Male circumcision an acceptable strategy for hiv prevention in botswana
Download
1 / 15

Male circumcision: An acceptable strategy for HIV prevention ... - PowerPoint PPT Presentation


  • 528 Views
  • Uploaded on

Male circumcision: An acceptable strategy for HIV prevention in Botswana . Roger Shapiro Poloko Kebaabetswe Shahin Lockman Serara Mogwe Rose Mandevu Ibou Thior Max Essex

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Male circumcision: An acceptable strategy for HIV prevention ...' - arleen


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Male circumcision an acceptable strategy for hiv prevention in botswana l.jpg

Male circumcision: An acceptable strategy for HIV prevention in Botswana

Roger Shapiro

Poloko Kebaabetswe

Shahin Lockman

Serara Mogwe

Rose Mandevu

Ibou Thior

Max Essex

The Botswana-Harvard AIDS Institute Partnership / The Botswana Ministry of Health /The Harvard School of Public Health / The University of Botswana


Abstract l.jpg
Abstract in Botswana

Background: Male circumcision is known to reduce the risk of acquiring HIV, but few studies have been performed to assess its acceptability among either children or adults in sub-Saharan Africa.Methods: We conducted a cross-sectional survey in nine geographically representative locations in Botswana to determine the acceptability of male circumcision in the country, as well as the preferred age and setting for male circumcision. Interviews were conducted using standardized questionnaires both before and after an informational session outlining the risks and benefits of male circumcision.Results: Among 605 persons surveyed, the median age was 29 years (range 18 – 74 years), 52% were male, and > 15 tribal groups were represented. Before the informational session, 408 (68%) responded that they would definitely or probably circumcise a male child if circumcision was offered free of charge in a hospital setting; this number increased to 542 (89%) after the informational session. Among 238 uncircumcised men, 145 (61%) stated that they would definitely or probably get circumcised themselves if it were offered free of charge in a hospital setting; this increased to 192 (81%) after the informational session. In a multivariate analysis of all participants, persons with children were more likely to favor circumcision than persons without children (Adjusted Odds Ratio 1.8, 95% CI = 1.0, 3.4). Most participants (55%) felt that the ideal age for circumcision is before 6 years, and 90% of participants felt that circumcision should be performed in the hospital setting.Conclusions: We conclude that male circumcision is highly acceptable in Botswana. The option for safe circumcision should be made available to parents in Botswana for their male children. Circumcision might also be an acceptable option for adults and adolescents, if its efficacy as an HIV prevention strategy is supported by clinical trials.


Background l.jpg
Background in Botswana

  • Male circumcision is known to reduce the risk of acquiring HIV, but few studies have been performed to assess its acceptability among either children or adults in sub-Saharan Africa

  • Male circumcision was traditionally practiced in almost all Bantu-speaking regions of sub–Saharan Africa, and remains a cultural practice throughout much of the region today

  • However, circumcision has become less common in some regions of Africa where it was traditionally practiced. Non-circumcising areas now include: almost all of Uganda, Rwanda, Burundi, Zambia, Malawi, Zimbabwe and Botswana, and parts of western Kenya, western Tanzania, the Democratic Republic of Congo, Namibia, Mozambique, and South Africa

  • Male circumcision is no longer a cultural practice in Botswana, nor is it offered for male infants at government hospitals


Methods survey administration l.jpg
Methods: Survey Administration in Botswana

  • Between March 17 and June 17, 2001, 605 interviews were conducted at 9 locations throughout Botswana

  • Sites were geographically and ethnically representative

    • 2 cities (Gaborone and Francistown), 1 town (Lobatse), 6 villages (Maun, Ghansi, Serowe, Kanye, Ramotswa, and Bobonong)

  • Interviews were conducted in Setswana by a team of 3 trained bilingual health educators

  • Interviewers approached potential participants at meeting places and public markets

  • Participants were eligible if they were age 18 or older

  • Informed consent was signed by all participants


Slide5 l.jpg

2 in Botswana

3

4

1

5

6

9

7

8


Methods survey design l.jpg
Methods: Survey Design in Botswana

  • Survey was administered in 2 parts:

    • Part 1 was administered before any information about male circumcision was provided to the participant by the health educator

    • Part 2 was administered after the health educator read a short informational pamphlet regarding the potential risks and benefits of male circumcision to the participant


Results response rate demographics and baseline knowledge l.jpg
Results: Response Rate, Demographics, and Baseline Knowledge in Botswana

  • 57% of those approached agreed to participate

  • 29 different tribal groups from throughout the country were represented 

  • Male circumcision was correctly described by 74% of participants

    • interviewers described circumcision to all participants who defined it incorrectly (4%) or who were unsure (22%) before proceeding with the interview


Characteristics of study participants l.jpg

Characteristic in Botswana

No. (%)

Median age

29 years (range 18 – 74 years)

Male sex

316 (52)

Marital status

Single

Cohabitating

Married

Separated, divorced, widowed

343 (57)

88 (15)

128 (21)

46 (7)

Number of children

0

1

2

3

4 or more

221 (36)

114 (19)

107 (18)

66 (11)

97 (16)

Education completed

None

Primary school

Secondary school

Tertiary / university

34 (5)

185 (31)

321 (53)

65 (11)

Occupation

Salaried (government)

Salaried (private)

Domestic work / manual labor

Self-employed

Student

Unemployed

134 (22)

105 (17)

64 (11)

103 (17)

36 (6)

163 (27)

Religion

Christian

Muslim

No religion / other

404 (67)

