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Uptake and acceptability of medical male circumcision among young males in two culturally distinct settings in South Africa: A longitudinal, community-based study (the MACHO study)

P J Smith, B Oulo, M Wallace, K Gill, J A Beijneveld, T Bennie, L Myer, J J Dietrich, L F Johnson, G Gray, L-G Bekker

Abstract


Background. Young South Africans experience high rates of HIV infection. While nationally scaled medical male circumcision (MMC) can help to curb HIV infection rates in countries such as South Africa (SA), MMC uptake has not been consistent or universal, suggesting variable acceptability among men. Both MMC and traditional male circumcision (TMC) are practised in SA. For male circumcision to be most effective for HIV prevention, it should be performed prior to sexual debut with complete removal of the foreskin.

Objectives. The MACHO (Male Adolescent Choices for HIV Prevention Options) study investigated uptake of and preference for MMC v. TMC in two culturally distinct settings in SA.

Methods. This observational, longitudinal, cohort study investigated circumcision preferences and uptake in 100 males (aged 14 - 17 years) and their legal guardians in Cape Town (Western Cape Province) and Soweto (Gauteng Province). Data were collected via surveys administered every 4 months over a 24-month period.

Results. A total of 100 uncircumcised adolescent boys (Cape Town n=50, Soweto n=50; mean (interquartile range) age 15 (14 - 16) years) and their guardians were enrolled. At baseline, 42 boys from Soweto (84%) and none from Cape Town expressed a preference for MMC over TMC. Sowetan participants were more likely to elect circumcision (MMC n=11 (22%), TMC n=1 (2%)) than those from Cape Town (TMC n=1 (2%), MMC n=0) over 13.6 months of follow-up (hazard ratio 18.9; 95% confidence interval 2.37 - 150.71; p=0.006).

Conclusions. MMC was the preferred option for young men in Soweto compared with those in Cape Town, and this translated into practice. Despite knowledge of the benefits of early MMC, many participants delayed uptake, potentially reducing the MMC benefits before sexual debut. Programmes promoting circumcision should consider the influence of local practices. To realise full HIV prevention benefits, efforts should be made to ensure that circumcision is promoted, and that all circumcision is safe, performed prior to sexual debut, and contextually responsive.


Authors' affiliations

P J Smith, Desmond Tutu HIV Centre, University of Cape Town, South Africa

B Oulo, Desmond Tutu HIV Centre, University of Cape Town, South Africa

M Wallace, Cancer Association of South Africa, Cape Town, South Africa

K Gill, Desmond Tutu HIV Centre, University of Cape Town, South Africa

J A Beijneveld, Desmond Tutu HIV Centre, University of Cape Town, South Africa

T Bennie, Desmond Tutu HIV Centre, University of Cape Town, South Africa

L Myer, Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

J J Dietrich, Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

L F Johnson, Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa

G Gray, Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

L-G Bekker, Desmond Tutu HIV Centre, University of Cape Town, South Africa

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Keywords

Circumcision; Prevention; HIV; Adolescents; Young men; South Africa

Cite this article

South African Medical Journal 2020;110(10):1050-1055. DOI:10.7196/SAMJ.2020.v110i10.14110

Article History

Date submitted: 2020-09-30
Date published: 2020-09-30

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