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Sample records for male circumcision findings

  1. Newborn male circumcision.

    PubMed

    Sorokan, S Todd; Finlay, Jane C; Jefferies, Ann L

    2015-01-01

    The circumcision of newborn males in Canada has become a less frequent practice over the past few decades. This change has been significantly influenced by past recommendations from the Canadian Paediatric Society and the American Academy of Pediatrics, who both affirmed that the procedure was not medically indicated. Recent evidence suggesting the potential benefit of circumcision in preventing urinary tract infection and some sexually transmitted infections, including HIV, has prompted the Canadian Paediatric Society to review the current medical literature in this regard. While there may be a benefit for some boys in high-risk populations and circumstances where the procedure could be considered for disease reduction or treatment, the Canadian Paediatric Society does not recommend the routine circumcision of every newborn male.

  2. Newborn male circumcision

    PubMed Central

    Sorokan, S Todd; Finlay, Jane C; Jefferies, Ann L

    2015-01-01

    The circumcision of newborn males in Canada has become a less frequent practice over the past few decades. This change has been significantly influenced by past recommendations from the Canadian Paediatric Society and the American Academy of Pediatrics, who both affirmed that the procedure was not medically indicated. Recent evidence suggesting the potential benefit of circumcision in preventing urinary tract infection and some sexually transmitted infections, including HIV, has prompted the Canadian Paediatric Society to review the current medical literature in this regard. While there may be a benefit for some boys in high-risk populations and circumstances where the procedure could be considered for disease reduction or treatment, the Canadian Paediatric Society does not recommend the routine circumcision of every newborn male. PMID:26435672

  3. Perspectives of Parents and Health Care Workers on Early Infant Male Circumcision Conducted Using Devices: Qualitative Findings From Harare, Zimbabwe

    PubMed Central

    Mavhu, Webster; Hatzold, Karin; Ncube, Getrude; Fernando, Shamiso; Mangenah, Collin; Chatora, Kumbirai; Mugurungi, Owen; Ticklay, Ismail; Cowan, Frances M

    2016-01-01

    ABSTRACT Background: The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) recommend early infant male circumcision (EIMC) for prevention of HIV. Here, we present findings from a qualitative study in Zimbabwe that assessed parental and health care workers' perspectives of EIMC conducted using devices. Methods: This qualitative study was nested within a trial of EIMC devices. Between January and May 2013, we held 4 focus group discussions (FGDs) and 12 in-depth interviews with parents and 12 in-depth interviews with clinicians (7 trial clinicians and 5 non-trial clinicians). We also conducted 95 short telephone interviews with parents who had arranged to bring their sons for EIMC but then defaulted. Results: Parents who had adopted EIMC spoke of their initial anxieties about the procedure. Additionally, they commented on both the procedure and outcome. Parents who decided against EIMC cited fear of harm, specifically the infant's death, penile injury, and excessive pain. Misperceptions about male circumcision in general and EIMC specifically were a significant barrier to EIMC adoption and were prevalent among health care workers as well as parents. In particular, the findings suggest strong parental concerns about the fate of the discarded foreskin. Parents who chose EIMC for their newborn sons felt that the procedure was safe and expressed satisfaction with the outcome. For their part, health care workers largely thought that EIMC was safe and that the outcome was aesthetically pleasing. They also felt that it would be feasible to offer wide-scale EIMC for HIV prevention in the public sector; they recommended strategies to increase EIMC uptake, in addition to highlighting a few concerns. Conclusions: The qualitative study enables us to better understand parental and health care workers' perspectives of EIMC conducted using devices, especially their perspectives on EIMC safety, feasibility, acceptability, and barriers. These findings