9 (2)

192 (31)

Characteristics of Study Participants


Acceptability of male circumcision by sex and circumcision status l.jpg

No. (%) before informational session in Botswana

No. (%) after informational session

P value for change in responses

Circumcising a male child in a safe hospital setting, free of charge:

All participants (N=605):

Would definitely / would probably circumcise

Would definitely not / would probably not circumcise

Unsure

Uncircumcised men only (N=238):

Would definitely / would probably circumcise

Would definitely not / would probably not circumcise

Unsure

Circumcised men only (N=78 ):

Would definitely / would probably circumcise

Would definitely not / would probably not circumcise

Unsure

Women only (N=289):

Would definitely / would probably circumcise

Would definitely not / would probably not circumcise

Unsure

408 (68)

86 (14)

111 (18)

159 (67)

38 (16)

41 (17)

73 (94)

1 (1)

4 (5)

178 (62)

45 (16)

66 (23)

542 (89)

34 (6)

29 (5)

208 (87)

15 (6)

15 (6)

76 (97)

1 (1)

1 (1)

260 (90)

17 (6)

12 (4)

< 0.0001

< 0.0001

NS

< 0.001

Uncircumcised men only (N=238):

Circumcising yourself in a safe hospital setting, free of charge:

Would definitely / would probably circumcise

Would definitely not / would probably not circumcise

Unsure

145 (61)

46 (19)

47 (20)

192 (81)

22 (9)

24 (10)

< 0.0001

Acceptability of Male Circumcision, by Sex and Circumcision Status


Slide10 l.jpg

% of Participants Who Would Choose to Circumcise a Male Child, if Offered in a Safe Hospital Setting, Free of Charge(data shown only for responses following informational session)

%

N=238

N=78

N=289

N=605


Slide11 l.jpg

% of Uncircumcised Men Who Would Choose to Be Circumcised, if Offered in a Safe Hospital Setting, Free of Charge (N=238) (data shown only for responses following informational session)

%


Acceptability of male circumcision continued l.jpg

Women only (N=289): if Offered in a Safe Hospital Setting, Free of Charge (N=238)

Prefer a circumcised or an uncircumcised partner:

Circumcised

Uncircumcised

No preference

Unsure

146 (50)

20 (7)

61 (21)

63 (22)

No. (%) before informational session

227 (79)

7 (2)

32 (11)

23 (8)

No. (%) after informational session

P value for change in responses

< 0.0001

Cultural acceptability of circumcision:

Circumcision is culturally acceptable

Circumcision is not culturally acceptable

Unsure

298 (50)

98 (16)

209 (34)

--

--

--

Best age for male circumcision:

Birth to 1 month

1 month to 1 year

2 years to 5 years

6 years to 10 years

11 years to 15 years

Older than 15 years

Never

Unsure / other

--

--

--

--

--

--

--

152 (25)

52 (9)

129 (21)

95 (16)

88 (14)

49 (8)

18 (3)

22 (4)

Best place for male circumcision:

Hospital

Traditional setting / other

No place(circumcision not acceptable)

Unsure / other

--

--

--

542 (90)

37 (6)

8 (1)

15 (3)

Acceptability of Male Circumcision (continued)


Differences in acceptability of male circumcision by participant characteristics l.jpg

Characteristic if Offered in a Safe Hospital Setting, Free of Charge (N=238)

Proportion (%) favoring circumcision* among those with characteristic

Proportion (%) favoring circumcision* among those without characteristic

Univariate analysis

P-value

Multivariate analysis

Adjusted Odds Ratio (95% CI)

Male sex

230/271 (85)

178/223 (80)

0.14

N/S

Married

111/127 (87)

297/367 (81)

0.10

N/S

Has children

286/331 (86)

122/163 (75)

0.001

1.8 (1.0, 3.4)

Secondary school education or higher

257/320 (80)

151/174 (87)

0.07

N/S

Christian religion

269/321 (84)

139/173 (80)

0.33

--

Employed

310/373 (83)

98/121 (81)

0.59

--

Ethnic group†

--

--

0.28

N/S

Location (all sites)

--

--

0.0002

0.03

Age (median)

Favor circumcision: 30 yrs

Do not favor circumcision: 26 yrs

0.002

N/S

Differences in Acceptability of Male Circumcision by Participant Characteristics


Conclusions l.jpg
Conclusions if Offered in a Safe Hospital Setting, Free of Charge (N=238)

  • Safe circumcision services in Botswana could provide an effective, available, permanent, and affordable means to reduce the incidence of HIV in the next generation of children

  • Our study demonstrates that circumcision services for male children in Botswana would be highly acceptable

    • After an informational session, 89% of all participants stated that they would definitely or probably circumcise their male child if this service were offered in a hospital setting

    • > 50% felt that the best age for circumcision is < 6 years

    • 90% felt that circumcision should be performed in a hospital setting

  • If randomized, clinical trials support the effectiveness and safety of circumcision among adolescents or adults, our study also indicates a high level of acceptability for such programs in Botswana


Recommendations l.jpg
Recommendations if Offered in a Safe Hospital Setting, Free of Charge (N=238)

  • Parents in Botswana should be offered the option of hospital-based circumcision for their male children to protect them from the acquisition of HIV

  • The majority of births in Botswana occur at the district hospitals, and circumcision services could be implemented with existing resources by training physicians and nurses at these locations

  • Based on the results of this study, the Botswana Ministry of Health has established a committee to discuss the implementation of infant circumcision services at district hospitals throughout the country


ad