acceptability in Chinese MSM, suggests a great potential benefit of circumcision intervention if proved effective. SRC might be a popular circumcision procedure in this population.

Do False Beliefs Predict Increased Circumcision Satisfaction in Men?

Medical male circumcision has been adopted by the WHO, and other professional public health and medical bodies, as a vital weapon in the fight against HIV. This has prompted a large body of research into the acceptability of the procedure, attitudes to it, and barriers to it. A systematic review of these studies found that satisfaction with circumcision is strongly associated with having accurate knowledge about it. A survey-based paper by Earp, Sardi and Jellison entitled “False beliefs predict increased circumcision satisfaction in a sample of US American men” is the only one to find the opposite. It therefore merits scrutiny. The present article presents the results of a critical examination of the study. Serious flaws were discovered. Half of the small number of 10 “true/false” statements used in its survey are questionable. All the large body of literature that contradicts the findings of Earp and co-workers is ignored. Importantly, the crucial question about whether dissatisfied circumcised males hold false beliefs about circumcision is not considered. Unlike most of the research on the acceptability of circumcision, the study is not motivated by a desire to evaluate the likely effectiveness of a public health measure, or how best to implement it. Rather it appears to be an attempt by a prominent anti-circumcision activist and his associates to generate a body of literature that they can then cite to further their cause. Considering this, and the serious flaws it contains, the study should be dismissed as misleading, biased and undermining public health.

Pre- and post-sexual exposure prophylaxis of HIV: An update.

Pitfalls in current HIV prevention strategies include late HIV testing, vulnerability among youth and females; lack of emphasis on treatment, low acceptance of circumcision, and nonavailability of protective vaccines. Continuing high-risk sexual behavior, forceful sex, coercive and nonconsensual sex, rape, and unprotected sexual activities make women the most vulnerable to acquisition of sexually transmitted infection/HIV and necessitates a more radical approach of prevention in high-risk individuals who do not have HIV. Preexposure prophylaxis is defined as the administration of antiretroviral drugs to an uninfected person before potential HIV exposure to reduce the risk of infection and continued during risk. The rationale of this approach is to administer preventive dose of drug(s) before exposure to HIV so the moment virus enters the body, HIV replication is inhibited and HIV is not able to establish permanent infection. Postexposure prophylaxis (PEP) following potential sexual exposure is an important form of nonoccupational PEP which is an emergency intervention to abort HIV acquisition arising from exposure to HIV-infected blood or potentially infectious bodily fluids following sexual exposure.

Parental factors affecting the circumcision of non-Muslim Chinese boys include education and family history.

This study investigated the prevalence of circumcision among non-Muslim schoolboys in Urumqi, China, and how acceptable their parents found the practice. A convenient cluster sample of non-Muslim schoolboys (n = 3614) aged six to 15 years of age and 873 mothers and 927 fathers completed self-administered questionnaires. We compared the consistency of the circumcision status reported by students and their parents and analysed the factors that influenced the parents to have their child circumcised. The mean age at circumcision was 8.3 years and the adjusted prevalence was 46.2%. Up to 45.4% of fathers and 66% of mothers with uncircumcised sons were willing to circumcise their sons after receiving further information on circumcision. Mothers were more likely to support circumcision if they had higher education levels and higher family income, were employed as government officials and had family members who had been circumcised, including their husband. Fathers were more likely to support circumcision if they were highly educated and had been circumcised themselves. The prevalence and acceptability of circumcision were higher than expected in this traditional schoolboy population in Urumqi, China. Factors that increased parental support for circumcision included high education and the father being circumcised.

Social representations of male circumcision as prophylaxis against HIV/AIDS in Zimbabwe.