  4. Non-therapeutic infant male circumcision

    PubMed Central

    Alkhenizan, Abdullah; Elabd, Kossay

    2016-01-01

    Objectives: To review the evidence of the benefits and harms of infant male circumcision, and the legal and ethical perspectives of infant male circumcision. Methods: We conducted a systematic search of the literature using PubMed, EMBASE, and the Cochrane library up to June 2015. We searched the medical law literature using the Westlaw and Lexis Library law literature resources up to June 2015. Results: Male circumcision significantly reduced the risk of urinary tract infections by 87%. It also significantly reduced transmission of human immunodeficiency virus among circumcised men by 70%. Childhood and adolescent circumcision is associated with a 66% reduction in the risk of penile cancer. Circumcision was associated with 43% reduction of human papilloma virus infection, and 58% reduction in the risk of cervical cancer among women with circumcised partners compared with women with uncircumcised partners. Male infant circumcision reduced the risk of foreskin inflammation by 68%. Conclusion: Infant male circumcision should continue to be allowed all over the world, as long as it is approved by both parents, and performed in facilities that can provide appropriate sterilization, wound care, and anesthesia. Under these conditions, the benefits of infant male circumcision outweigh the rare and generally minor potential harms of the procedure. PMID:27570848

  5. Perceptions of voluntary medical male circumcision among circumcising and non-circumcising communities in Malawi.

    PubMed

    Rennie, Stuart; Perry, Brian; Corneli, Amy; Chilungo, Abdullah; Umar, Eric

    2015-01-01

    Three randomised controlled trials in Africa indicated that voluntary medical male circumcision (VMMC) is an effective method to reduce a man's risk of becoming infected through sex with an HIV-positive female partner. The success of recent public health initiatives to increase numbers of circumcised men in Malawi has been very limited. We conducted in-depth interviews and focus group discussions (FGDs) with men, women and male adolescents from non-circumcising and circumcising communities in southern Malawi to better understand their beliefs about male circumcision and the promotion of VMMC for HIV prevention. Results revealed that beliefs about male circumcision, in general, are strongly mediated by Malawian culture and history. Participants have attempted to develop a new meaning for circumcision in light of the threat of HIV infection and the publicised risk reduction benefits of VMMC. Several study participants found it difficult to distinguish VMMC from traditional circumcision practices (jando and lupanda), despite awareness that the new form of circumcision was an expression of (western) modern medicine performed largely for public health purposes. Greater recognition of background cultural beliefs and practices could inform future efforts to promote medical male circumcision as an HIV prevention strategy in this context.

  6. Perceptions of voluntary medical male circumcision among circumcising and non-circumcising communities in Malawi

    PubMed Central

    Rennie, Stuart; Perry, Brian; Corneli, Amy; Chilungo, Abdullah; Umar, Eric

    2015-01-01

    Three randomised controlled trials in Africa indicated that voluntary medical male circumcision (VMMC) is an effective method to reduce a man’s risk of becoming infected through sex with an HIV-positive female partner. The success of recent public health initiatives to increase numbers of circumcised men in Malawi has been very limited. We conducted in-depth interviews (IDIs) and focus group discussions (FGDs) with men, women, and male adolescents from non-circumcising and circumcising communities in southern Malawi to better understand their beliefs about male circumcision and the promotion of VMMC for HIV prevention. Results revealed that beliefs about male circumcision, in general, are strongly mediated by Malawian culture and history. Participants have attempted to develop a new meaning for circumcision in light of the threat of HIV infection and the publicised risk reduction benefits of VMMC. Several study participants found it difficult to distinguish VMMC from traditional circumcision practices (jando and lupanda), despite awareness that the new form of circumcision was an expression of (western) modern medicine performed largely for public health purposes. Greater recognition of background cultural beliefs and practices could inform future efforts to promote medical male circumcision as an HIV prevention strategy in this context. PMID:25630610

  7. Male circumcision for the prevention of acquisition and transmission of sexually transmitted infections: the case for neonatal circumcision.

    PubMed

    Tobian, Aaron A R; Gray, Ronald H; Quinn, Thomas C

    2010-01-01

    The American Academy of Pediatrics (AAP) male circumcision policy states that while there are potential medical benefits of newborn male circumcision, the data are insufficient to recommend routine neonatal circumcision. Since 2005, however, 3 randomized trials have evaluated male circumcision for prevention of sexually transmitted infections. The trials found that circumcision decreases human immunodeficiency virus acquisition by 53% to 60%, herpes simplex virus type 2 acquisition by 28% to 34%, and human papillomavirus prevalence by 32% to 35% in men. Among female partners of circumcised men, bacterial vaginosis was reduced by 40%, and Trichomonas vaginalis infection was reduced by 48%. Genital ulcer disease was also reduced among males and their female partners. These findings are also supported by observational studies conducted in the United States. The AAP policy has a major impact on neonatal circumcision in the United States. This review evaluates the recent data that support revision of the AAP policy to fully reflect the evidence of long-term health benefits of male circumcision.

