Circumcision Rate Research Articles

Effect of Distraction Therapy in Reducing Children's Anxiety During Circumcision

Circumcision or circumcision is a surgical procedure that involves removing all or part of the foreskin of the penis with the aim of keeping the vital area clean so that it is not easily infected. By 2020, 85% of boys will be circumcised, equating to around 8.7 million boys annually. The circumcision rate will increase along with population growth in Indonesia. Most children who undergo circumcision will encounter obstacles such as fear, crying, refusing to enter the room and having to ask their parents to accompany them when they want to enter the room. This shows that there are fundamental problems in children who will be circumcised. Anxiety is one of the things a child will face before being circumcised. Anxiety can cause prolonged trauma, causing children to experience stressor crises. The cause of anxiety is pain and fear during the circumcision process. Often parents and medical personnel think this is trivial, but in fact if left unchecked it will have a serious impact on the child's mental condition. Distraction therapy is an example of therapy that can help reduce a child's anxiety about circumcision. Children who are circumcised will naturally feel afraid and anxious, so play therapy is carried out to reduce these feelings of anxiety. This therapy involves diverting attention to the child who will be circumcised. The goal is to change the child's orientation and thinking, which was initially focused on circumcision, towards the proposed therapy. This will create a feeling of security and comfort, thereby helping the circumcision process run smoothly.

Prevalence and perceptions of voluntary medical male circumcision among University of Juba students, South Sudan

Introduction: Voluntary medical male circumcision (VMMC) is one of the key interventions against heterosexual spread of HIV. However, its prevalence in South Sudan is not clearly understood. This study aimed to assess the prevalence and perceptions of VMMC among University of Juba students.Method: A cross sectional descriptive study design was adopted. Data from randomly selected students from six schools of the University of Juba were collected using a respondent-administered structured questionnaire. IBM SPSS Statistics version 23.0 was used for data analysis. Chi-squared tests were performed to determine variables significantly associated with VMMC.Results: Amongst 390 students interviewed, the prevalence of VMMC was 41.8% and the overall male circumcision rate was 83.8%. Most respondents expressed positive attitudes and perceptions towards VMMC. The respondents believe VMMC is an important health programme. The decision to get circumcised is associated with age, marital status, religion and state of origin (p<0.001).Conclusion: Most participants were circumcised and perceive VMMC positively. A countrywide study and scale up of the current VMMC programme are recommended.

Referrals from primary care with foreskin symptoms: Room for improvement

AimsReferrals to secondary care for boys with foreskin symptoms require face-to-face review, resulting in time out of school / work and costs to the family. This study aimed to review outcomes of referrals to ascertain if there was scope to reduce referrals. MethodsNew patients referred to a UK regional paediatric surgery clinic during 2019 were identified and screened retrospectively. Medical records for boys over one year of age referred due to foreskin symptoms were reviewed. ResultsOf 2598 referrals, 1939 (75%) were boys & 1094 were > 1 yr; 398 (21%) were referred with foreskin symptoms at median age 7.2 yrs (IQR 4–10). 307 (77%) were diagnosed with physiological phimosis, 67 (18%) with pathological phimosis, 9 (2%) with balanitis (the remainder had ‘smegma’ retention cysts, preputial adhesions, tight frenulum or anatomical abnormalities). 211 (53%) were discharged at the initial appointment, this was significantly more likely for younger boys, and those with physiological phimosis (p<0.001). 62 (16%) were prescribed topical steroids (more likely in older boys, p<0.001). 70 (18%) were offered surgery: circumcisions (n = 51), preputioplasties (n = 13), other (n = 4). The circumcision rate was therefore 12%. Age at referral was positively correlated with GP trial of steroid (older more likely), diagnosis (physiological phimosis more likely if younger) and outcome (topical steroids or surgery more likely if older): Spearman's rank correlation p<0.001. ConclusionsOver 75% of boys referred had a normal foreskin, over half were discharged at their first review. Improved knowledge amongst parents and primary care providers could reduce referrals and save money and resources. Level of evidenceLevel IV - Case series with no comparison group.