BackgroundThe World Health Organisation recommended the scale-up of voluntary medical male circumcision (VMMC) as an additional HIV prevention method in 2007 and several countries with high HIV prevalence rates including Zimbabwe have since adopted the procedure. Since then researchers have been preoccupied with establishing the level of knowledge and acceptability of circumcision in communities that did not traditionally circumcise. Despite evidence to suggest that knowledge and acceptability of voluntary medical male circumcision is high, there is also emerging evidence that suggest that uptake of circumcision among men has been below expectations. The purpose of this study was thus to investigate people’s representations of male circumcision that may influence its uptake.MethodsData for this study was collected through focus group discussions with men and women aged between 18 and 49 years. This age group was selected because they are still very sexually active and are within the target population of the upscale of voluntary medical male circumcision programme. Women were included in the study because they would be directly involved in a decision to have their son(s) get circumcised for HIV prevention. The study was carried out in Harare, Zimbabwe. Obtained qualitative data was analysed using thematic content analysis.ResultsResults suggest that circumcision is perceived as an alien culture or something for “younger” men or “boys” who are not yet married. The findings also suggest that there are beliefs that circumcision maybe associated with satanic rituals. The issue of condom use after circumcision was also discussed and it was found that some men do not see the need for using condoms after getting circumcised.ConclusionsThere is an urgent need for the development of communications that directly address the misconceptions about voluntary medical male circumcision. There is need for communication that encourages circumcised men to continue using condoms.

Acceptability of Condoms, Circumcision and PrEP among Young Black Men Who Have Sex with Men: A Descriptive Study Based on Effectiveness and Cost.

The current study examined and compared the willingness of young Black men who have sex with men (YBMSM) to accept pre-exposure prophylaxis (PrEP), adult male circumcision, and condoms for reducing their risk of HIV acquisition. The majority (67%) reported unprotected receptive anal sex in the last six months. About three-quarters (71%) would accept using PrEP if it was 100% effective. Cost influenced PrEP acceptance with 19% indicating acceptance at $100 per month co-pay. Of those not circumcised, 50% indicated willingness if circumcision was 100% effective. Acceptance of circumcision decreased markedly to 17% with co-pays of $100. About 73% of men were willing to use condoms if they were 100% effective and 50% indicated a willingness at the cost of $10 per month. The findings suggest that condom use promotion strategies should remain at the forefront of public health efforts to control HIV incidence among YBMSM.

Factors associated with acceptability of circumcision among male drug users in western China: a cross-sectional study

This study is aimed to investigate whether male circumcision (MC) is feasible among IDUs in China. 1304 drug users who attended methadone maintenance therapy clinics in Guangxi, Chongqing and Xinjiang were selected for participation by using convenience sampling, and completed a self-administered questionnaire. The factors associated with the acceptability of MC were examined via multiple logistic regression models. 45.2% (589/1304) of the participants reported an acceptance of MC. Many of the participants who were initially not willing to accept MC (715/1304) had changed their mind when they were informed that MC would reduce the risk of HIV and STDs (43.4%; 310/715), that MC is associated with few surgery-related complications (23.1%; 165/715), that the surgical procedure could be arranged free of charge (20.1%, 144/715). In the multivariate analysis, higher acceptability of MC was associated with knowledge of the hazards of phimosis (OR=2.22), the presence of phimosis (OR=14.87), and knowledge that MC can prevent AIDS and STDs (OR=1.49); while lower acceptability was associated with residing in Chongqing province (OR=0.41) and an educational level of junior (OR=0.64) and senior high (OR=0.63) school. The MC policy targeting IDUs in China should take into account these factors associated with MC acceptability.

Ethnic identity, region and attitudes towards male circumcision in a high HIV-prevalence country

We study how considerations of male circumcision (MC) as both a favourable practice and as protective against HIV are linked with ethnicity in sub-Saharan Africa, where many ethnic groups do not traditionally circumcise. We focus on Malawi, a country with a high HIV prevalence but low MC prevalence. Survey data from a population-based random sample in rural Malawi (N =3400) were analysed for ethnoregional patterns in attitudes towards MC. We used logit regression models to measure how reported circumcision status, region of residence and ethnic identity relate to attitudes towards circumcision. Overall, Malawians reported more negative than positive opinions about MC, but attitudes towards circumcision varied by ethnicity and region. The implications for agencies and governments aggressively scaling up the provision of MC are clear; acceptance of circumcision as a tool for HIV prevention could be low in societies divided by ethnoregional identities that also shape the practice of circumcision.

