Acceptability of male circumcision as a tool for preventing HIV infection in a highly infected community in South Africa

Background: Because a growing body of evidence suggests that male circumcision (MC) is associated with a reduced risk of HIV infection in Africa, it is being considered as a potential prevention tool to reduce the spread of infection. Its feasibility must therefore be assessed. Methods: A community-based cross-sectional study was conducted among a random sample of 482 men aged 19-29 years and 302 women aged 14-25 years, all living in the Westonaria district, South Africa. The prevalence of HIV infection was 11% among the men and 30% among the women. Trained personnel administered standardized questionnaires. Results: Two-thirds of the 108 circumcised men (CM) were circumcised during a traditional ceremony and one-third in a clinical setting; the latter reported less pain and adverse outcomes. More than 70% of the non-circumcised men (NCM) stated that they would want to be circumcised if MC were proved to protect against sexually transmitted diseases (STD). Twenty-nine per cent of the CM and 22% of the NCM believed that MC protects against HIV and other STD. Moreover, 30% and 18%, respectively, believed that CM could safely have sex with multiple partners. Multivariate analysis showed that CM were more likely to report many lifetime partners. Conclusion: Although the level of MC in the area is relatively low, it is perceived positively. A significant proportion of the CM felt protected by their circumcision, a feeling unfortunately translated into unsafe practices. Our results strongly suggest that interventions including MC should carefully address the false sense of security that it may provide. (C) 2003 Lippincott Williams Wilkins.