Advancing the Evidence Base in the Care of Term and Late Preterm Infants.

Advancing the Evidence Base in the Care of Term and Late Preterm Infants.

Early childhood circumcision in Australia: Trends over 20 years and interrupted time series analysis.

Male circumcision is one of the most common surgical procedures performed in the Australian private sector. This study examines the trends in childhood circumcision throughout the early 21st century. Circumcisions performed between 2000 and 2019 amongst preschool-aged Australian boys (0-4 years) were obtained from the Medicare Benefits Schedule. Quarterly data for Victoria and South Australia were divided into three phases separated by (i) state-wide bans of non-therapeutic circumcision in the public sector (2007) and (ii) a disfavouring of non-therapeutic circumcisions by the Royal Australasian College of Physicians (2010). Interrupted time series analyses determined differences between pre-ban (2000-2007), post-ban (2007-2010) and reversal (2010-2019) phases. Altogether, 478 717 circumcisions were performed on preschool-aged boys. Incidence progressed from 2675 per 100 000 preschoolers in 2000 to 3140 in 2008 to 1875 in 2019. In Victoria, the baseline (Q1-2000) rate of circumcision was 294.9 per 100 000. This rose by +1.3 (1.1 to 4.1, p< 0.001) per quarter pre-ban and +6.6 (3.0 to 10.3, p= 0.001) post-ban before decreasing by -13.1 (-16.4 to -9.8, p< 0.001) in the reversal phase. In South Australia, the initial rate was 745.2 per 100 000 and increased by +1.4 (0.0 to 2.8, p= 0.045) per quarter pre-ban, +7.6 (0.5 to 14.7, p= 0.035) post-ban and retracted by -20.8 (-27.9 to -13.7, p< 0.001) during the reversal phase. The incidence of childhood circumcisions in Australia observed a significant rise and fall throughout the early 21st century. Medical and surgical authorities may have played an important role in the gradual reduction of procedures over the last decade.

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.

Knowledge, Attitude and Practice of General Practitioners on Circumcision and Its Complications in the District Hospitals of the Center Region

Background: The complication rate of circumcision in medical settings is between 0.4% and 2.0%. Circumcision accidents constituted 2.0% of urological emergencies at the Yaoundé Central Hospital. Aim: To assess the level of knowledge, attitudes and practices of general practitioners on circumcision and its complications in Central Region District Hospitals. Population and Methods: We conducted a multicenter descriptive cross-sectional study the CAP (Knowledge, Attitudes and Practices) type. Which took place from March 9 to June 30, 2021 (16 weeks). We included 138 physicians. The variables collected were: socio-demographic characteristics, knowledge about circumcision and its complications, attitudes towards circumcision and its complications, practices towards circumcision and its complications. Results: In our study, the median age of the study population was 29 years, the sex ratio (M/F) was 0.8. The median ideal age to perform circumcision was 12 months. In our study, 94.9% of general practitioners clearly identified bleeding disorders as a contraindication for circumcision. The material needed to be used to perform a circumcision was ignored by 81.2% of general practitioners. The global knowledge assessment showed that 68.9% of participants had unsatisfactory knowledge about circumcision and its complications. Before circumcision, 91.3% general practitioners first recommended effective disinfection of the operating field, and 83.3% used sterile equipment. Faced with a hemorrhage, 61.6% of general practitioners proposed surgical exploration in the face of rebellious bleeding. 60.2% of general practitioners had bad attitudes towards circumcision and its complications. In our study, 49.2% of the general practitioners questioned did not know the normal procedure for performing a circumcision. Forty-one (29.7%) general practitioners had never performed a circumcision. The median occurrence of a complication during circumcision was 2 times. Bleeding was the most common early postoperative complication (89.2%) in general practitioner practice during circumcision. Conclusion: The majority of general practitioners have not received formal education on circumcision.