Male Circumcision within the context of HIV prevention in India: a qualitative study conducted among young men in Chandigarh, India

Male circumcision has been advocated as an additional HIV prevention strategy but in India, it is not yet a part of the comprehensive HIV prevention package. In the Indian context male circumcision is strongly associated with specific religions and little is known about the socio-cultural and religious dimensions of this practice at the community level, the sensitivities attached to this practice, and its acceptance as a potential method of HIV infection prevention. The objectives of the study were to assess the level of knowledge and understanding of male circumcision among male youth of sexually active age group and to explore the practice of traditional male circumcision in a north Indian city. Data was collected by conducting 25 in-depth interviews, 5 key informant interviews and 2 focus group discussions. These interviews were tape recorded, transcribed, coded and analyzed using a qualitative software package. Results show that a majority of the respondents belonging to the non circumcising communities had limited understanding on male circumcision. Respondents from the circumcising community listed several benefits of doing male circumcision such as, better hygiene, prevention of infections, and enhancement of pleasure during sexual intercourse. The non circumcising community respondents considered male circumcision as a social stigma and carried the belief that approaching a traditional circumciser (nai or hajjam) to undergo circumcision will or may convert them to the religion of Islam. The acceptance of circumcision as a practice to improve health and prevent infections such as, HIV, looked seemingly negative among respondents from the non circumcising communities. Due to its strong association as an identifier of a particular religion, there are fears in adopting it and being discriminated or targeted as being a member of the minority community.

Male Circumcision Rates in Patients From a Sexually Transmitted Disease Clinic in Southern Florida and Acceptability of Circumcision Among Hispanics.

The objectives of this study were assessment of the prevalence of male circumcision (MC) among patients attending the Miami-Dade County (MDC) sexually transmitted diseases (STDs) clinic and exploration of attitudes of MC among Hispanic STD clinic attendees. Prevalence of MC was assessed by a review of 500 clinic records. Attitudes toward MC were explored during focus group sessions. The overall rate of MC was 27%. Men associated acceptability of MC with sexual performance, their partner's anticipated responses to MC, and scientific proof of STD protection; whereas women focused on experiences with previous partners and hygiene. We found a low rate of circumcision in males attending the MDC STD clinic. Approximately half of the Hispanic men and women in focus groups also found MC acceptable or desirable.

Popular perceptions of circumcision among Colombian men who have sex with men

Male circumcision has received increased attention for its potential to reduce sexual transmission of HIV. Research on the acceptability of circumcision as a means of HIV prevention among men who have sex with men is limited. Men who have sex with men in Bogotá, Colombia, either participated in a focus group in which they shared information regarding their perceptions of circumcision or completed a survey that assessed circumcision experiences, attitudes, beliefs and willingness. Few participants reported they were circumcised, yet most participants reported knowing something about the procedure. Overall, attitudes towards circumcision were mixed: although circumcision was viewed as safe, it was also viewed as unnatural and cruel to babies. Beliefs that circumcision could improve sexual functioning and protect against STIs and HIV were not widely endorsed by survey participants, although focus-group participants discussed the potential impacts of circumcision on the availability of sexual partners and sexual performance. Some focus-group participants and many survey participants reported a hypothetical willingness to get circumcised if strong evidence of its effectiveness could be provided, barriers removed and recovery time minimised.