  8. Informing the scaling up of voluntary medical male circumcision efforts through the use of theory of reasoned action: survey findings among uncircumcised young men in Swaziland.

    PubMed

    Gurman, Tilly A; Dhillon, Preeti; Greene, Jessica L; Makadzange, Panganai; Khumlao, Philisiwe; Shekhar, Navendu

    2015-04-01

    Assessing predictors of intention to circumcise can help to identify effective strategies for increasing uptake of voluntary medical male circumcision (VMMC). Grounded in the theory of reasoned action (TRA), the current study of uncircumcised males ages 13-29 in Swaziland (N = 1,257) employed multivariate logistic regression to determine predictors of VMMC intention. The strongest predictors were strongly disagreeing/disagreeing that sex was more painful for a circumcised man (odds ratio [OR] = 4.37; p = < .007), a Christian man should not get circumcised (OR = 2.47; p < .001), and circumcision makes penetration more painful and difficult (OR = 2.44; p = .007). Several beliefs about enhanced sexual performance, normative beliefs (parents, sexual partner, and friends), and non-TRA-related factors (e.g., importance of plowing season to daily schedule) were also statistically significant predictors. TRA proved a useful theory to explore young men's intention to circumcise and can help inform interventions aimed at increasing uptake of VMMC.

  9. Informing the scaling up of voluntary medical male circumcision efforts through the use of theory of reasoned action: survey findings among uncircumcised young men in Swaziland.

    PubMed

    Gurman, Tilly A; Dhillon, Preeti; Greene, Jessica L; Makadzange, Panganai; Khumlao, Philisiwe; Shekhar, Navendu

    2015-04-01

    Assessing predictors of intention to circumcise can help to identify effective strategies for increasing uptake of voluntary medical male circumcision (VMMC). Grounded in the theory of reasoned action (TRA), the current study of uncircumcised males ages 13-29 in Swaziland (N = 1,257) employed multivariate logistic regression to determine predictors of VMMC intention. The strongest predictors were strongly disagreeing/disagreeing that sex was more painful for a circumcised man (odds ratio [OR] = 4.37; p = < .007), a Christian man should not get circumcised (OR = 2.47; p < .001), and circumcision makes penetration more painful and difficult (OR = 2.44; p = .007). Several beliefs about enhanced sexual performance, normative beliefs (parents, sexual partner, and friends), and non-TRA-related factors (e.g., importance of plowing season to daily schedule) were also statistically significant predictors. TRA proved a useful theory to explore young men's intention to circumcise and can help inform interventions aimed at increasing uptake of VMMC. PMID:25915700

  10. Ritual male infant circumcision and human rights.

    PubMed

    Jacobs, Allan J; Arora, Kavita Shah

    2015-01-01

    Opponents of male circumcision have increasingly used human rights positions to articulate their viewpoint. We characterize the meaning of the term "human rights." We discuss these human rights arguments with special attention to the claims of rights to an open future and to bodily integrity. We offer a three-part test under which a parental decision might be considered an unacceptable violation of a child's right. The test considers the impact of the practice on society, the impact of the practice on the individual, and the likelihood of adverse impact. Infant circumcision is permissible under this test. We conclude that infant circumcision may be proscribed as violating local norms, even though it does not violate human rights. PMID:25674955

  11. Ritual male infant circumcision and human rights.

    PubMed

    Jacobs, Allan J; Arora, Kavita Shah

    2015-01-01

    Opponents of male circumcision have increasingly used human rights positions to articulate their viewpoint. We characterize the meaning of the term "human rights." We discuss these human rights arguments with special attention to the claims of rights to an open future and to bodily integrity. We offer a three-part test under which a parental decision might be considered an unacceptable violation of a child's right. The test considers the impact of the practice on society, the impact of the practice on the individual, and the likelihood of adverse impact. Infant circumcision is permissible under this test. We conclude that infant circumcision may be proscribed as violating local norms, even though it does not violate human rights.