Geospatial assessment of the voluntary medical male circumcision programme in Tanzania, 2011–2016

IntroductionTanzania is one of the 14 priority countries in sub-Saharan Africa scaling up voluntary medical male circumcision (VMMC) for HIV prevention. In this study, we assessed the progress of VMMC...

Modeling economic and epidemiological impact of voluntary medical male circumcision among men who have sex with men in Beijing, China.

Voluntary medical male circumcision (VMMC) among men who have sex with men (MSM) may protect against HIV acquisition. We conducted a series of analyses to assess if expanded VMMC might reduce HIV incidence among MSM effectively and economically. We used a deterministic compartmental model to project new HIV cases (2016-2026) under annual VMMC coverage rates (λ) ranging from 0.0001 to 0.15. The 'number needed to avert' (NNA) is defined as the cumulative number of VMMCs conducted up to that year divided by the cumulative number of HIV cases averted in that specific year. Compared with the baseline circumcision coverage rate, we projected that new HIV cases would be reduced with increasing coverage. By 2026 (last year simulated), the model generated the lowest ratio (11.10) when the annual circumcision rate was the most optimistic (λ = 0.15). The breakeven point was observed at the year of 2019 with the annual VMMC coverage rate of 0.001. The total cost saved by averting HIV cases would range from 2.5 to 811 million US dollars by the end of 2026 with different hypothetical coverage rates. Our model suggests that acceleration in VMMC implementation among MSM could help stem the HIV/AIDS epidemic.

The postnatal management of boys in a national cohort of bladder outlet obstruction

AimThe most common cause of congenital bladder outlet obstruction (BOO) is posterior urethral valves (PUV). Initial treatment requires decompression, but transurethral incision (TUI) or primary diversion is all described. There is no randomized control trial to guide management. This study aims to describe management, circumcision, and UTI rate in a national cohort of PUV boys. MethodsBoys diagnosed with BOO were recruited (via BAPS CASS) over 1 year with ethics committee approval (ref: 12/SC/0416). Data were collected via questionnaire, presented as number (%), analyzed by Mann–Whitney/chi-square/Fisher Exact tests, and p < 0.05 was taken as significant. ResultsBOO presented in 121 boys during 2014–2015, and 113 were PUV. Catheter placement in 87/121(72%) was more likely to happen in antenatal vs. postnatal vs. late(>1 y) presentations, p < 0.0001. Polyuria occurred in 23/45(51%), 12/48(25%), 0/28(0%), respectively, p < 0.0001. Initial surgical treatment was TUI in 108/121(89%) and vesicostomy in 2. Two ureterostomies were secondary procedures. Circumcision was performed in 52/121(43%) in antenatal presentation vs. postnatal vs. late 27/45(60%), 20/48(42%), 2/28(7%), respectively, p = 0.01. 69 UTIs occurred in 49 patients. Circumcision was associated with an 86% reduced risk of UTI, p < 0.0001. There was a 66% reduction in UTI risk associated with TUI alone, p < 0.01. There was 1 death due to pulmonary hypoplasia and renal failure, and 2 experienced end-stage renal failure (ESRF). ConclusionStandard treatment for BOO and PUV in the current UK cohort is urethral catheterization followed by TUI. Supravesical diversion is a rescue therapy. UTIs are common and reduced by circumcision, with 43% being circumcised. Initial mortality rate was 1%, and 1.6% present in ESRF. Level of EvidencePrognostic study – Level I – Prospective National Cohort Study.

