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Trial Intervention of Male Circumcision Services in Nyanza Province, Kenya

Trial Intervention of Male Circumcision Services in Nyanza Province, Kenya. Tom Onyango Matinde Robert Bailey Kenya Ministry of Health Univ of Illinois at Chgo Dr. Richard Muga, Director Dr. Rudi Poulussen Kenya Medical Services Belgium Develop Corp. Background.

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Trial Intervention of Male Circumcision Services in Nyanza Province, Kenya

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  1. Trial Intervention of Male Circumcision Services in Nyanza Province, Kenya Tom Onyango Matinde Robert Bailey Kenya Ministry of Health Univ of Illinois at Chgo Dr. Richard Muga, Director Dr. Rudi Poulussen Kenya Medical Services Belgium Develop Corp

  2. Background • The Luo are a population of approximately 3,000,000 people living in Nyanza Province, Kenya. • They are the only major ethnic group in Kenya who do not traditionally practice male circumcision. • 90% of Luo men are not circumcised. • Adult HIV prevalence in Nyanza is 28-35%; in Siaya 38.4%.

  3. Summary of Acceptability Studies • >75% of Luo men and women equate MC with greater cleanliness and reduced risk of STDs. • >50% of Luo men and women believe that circumcised men enjoy sex more and give greater sexual pleasure to their partners. • Approximately 60% of Luo men and women would prefer to be circumcised or have a circumcised partner. • 74% of men and 88% of women said they would circumcise their son if affordable, safe services were available. • Few clinicians have comprehensive training and experience in MC procedures.

  4. Objectives of the Intervention • Increased numbers of circumcisions among males >8 years. • Increased numbers of health providers trained to perform safe circumcisions. • Increased knowledge by health providers of the risks and benefits of MC. • Increased availability of the instruments and supplies necessary for safe circumcisions to 20 facilities. • Consistent policy and practice regarding pricing.

  5. Intervention Design • Training for clinicians (n=26) • Lectures by surgeon and Medical Superintendant • Video • Informed Consent • Attend and perform procedure under supervision • Provide facilities with instruments and supplies • Inform community that the services are available and of the risks and benefits of MC at 120 Schools, 10 churches, 15 local administrative forums.

  6. Results of Interviews with Clinicians

  7. Results

  8. Results • It was not possible to evaluate accurately the rate of complications. • There were anecdotal reports of bleeding and infection which were treated. • Cost was the most important factor determining numbers reporting for MC. • When the price was reduced, large numbers came. • There was a very high rate of patient satisfaction with the procedure and its results.

  9. Conclusions • The intervention resulted in a significant increase in circumcisions performed in Siaya District. • Before circumcision can be offered elsewhere, there are likely to be operational requirements: • Proper instruments and supplies must be made available • Training of clinicians in MC procedure, informed consent and HIV/STD counseling is necessary. • Community leadership support is necessary. • Cost is likely to be a significant factor in determining demand in non-circumcising regions. • Data on rates of complications are urgently needed to assess the risks in clinical settings.

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