  12. Behavior Change Pathways to Voluntary Medical Male Circumcision: Narrative Interviews with Circumcision Clients in Zambia

    PubMed Central

    Price, Jessica E.; Phiri, Lyson; Mulenga, Drosin; Hewett, Paul C.; Topp, Stephanie M.; Shiliya, Nicholas; Hatzold, Karin

    2014-01-01

    As an HIV prevention strategy, the scale-up of voluntary medical male circumcision (VMMC) is underway in 14 countries in Africa. For prevention impact, these countries must perform millions of circumcisions in adolescent and adult men before 2015. Although acceptability of VMMC in the region is well documented and service delivery efforts have proven successful, countries remain behind in meeting circumcision targets. A better understanding of men's VMMC-seeking behaviors and experiences is needed to improve communication and interventions to accelerate uptake. To this end, we conducted semi-structured interviews with 40 clients waiting for surgical circumcision at clinics in Zambia. Based on Stages of Change behavioral theory, men were asked to recount how they learned about adult circumcision, why they decided it was right for them, what they feared most, how they overcame their fears, and the steps they took to make it to the clinic that day. Thematic analysis across all cases allowed us to identify key behavior change triggers while within-case analysis elucidated variants of one predominant behavior change pattern. Major stages included: awareness and critical belief adjustment, norming pressures and personalization of advantages, a period of fear management and finally VMMC-seeking. Qualitative comparative analysis of ever-married and never-married men revealed important similarities and differences between the two groups. Unprompted, 17 of the men described one to four failed prior attempts to become circumcised. Experienced more frequently by older men, failed VMMC attempts were often due to service-side barriers. Findings highlight intervention opportunities to increase VMMC uptake. Reaching uncircumcised men via close male friends and female sex partners and tailoring messages to stage-specific concerns and needs would help accelerate men's movement through the behavior change process. Expanding service access is also needed to meet current demand

  13. Behavior change pathways to voluntary medical male circumcision: narrative interviews with circumcision clients in Zambia.

    PubMed

    Price, Jessica E; Phiri, Lyson; Mulenga, Drosin; Hewett, Paul C; Topp, Stephanie M; Shiliya, Nicholas; Hatzold, Karin

    2014-01-01

    As an HIV prevention strategy, the scale-up of voluntary medical male circumcision (VMMC) is underway in 14 countries in Africa. For prevention impact, these countries must perform millions of circumcisions in adolescent and adult men before 2015. Although acceptability of VMMC in the region is well documented and service delivery efforts have proven successful, countries remain behind in meeting circumcision targets. A better understanding of men's VMMC-seeking behaviors and experiences is needed to improve communication and interventions to accelerate uptake. To this end, we conducted semi-structured interviews with 40 clients waiting for surgical circumcision at clinics in Zambia. Based on Stages of Change behavioral theory, men were asked to recount how they learned about adult circumcision, why they decided it was right for them, what they feared most, how they overcame their fears, and the steps they took to make it to the clinic that day. Thematic analysis across all cases allowed us to identify key behavior change triggers while within-case analysis elucidated variants of one predominant behavior change pattern. Major stages included: awareness and critical belief adjustment, norming pressures and personalization of advantages, a period of fear management and finally VMMC-seeking. Qualitative comparative analysis of ever-married and never-married men revealed important similarities and differences between the two groups. Unprompted, 17 of the men described one to four failed prior attempts to become circumcised. Experienced more frequently by older men, failed VMMC attempts were often due to service-side barriers. Findings highlight intervention opportunities to increase VMMC uptake. Reaching uncircumcised men via close male friends and female sex partners and tailoring messages to stage-specific concerns and needs would help accelerate men's movement through the behavior change process. Expanding service access is also needed to meet current demand

  14. Infant Male Circumcision: Healthcare Provider Knowledge and Associated Factors

    PubMed Central

    Starzyk, Erin J.; Kelley, Michele A.; Caskey, Rachel N.; Schwartz, Alan; Kennelly, Joan F.; Bailey, Robert C.