Human Papillomavirus Vaccine Completion and Associated Factors Among 13-17 Year-Old Hispanic and Non-Hispanic White Females

Barriers to human papillomavirus (HPV) vaccine acceptability in Israel include Israel's relatively low incidence of cervical cancer; the religiously-based 80% circumcision rate in Israel, which is regarded as contributing to the lower incidence of HPV infection in the country; the fact that HPV vaccine provides immunity against only few virus types; the vaccine's high cost; and the perception that HPV transmission is associated with unacceptable sexual relations. A recent survey has demonstrated that, following media two campaigns, Israeli's level of awareness of the vaccine increased but the actual vaccination rate remained low, at approximately 10%. Survey findings also indicated that an enduring barrier to HPV vaccination is the vaccine's high cost. Recent research on a convenience sample of Israeli undergraduate women 21 to 24 years of age showed that intentions to receive HPV vaccination in the coming year were a function of women's attitudes towards getting vaccinated and their perceptions of social support for doing so. Undergraduate women who intended to be vaccinated perceived the prevention of cervical cancer, avoidance of personal health threat, and avoidance of HPV infection per se to be the advantages of undergoing HPV vaccination. Disadvantages of getting vaccinated included fear of vaccine side effects, cost of the vaccine, and newness of the vaccine, doubts about vaccines, time required to undergo multiple vaccinations, and dislike of injections. Friends’, mothers’ and physicians’ recommendations influenced women's intentions to be vaccinated in the coming year as well.This article forms part of a regional report entitled “Comprehensive Control of HPV Infections and Related Diseases in Israel” Vaccine Volume 31, Supplement 8, 2013. Updates of the progress in the field are presented in a separate monograph entitled “Comprehensive Control of HPV Infections and Related Diseases” Vaccine Volume 30, Supplement 5, 2012.

Neonatal circumcision and prematurity are associated with sudden infant death syndrome (SIDS)

Sudden infant death syndrome (SIDS) is the most common cause of postneonatal unexplained infant death. The allostatic load hypothesis posits that SIDS is the result of cumulative perinatal painful, stressful, or traumatic exposures that tax neonatal regulatory systems. To test the predictions of the allostatic load hypothesis we explored the relationships between SIDS and two common phenotypes, male neonatal circumcision (MNC) and prematurity. We collated latitudinal data from 15 countries and 40 US states sampled during 2009 and 2013. We used linear regression analyses and likelihood ratio tests to calculate the association between SIDS and the phenotypes. SIDS mortality rate was significantly and positively correlated with MNC. Globally (weighted): Increase of 0.06 (95% CI: 0.01-0.1, t = 2.86, p = 0.01) per 1000 SIDS mortality per 10% increase in circumcision rate. US (weighted): Increase of 0.1 (95% CI: 0.03-0.16, t = 2.81, p = 0.01) per 1000 unexplained mortality per 10% increase in circumcision rate. US states in which Medicaid covers MNC had significantly higher MNC rates (χ̄ = 0.72 vs 0.49, p = 0.007) and male/female ratio of SIDS deaths (χ̄ = 1.48 vs 1.125, p = 0.015) than other US states. Prematurity was also significantly and positively correlated with MNC. Globally: Increase of 0.5 (weighted: 95% CI: 0.02-0.086, t = 3.37, p = 0.004) per 1000 SIDS mortality per 10% increase in the prematurity rates. US: Increase of 1.9 (weighted: 95% CI: 0.06-0.32, t = 3.13, p = 0.004) per 1000 unexplained mortalities per 10% increase in the prematurity rates. Combined, the phenotypes increased the likelihood of SIDS. Epidemiological analyses are useful to generate hypotheses but cannot provide strong evidence of causality. Biological plausibility is provided by a growing body of experimental and clinical evidence linking aversive preterm and early-life SIDS events. Together with historical and anthropological evidence, our findings emphasize the necessity of cohort studies that consider these phenotypes with the aim of improving the identification of at-risk infants and reducing infant mortality. Preterm birth and neonatal circumcision are associated with a greater risk of SIDS, and efforts should be focused on reducing their rates.

