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A random household survey of male circumcision and HIV in Kisumu, Kenya

A random household survey of male circumcision and HIV in Kisumu, Kenya. Circumcision Impact Study (CIRCIS) Matthew Westercamp University of Illinois at Chicago. Background Kisumu, Kenya. Kenya’s third largest city with a population of over 350,000

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A random household survey of male circumcision and HIV in Kisumu, Kenya

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  1. A random household survey of male circumcision and HIV in Kisumu, Kenya Circumcision Impact Study (CIRCIS) Matthew WestercampUniversity of Illinois at Chicago

  2. BackgroundKisumu, Kenya • Kenya’s third largest city with a population of over 350,000 • Luo ethnic group, traditionally non-circumcising, majority • 60% of residents live in peri-urban and informal settlements often lacking in municipal water, sewage, and/or electrical services

  3. BackgroundCircumcision in Kisumu (1997-1998) Multicentre study in sub-Saharan Africa – Kisumu [Buve, et al. 2001] Pre-2000 2002 (Feb 2002) Recruitment for Kisumu circumcision RCT begins (Jul - Oct 2006) ARTIS, cross-sectional population based survey [Cohen, et al. 2009)] 2006 (Dec 2006) Trial concludes showing 60% reduction of risk in concordance with two concurrent trials in Uganda & South Africa – results released 2008 (Sep 2008) Rollout of Circumcision service in Nyanza (Nov 2008-Apr 2009) Circumcision Impact Study (CIRCIS) data collection 2010 (Feb 2011) Planned start of CIRCIS2 data collection

  4. Methods • Households were selected by multi-stage sampling. • All men and women aged 15-49 years, sleeping in the house the night before the first visit by the field team were eligible for study participation. • 40 study clusters by random PPS sampling • ~ 28 households by systematic random sampling • 2,563 eligible individuals • 1,868 (72.9%) located and asked to participate • 105 (5.6%) refused to participate • Final sample size = 1,763

  5. Circumcision Prevalence • Circumcision status based on self-report • 460 men (68%) uncircumcised • 215 (32%) circumcised • 351 (52%) men agreed to visual confirmation • 234 men (67%) were determined uncircumcised • 117 (33%) circumcised • PPV of self-report = 0.99 / NPV of self-report = 0.97 • Preference to be circumcised in uncircumcised males = 272 (59%) men • Preference for circumcised partners in Luo women = 658 (73%) women

  6. Prevalence – Kisumu, Kenya p=0.005 p=0.0001 p<0.0001 p=0.24

  7. Uncircumcised Men MC and HIV infection risk

  8. Now that MC is available, you are less worried about HIV infection (Percent Agreement) p = 1.00 p = 0.0043

  9. Now that MC is available, condom use during sex is less necessary (Percent Agreement) p = 0.16 p = 0.0015

  10. Circumcised men have more, less, about the same sexual pleasure than uncircumcised men. p <.001

  11. Perception of HIV Risk • Participants self identified as low vs. high risk • No difference by circumcision status (p=0.78) • No difference by preference of circumcision (p=0.81)

  12. Limitations • Cross-sectional design • Cannot show causation nor temporality • Self-reported circumcision status • Misclassification bias unlikely • Difficulty in recruiting males • Possible selection bias • Prevalence comparisons based on different study methodologies • Different study cluster/areas within Kisumu • Results may not be generalizable to other populations in Kenya or sub-Saharan Africa

  13. Conclusions • The prevalence of circumcision appears to have remained stable between 2000 and 2006 and increased between 2006 and 2009 in Kisumu, Kenya • Circumcised and uncircumcised men have similar perceived risk of HIV infection. This is consistent with no sexual risk compensation by circumcised men • However, uncircumcised men who prefer to become circumcised do perceive circumcised men as being at lower risk of HIV and as engaging in riskier behavior • Preference for circumcision is related to ideas consistent with circumcision enhancing the sexual experience

  14. Acknowledgments • William Nyongo and Mr. Obudno • Kenya National Bureau of Statistics • NatechoWekesa • District Commissioner – Kisumu East • Chiefs and Assistant Chiefs of Kisumu • CIRCIS Staff and Participants • Dr. Robert Bailey • Dr. KawangoAgot • Prof Ndinya-Achola • Dr. Craig Cohen

  15. References • Buve, A., et al., The multicentre study on factors determining the differential spread of HIV in four African cities: summary and conclusions. AIDS, 2001. 15 Suppl 4: p. S127-31. • Cohen, C.R., et al., Association of Attitudes and Beliefs towards Antiretroviral Therapy with HIV-Seroprevalence in the General Population of Kisumu, Kenya. PLoS ONE., 2009. 4(3): p. e4573. Latest in MC Information For HIV Prevention www.malecircumcision.org

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