    2015-01-01

    Background and Objectives The emerging science demonstrates various health benefits associated with infant male circumcision and adult male circumcision; yet rates are declining in the United States. The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend that healthcare providers present evidence-based risk and benefit information for infant male circumcision to parent(s) and guardian(s). The purpose of this study was to assess providers’ level of infant male circumcision knowledge and to identify the associated characteristics. Methods An online survey was administered to healthcare providers in the family medicine, obstetrics, and pediatrics medical specialties at an urban academic health center. To assess infant male circumcision knowledge, a 17 point summary score was constructed to identify level of provider knowledge within the survey. Results Ninety-two providers completed the survey. Providers scored high for the following knowledge items: adverse event rates, protects against phimosis and urinary tract infections, and does not prevent hypospadias. Providers scored lower for items related to more recent research: protection against cervical cancer, genital ulcer disease, bacterial vaginosis, and reduction in HIV acquisition. Two models were constructed looking at (1) overall knowledge about male circumcision, and (2) knowledge about male circumcision reduction in HIV acquisition. Pediatricians demonstrated greater overall infant male circumcision knowledge, while obstetricians exhibited significantly greater knowledge for the HIV acquisition item. Conclusion Providers’ knowledge levels regarding the risks and benefits of infant male circumcision are highly variable, indicating the need for system-based educational interventions. PMID:25635664

  15. Effects of adult male circumcision on premature ejaculation: results from a prospective study in China.

    PubMed

    Gao, Jingjing; Xu, Chuan; Zhang, Jingjing; Liang, Chaozhao; Su, Puyu; Peng, Zhen; Shi, Kai; Tang, Dongdong; Gao, Pan; Lu, Zhaoxiang; Liu, Jishuang; Xia, Lei; Yang, Jiajia; Hao, Zongyao; Zhou, Jun; Zhang, Xiansheng

    2015-01-01

    The purpose of this study is to investigate the effects of adult male circumcision on premature ejaculation (PE). Therefore, between December 2009 and March 2014, a total of 575 circumcised men and 623 uncircumcised men (control group) were evaluated. Detailed evaluations (including circumcision and control groups) on PE were conducted before circumcision and at the 3-, 6-, 9-, and 12-month follow-up visits after circumcision. Self-estimated intravaginal ejaculatory latency time (IELT), Patient-Reported Outcome measures, and 5-item version of the International Index of Erectile Function were used to measure the ejaculatory and erectile function for all subjects. The results showed that, during the one-year follow-up, men after circumcision experienced higher IELT and better scores of control over ejaculation, satisfaction with sexual intercourse, and severity of PE than men before circumcision (P < 0.001 for all). Similarly, when compared with the control group, the circumcised men reported significantly improved IELT, control over ejaculation, and satisfaction with sexual intercourse (P < 0.001 for all). These findings suggested that circumcision might have positive effects on IELT, ejaculatory control, sexual satisfaction, and PE severity. In addition, circumcision was significantly associated with the development of PE.

  16. Male Circumcision for the Prevention of Acquisition and Transmission of Sexually Transmitted Infections

    PubMed Central

    Tobian, Aaron A. R.; Gray, Ronald H.; Quinn, Thomas C.

    2010-01-01

    The American Academy of Pediatrics (AAP) male circumcision policy states that while there are potential medical benefits of newborn male circumcision, the data are insufficient to recommend routine neonatal circumcision. Since 2005, however, 3 randomized trials have evaluated male circumcision for prevention of sexually transmitted infections. The trials found that circumcision decreases human immunodeficiency virus acquisition by 53% to 60%, herpes simplex virus type 2 acquisition by 28% to 34%, and human papillomavirus prevalence by 32% to 35% in men. Among female partners of circumcised men, bacterial vaginosis was reduced by 40%, and Trichomonas vaginalis infection was reduced by 48%. Genital ulcer disease was also reduced among males and their female partners. These findings are also supported by observational studies conducted in the United States. The AAP policy has a major impact on neonatal circumcision in the United States. This review evaluates the recent data that support revision of the AAP policy to fully reflect the evidence of long-term health benefits of male circumcision. PMID:20048246

  17. Circumcision

    MedlinePlus

    Foreskin removal; Removal of foreskin; Newborn care - circumcision; Neonatal care - circumcision ... cream. There are several ways to perform a circumcision. Most commonly, the foreskin is pushed from the ...