Female Circumcision Between Extinction and Diffusion in Red Sea State, Sudan

The Study aims at identifying the quantitative rate of female circumcision in the Red Sea State during June 2016, where the diffusion of such phenomenon expresses the characteristics of the local community. The methodology of the study aimed at recognizing the extent of the diffusion of female circumcision in the ten localities through exploratory survey targeted at the female teachers and the mothers of the girls at the basic level and kindergarten age. The sample of the study consisted of (1060) items taken from (166) kindergarten and (198) basic level schools. The study arrived at main results which are summarized in the extinction of this phenomenon in certain housing units in Portsudan locality (Deim Medina and Darasalam). There are indicators that point to the fact that this phenomenon is dominating rural areas. If we made a comparison between last decade and the existing study, we find that there is remarkable development in the extinction indicator (68-72%). The study presented a number of recommendations; the most important are forming pressing community currencies for the purpose of close surveillance of rural areas, particularly Haya and Dordeib. In conclusion Female genital circumcision is still a serious problem in Red Sea State not only in rural area, but also among people living in urban areas. Elimination of poverty and improvement of education level will contribute to end this harmful phenomenon. Empowerment of people and polices is highly needed and effort should made to end terrible social and cultural norms which indigenize this practice.

Toplu Sünnet Etkinliğinde Tıbbi Uygulama Hatası: İki Olgu

Gerek dini ve kültürel sebeplerle gerekse de tıbbi sebeplerle yapılmış olsun erkek dünya nüfusunun yaklaşık 6’da birinin sünnet edildiği tahmin edilmektedir. Sünnetin komplikasyon oranının ise %0,2 ile %5 arasında değiştiği bildirilmektedir. Bu çalışmada, aynı hastanede, aynı gün içerisinde, aynı hekim tarafından yapılan toplu sünnet etkinliği sırasında iki sünnet işlemi sonrası gelişen klinik tablo, tıbbi uygulama hatası yönünden irdelenmiş, adli tıbbi boyutu ortaya konulmuş ve bu olguların özellikleri literatür bilgileri ile karşılaştırılmıştır. Sonuç olarak, toplu sünnet aktivitelerinden mümkün olduğunca kaçınılması, ülkemizde olduğu gibi sosyoekonomik nedenlere bağlı olarak toplu sünnet uygulaması yapılması kaçınılmaz olan durumlarda bile, ailelerin aydınlatılması ile ilgili prosedürlerin göz ardı edilmemesinin, bu konuda yetkin ve yeterli sayıda hekimlerce, asepsi-antisepsi ilkelerine uygun ortamlarda, bilimsel kaidelere ve yürürlükteki mevzuata uygun olarak yapılmasının komplikasyon gelişimini azaltacağı ve bu alandaki tıbbi uygulama hataları iddialarının önüne geçeceği vurgulanmıştır.

Prepuce health and childhood circumcision: Choices in Canada.

Worldwide, almost 100% of boys are born with penises with a "hood" called prepuce or foreskin. In the course of the boy's life, the prepuce can be circumcised, can become affected by diseased (e.g., phimosis), or a can become infected and hurt the neonate (and his sexual partner) in adulthood. The objectives of this report are to: 1) review the state, function, fate, and care of the prepuce in childhood, with focus on the neonate, in Canada; 2) understand the current practice of childhood male circumcision in terms of age, indications, performers, techniques, outcomes, and education; and 3) consider ways to sustain a good healthcare professional-parental dialogue for safe practices that are accessible, acceptable, and culturally sensitive in the care of the prepuce. A literature review was carried out in the English language through the major databases: PubMed (MEDLINE), EMBASE, the Cochrane Library, CINAHL, Web of Science (WOS) Core Collection, LILAC, WHO/UNAIDS, Clinical Trials (www.clinicaltrials.gov), Google Scholar, and grey literature. Search words included: prepuce, diseases of prepuce, prepuce in the neonate, prepuce in the neonate in Canada, male circumcision, childhood male circumcision, neonatal circumcision, neonatal circumcision in Canada, complications of neonatal circumcision in Canada, and circumcision adverse events. From 1970-1999, three of 10 Canadian newborn males were circumcised for religious, cultural, and medical reasons. The rest of the neonates, if alive, are living with their prepuce; <4% expected to require treatment for afflictions of the prepuce at some point. There are several providers of circumcision with different levels of training and competencies and using a diversity of devices and techniques. Neonatal and childhood circumcision in Canada is carried out to fulfill parental wishes, as well as for medical, religious, and cultural reasons. Appropriate informed consent and education regarding choices of care of the neonatal prepuce and genitals are vital. Going by current prevalent rate of circumcision in Canada, most Canadian newborn males are likely to live out their lives with an intact prepuce. Despite the age-old debate, childhood circumcision is likely to remain. There is need for careful and proper discussion of the potential risks and benefits, including alternatives, costs, and personal/psychological factors. Acceptance, access, and judicious choices in a culturally sensitive environment will offer the Canadian neonate desirable care of the prepuce for life.