Low acceptability of medical male circumcision as an HIV/AIDS prevention intervention within a South African community that practises traditional circumcision

Traditional circumcision is practised among some indigenous tribes in South Africa (SA) such as the Xhosa. Recent experimental evidence has demonstrated the benefits of male circumcision for the prevention of HIV infection in heterosexual men. The acceptability of circumcision as a biomedical intervention mirroring an ingrained cultural practice, as well as the age and extent of the procedure, are poorly understood. Men aged 15 - 42 years were recruited in a peri-urban settlement near Cape Town. Participants completed an interviewer-administered questionnaire assessing self-reported circumcision status, context and reasons for previous or planned circumcision, and willingness to undergo medical circumcision for themselves or their sons. Results were confirmed by clinical examination. The most recent HIV test result was compared with circumcision status. Of the 199 men enrolled, 148 (74%) reported being traditionally circumcised; of the 51 not circumcised, 50 were planning the traditional procedure. Among men self-reporting circumcision, 40 (27%) had some or all of the foreskin remaining. The median age at traditional circumcision was 21 years (interquartile range 19 - 22 years). While knowledge of the preventive benefit of circumcision was reported by 128 men (66%), most were unwilling to undergo medical circumcision or allow their sons to do so, because of religion/culture, notions of manhood, and social disapproval. Almost all men in this study had undergone or were planning to undergo traditional circumcision and were largely opposed to the medically performed procedure. In the majority, traditional circumcision had occurred after the mean age of sexual debut and almost a quarter were found to have only partial foreskin removal. To ensure optimal HIV prevention benefits, strategies to facilitate complete foreskin removal prior to sexual debut within traditional circumcision practices require further attention.

Acceptability of Circumcision Among Clients of Female Sex Worker in Hong Kong

Clients of female sex workers (CFSW) are at high risk of HIV transmission. Circumcision reduces the risk of heterosexual transmission of HIV. A total of 353 CFSW were interviewed using a combined interviewer-computer-assisted method. Amongst the participants, 28.0% were circumcised, whilst 63.8% of the uncircumcised participants were willing to take up circumcision (conditioned on being briefed about a 50% potential risk reduction effect). In a stepwise logistic regression model, frequency of patronizing female sex workers and factors related to the Health Belief Model were significantly associated with conditional willingness. Amongst uncircumcised participants, 20.9% anticipated risk compensation (i.e. would use condoms less frequently after being circumcised). Adjusting for background variables, inconsistent condom use during commercial sex and self-reported STD history in the last 6months were significantly associated with anticipated risk compensation. It is feasible to promote circumcision among CFSW but such programs also need to promote condom use.

Acceptability of circumcision as a means of HIV prevention among men who have sex with men in China

Conclusive evidence-based research has shown that circumcision reduces the risk of HIV transmission via heterosexual intercourse, whilst ongoing studies are investigating similar effects via homosexual transmissions and the results are equivocal. Few acceptability studies regarding circumcision were conducted among men who have sex with men (MSM). In this cross-sectional study, a total of 307 MSM were recruited by snowball sampling and were interviewed anonymously by some peer field workers in Yangzhou, China. Amongst all uncircumcised participants (93.4% of all participants were uncircumcised), the willingness to be circumcised increased from 8.1% to 30.7%, before and after the participants were briefed about a hypothetical potential benefit of a 50% risk reduction of circumcision in preventing HIV transmission among MSM. In the multivariate analysis, perception of overly long foreskin (odds ratio [OR] = 6.04), unprotected sexual intercourse with male regular sex partners in the last six months (OR = 2.04), and seeing no chance for contracting HIV in the next 12 months (OR = 0.54) were significantly associated with conditional willingness for circumcision. Adjusting for these variables, other significant factors were identified by multiple logistic regression analysis, including number of perceived disadvantages for having overly long foreskin (adjusted OR = 2.60), variables that were derived from the Theory of Planned Behaviors (TPB), and having some circumcised MSM peers (adjusted OR = 0.45–4.38). Some risk compensation behaviors however, may be practiced by 15.9% of the MSM who were willing to undergo circumcision. The acceptability would increase slightly with the effect size of circumcision in protecting MSM from HIV transmission via homosexual intercourse. However, it was only around 30%, even if circumcision could result in a large (50%) risk reduction in HIV transmission among MSM. If future studies can establish efficacy of circumcision, relevant promotion programs need to guard against risk compensation, though the magnitude of risk compensation may be moderate.