  18. A qualitative study of sexual behavior change and risk compensation following adult male circumcision in urban Swaziland.

    PubMed

    Grund, Jonathan M; Hennink, Monique M

    2012-01-01

    Male circumcision has been shown to reduce the risk of heterosexual transmission of HIV infection in men by up to 60% in three randomized controlled trials. Less is known, however, about sexual behavior change in men who have been circumcised and whether male circumcision's protective effect leads to riskier sexual behaviors. This study used qualitative in-depth interviews to understand men's sexual behavior after circumcision and to determine whether and how men participated in riskier sexual behaviors following male circumcision. Men in urban Swaziland, circumcised in the previous 12 months, were recruited and asked about their perceptions of sexual risk and sexual behavior post-circumcision. Results showed that following circumcision, men experience changes in both their sexual attitudes and behavior, which can be considered both protective and risky for HIV transmission. Most of them described protective changes (e.g., more responsible attitudes towards safe sex, reducing sexual temptation and partners, easier condom use). A minority, however, experienced increased sexual risk-taking, typically during a brief period of sexual experimentation shortly after circumcision. HIV counseling and counseling throughout the circumcision process is shown to be critical in influencing protective behaviors. Findings in this study confirm the existence of risk compensation following circumcision; however, this study adds important contextual insight about precisely when and why such risk-taking occurs. Nevertheless this study suggests that male circumcision scale-up as an HIV prevention strategy is likely to foster protective behavior change among men. The integration of HIV counseling with circumcision provision remains critical for effectively mitigating HIV risk behavior as male circumcision gains momentum as a viable HIV prevention tool.

  19. Ritual male circumcision: a brief history.

    PubMed

    Doyle, D

    2005-10-01

    Circumcision is arguably the oldest surgical procedure, preformed since before recorded history. This paper looks at its history and speculates on why and how it spread; at what it can teach us about the origins of the Bantu tribes of Southern Africa; all of whom practice circumcision, and finally looks at medical aspects of circumcision and its place in developing societies. PMID:16402509

  20. Adult male circumcision with a circular stapler versus conventional circumcision: A prospective randomized clinical trial.

    PubMed

    Jin, X D; Lu, J J; Liu, W H; Zhou, J; Yu, R K; Yu, B; Zhang, X J; Shen, B H

    2015-06-01

    Male circumcision is the most frequently performed procedure by urologists. Safety and efficacy of the circumcision procedure requires continual improvement. In the present study, we investigated the safety and efficacy of a new male circumcision technique involving the use of a circular stapler. In total, 879 consecutive adult male patients were randomly divided into 2 groups: 441 underwent stapler circumcision, and 438 underwent conventional circumcision. The operative time, pain score, blood loss volume, healing time, treatment costs, and postoperative complications were compared between the two groups. The operative time and blood loss volume were significantly lower in the stapler group than in the conventional group (6.8 ± 3.1 vs 24.2 ± 3.2 min and 1.8 ± 1.8 vs 9.4 ± 1.5 mL, respectively; P<0.01 for both). The intraoperative and postoperative pain scores were significantly lower in the stapler group than in the conventional group (0.8 ± 0.5 vs 2.4 ± 0.8 and 4.0 ±0.9 vs 5.8 ± 1.0, respectively; P<0.01 for both). Additionally, the stapler group had significantly fewer complications than the conventional group (2.7% vs 7.8%, respectively; P<0.01). However, the treatment costs in the stapler group were much higher than those in the conventional group (US$356.60 ± 8.20 vs US$126.50 ± 7.00, respectively; P<0.01). Most patients (388/441, 88.0%) who underwent stapler circumcision required removal of residual staple nails. Overall, the present study has shown that stapler circumcision is a time-efficient and safe male circumcision technique, although it requires further improvement.