Male Circumcision Pilot Program in Lilongwe, Malawi

Male circumcision is one method of effective prevention against HIV/AIDS. In Malawi, however, male circumcision is not the predominant practice. Project Malawi conducted a pilot program of male circumcision for villagers with fully subsidized operation costs. After we conducted sensitization programs to create demand for circumcision, the rate of male circumcision has increased. This pilot project allowed us to consider the acceptability of male circumcision in Malawi. Unsafe surgery, a long recovery period, religious beliefs, and age were the mostcited reasons Malawians rejected male circumcision. We also have found three critical barriers—operation cost, transportation cost, and opportunity cost—which can largely explain the limited accessibility of male circumcision procedures. Lastly, in order to scale up male circumcision in Malawi, the importance of delivering the complete information and significant availability issues need to be addressed.

Women Who Study in Madrasah School Experienced Higher Number of Female Circumcision Compared to Western or English Schools

Female circumcision refers to the procedures that intentionally alter or cause injury to the female external genital organs. The reasons for doing this vary but it is commonly observed in places where Muslims predominate. The study is intended to determine: 1) the rate of females who had undergone female circumcision in Madrasah School compared to those who went to English schools, 2) the prevalence rate of female circumcision among Meranaos, and 3) the practices and experiences of women who have undergone FC. The study utilized a combination of quantitative and qualitative methods using a designed questionnaire, interview and focus group discussions with the respondents. The results showed that more girls who were studying in Madrasah have undergone this practice compared to the number of girls who are in Western or English schools. It also showed that the prevalence rate of this practice is indeed high in the rural areas, which is 86%. The practice of FC is performed either during Fridays, Holidays or Mondays and Thursdays. Each mentioned day has meanings and there are certain procedures and instructions being followed in doing the practice. In conclusion, religious justification remains the strong reason why FC is still rampantly performed in the different rural areas of Lanao del Sur, Philippines.

Lower HIV Risk Among Circumcised Men Who Have Sex With Men in China: Interaction With Anal Sex Role in a Cross-Sectional Study.