Acceptability of Male Circumcision for Prevention of HIV/AIDS in Sub-Saharan Africa: A Review

Based on epidemiological, clinical and experimental evidence, male circumcision (MC) could have a significant impact on the HIV epidemic in selected areas. We reviewed studies of the acceptability of MC in sub-Saharan Africa to assess factors that will influence uptake of circumcision in traditionally non-circumcising populations. Thirteen studies from nine countries were identified. Across studies, the median proportion of uncircumcised men willing to become circumcised was 65% (range 29–87%). Sixty nine percent (47–79%) of women favored circumcision for their partners, and 71% (50–90%) of men and 81% (70–90%) of women were willing to circumcise their sons. Because the level of acceptability across the nine countries was quite consistent, additional acceptability studies that pose hypothetical questions to participants are unnecessary. We recommend pilot interventions making safe circumcision services available in conjunction with current HIV prevention strategies and evaluating the safety and acceptability of circumcision.

Pathologizing Male Sexuality: Lallemand, Spermatorrhea, and the Rise of Circumcision

Although spermatorrhea as a disease entity and an episode in nineteenth-century medical history has received significant scholarly attention over the past decade, many aspects of its nature, origins, and consequences remain obscure. The aim of this article is to indicate its origins in and links with medical anxiety about masturbation and to discuss the therapies devised to treat the condition. Particular attention is given to the work of Claude-Francois Lallemand and his influence on English doctors, especially William Acton, and the implications of their identification of the foreskin as the major risk factor for childhood masturbation and later spermatorrhea. It is further argued that fear of spermatorrhea was an important factor in the acceptance of circumcision as a valid medical intervention in the late nineteenth century.

Dynamics of male circumcision practices in northwest Tanzania.

Male circumcision status is considered an important cofactor in the spread of HIV and sexually transmitted disease. There is limited evidence that male circumcision practices in Africa may be changing. To assess the determinants of male circumcision status in a traditionally noncircumcising ethnic group and to investigate the reasons for increasing acceptance of circumcision. Data from a factory workers study and a rural cohort study in northwest Tanzania were used to analyze the levels and determinants of male circumcision status and assess the reliability of self-reported data. Qualitative data from focus group discussions and in-depth interviews were obtained to ascertain norms and values in relation to male circumcision. Male circumcision has become more popular in recent years, and 21% of 3,491 men reported themselves as circumcised. An increase in circumcision rates was observed in the rural cohort study during 1994 to 1997, though reporting inconsistencies are common. Circumcision rates were higher among men with higher levels of education and in Muslim men. Men are often circumcised in their late teens or twenties. The reasons for the increasing popularity of circumcision were investigated in group discussions and in-depth interviews. The most frequently mentioned reason was health-related; circumcision was thought to enhance penile hygiene, reduce sexually transmitted disease incidence, and improve sexually transmitted disease cure rates. Male circumcision is becoming more popular among a traditionally noncircumcising ethnic group in Tanzania, especially in urban areas and among boys who have attended secondary schools.

Circumcision: The Painful Dilemma

This book is a highly emotional, thoroughly biased presentation of the horrors and disadvantages of circumcision, especially neonatal. Chapters are also devoted to the procedure in children after the neonatal period, females, and adult males. The author starts by describing her conversion from acceptance of circumcision for her three boys to violent opposition. Fifty-two pages are devoted to circumcision and Judaism. This chapter contains a section (pp 67-73) in which there is the only interview in the book with someone in favor of circumcision—a rabbi, not a physician. The chapter on complications is extensively referenced (pp 231-234)— mostly with case reports. The fact that nearly all significant complications can be prevented by proper techniques is not clearly stated and only indirectly referenced (p 203). Much of the text is devoted to quotations from persons interviewed by the author, either in person or by letter—parents, older circumcised individuals, nurses, physicians, and