Voluntary medical male circumcision reduces the risk of HIV heterosexual transmission in men, but its effect on male-to-male sexual transmission is uncertain. Circumcision status of men who have sex with men (MSM) in China was evaluated by genital examination and self-report; anal sexual role was assessed by questionnaire interview. Serostatus for HIV and syphilis was confirmed. Among 1155 participants (242 were seropositive and 913 with unknown HIV status at enrollment), the circumcision rate by self-report (10.4%) was higher than confirmed by genital examination (8.2%). Male circumcision (by examination) was associated with 47% lower odds of being HIV seropositive [adjusted odds ratio (aOR): 0.53; 95% confidence interval (CI): 0.27 to 1.02] after adjusting for demographic covariates, number of lifetime male sexual partners, and anal sex role. Among MSM who predominantly practiced insertive anal sex, circumcised men had 62% lower odds of HIV infection than those who were uncircumcised (aOR: 0.38; 95% CI: 0.09 to 1.64). Among those whose anal sex position was predominantly receptive or versatile, circumcised men have 46% lower odds of HIV infection than did men who were not circumcised (aOR: 0.54; 95% CI: 0.25 to 1.14). Compared to uncircumcised men reporting versatile or predominantly receptive anal sex positioning, those who were circumcised and reported practicing insertive sex had an 85% lower risk (aOR: 0.15; 95% CI: 0.04 to 0.65). Circumcision was not associated clearly with lower syphilis risk (aOR: 0.91; 95% CI: 0.51 to 1.61). Circumcised MSM were less likely to have acquired HIV, most pronounced among men predominantly practicing insertive anal intercourse. A clinical trial is needed.

P18.03 Rapid training and implementation of the pollock technique, a safe, rapid and effective newborn circumcision procedure, in a low-resource setting

Background Male circumcision is highly protective against urinary tract infections, inflammatory conditions of the penis, sexually transmitted infections, and urogenital cancers. We aimed to re-introduce newborn male circumcision through the creation of a training program in Port-au-Prince, Haiti—an area with a considerable burden of preventable urogenital infections, sexually transmitted infections, and low circumcision rate—after an earlier study reported that a majority of Haitian medical providers were in need of and wanted newborn circumcision training. Methods The rapid, newborn circumcision training program was conducted in November 2014 at the GHESKIO Health Centres, a large, non-governmental clinic offering comprehensive paediatric and adult health services. Two Haitian obstetricians and seven nurses learned administrative, educational, and clinical newborn male circumcision procedures. Complications were monitored and surveys were given to the obstetricians, nurses, and parents of the newborns for assessment. Results Upon training completion, one of two obstetricians achieved procedural competence. The team circumcised 92 newborns with minor bleeding observed in 1 infant; there were 0 moderate or severe complications. Obstetricians, nurses, and parents of the newborns reported that they were very satisfied with the program (100%, 92%, and 94%, respectively). Of the parents, 100% reported they would recommend the procedure to their friends and 100% reported that they were satisfied with the cosmetic result of the procedure. The nurse-collected survey indicated that 100% of the procedures followed the proper protocol. Since the rapid newborn circumcision training program concluded, the GHESKIO Health Centres have dedicated two days a week to perform newborn male circumcisions, averaging 14 patients per week Conclusion Introduction of a newborn male circumcision training program was feasible, achieving an acceptable rate of procedural competency and high quality services. Permanent resources now exist in Haiti to train additional providers to perform newborn male circumcisions. Funding UCLA Centre for AIDS Research (CFAR) NIH/NIAID AI028697, NIH/NICHD R21HD076685, Pollock Foundation, and Klausner Research and Education Fund.

Circumcision as a primary HIV preventive: Extrapolating from the available data

Billions of dollars to circumcise millions of African males as an HIV infection prevention have been sought, yet the effectiveness of circumcision has not been demonstrated. Data from 109 populations comparing HIV prevalence and incidence in men based on circumcision status were evaluated using meta-regression. The impact on the association between circumcision and HIV incidence/prevalence of the HIV risk profile of the population, the circumcision rates within the population and whether the population was in Africa were assessed. No significant difference in the risk of HIV infection based on the circumcision status was seen in general populations. Studies of high-risk populations and populations with a higher prevalence of male circumcision reported significantly greater odds ratios (odds of intact man having HIV) (p < .0001). When adjusted for the impact of a high-risk population and the circumcision rate of the population, the baseline odds ratio was 0.78 (95% CI = 0.56–1.09). No consistent association between presence of HIV infection and circumcision status of adult males in general populations was found. When adjusted for other factors, having a foreskin was not a significant risk factor. This undermines the justification for using circumcision as a primary preventive for HIV infection.