  1. Circumcision of male infants as a human rights violation.

    PubMed

    Svoboda, J Steven

    2013-07-01

    Every infant has a right to bodily integrity. Removing healthy tissue from an infant is only permissible if there is an immediate medical indication. In the case of infant male circumcision there is no evidence of an immediate need to perform the procedure. As a German court recently held, any benefit to circumcision can be obtained by delaying the procedure until the male is old enough to give his own fully informed consent. With the option of delaying circumcision providing all of the purported benefits, circumcising an infant is an unnecessary violation of his bodily integrity as well as an ethically invalid form of medical violence. Parental proxy 'consent' for newborn circumcision is invalid. Male circumcision also violates four core human rights documents-the Universal Declaration of Human Rights, the Convention on the Rights of the Child, the International Covenant on Civil and Political Rights, and the Convention Against Torture. Social norm theory predicts that once the circumcision rate falls below a critical value, the social norms that currently distort our perception of the practice will dissolve and rates will quickly fall. PMID:23698885

  2. Voluntary Medical Male Circumcision for HIV Prevention in Swaziland: Modeling the Impact of Age Targeting

    PubMed Central

    Kripke, Katharine; Okello, Velephi; Maziya, Vusi; Benzerga, Wendy; Mirira, Munamato; Gold, Elizabeth; Schnure, Melissa; Sgaier, Sema; Castor, Delivette; Reed, Jason

    2016-01-01

    Background Voluntary medical male circumcision (VMMC) for HIV prevention has been a priority for Swaziland since 2009. Initially focusing on men ages 15–49, the Ministry of Health reduced the minimum age for VMMC from 15 to 10 years in 2012, given the existing demand among 10- to 15-year-olds. To understand the implications of focusing VMMC service delivery on specific age groups, the MOH undertook a modeling exercise to inform policy and implementation in 2013–2014. Methods and Findings The impact and cost of circumcising specific age groups were assessed using the Decision Makers’ Program Planning Tool, Version 2.0 (DMPPT 2.0), a simple compartmental model. We used age-specific HIV incidence from the Swaziland HIV Incidence Measurement Survey (SHIMS). Population, mortality, births, and HIV prevalence were imported from a national Spectrum/Goals model recently updated in consultation with country stakeholders. Baseline male circumcision prevalence was derived from the most recent Swaziland Demographic and Health Survey. The lowest numbers of VMMCs per HIV infection averted are achieved when males ages 15–19, 20–24, 25–29, and 30–34 are circumcised, although the uncertainty bounds for the estimates overlap. Circumcising males ages 25–29 and 20–24 provides the most immediate reduction in HIV incidence. Circumcising males ages 15–19, 20–24, and 25–29 provides the greatest magnitude incidence reduction within 15 years. The lowest cost per HIV infection averted is achieved by circumcising males ages 15–34: $870 U.S. dollars (USD). Conclusions The potential impact, cost, and cost-effectiveness of VMMC scale-up in Swaziland are not uniform. They vary by the age group of males circumcised. Based on the results of this modeling exercise, the Ministry of Health’s Swaziland Male Circumcision Strategic and Operational Plan 2014–2018 adopted an implementation strategy that calls for circumcision to be scaled up to 50% coverage for neonates, 80

  3. Critical evaluation of unscientific arguments disparaging affirmative infant male circumcision policy.

    PubMed

    Morris, Brian J; Krieger, John N; Klausner, Jeffrey D

    2016-08-01

    We evaluate recent claims opposing infant male circumcision, a procedure now supported by the evidence-based policy of the American Academy of Pediatrics. We find those criticisms depend on speculative claims about the foreskin and obfuscation of the strong scientific evidence supporting pediatric policy development. An argument that circumcision should be delayed to allow a boy to make up his own mind as an adult fails to appreciate the psychological, scheduling and financial burdens later circumcision entails, so reducing the likelihood that it will occur. In contrast, early infant circumcision is convenient, safer, quicker, lower risk, healing is faster, cosmetic outcome is routinely good and the lifetime benefits accrue immediately. Benefits include reduction in urinary tract infections, inflammatory skin conditions, foreskin problems, and, when older, substantial protection against sexually transmitted infections and genital cancers in the male and his female sexual partners. Some authorities regard the failure to offer parents early infant circumcision as unethical, just as it would be unethical to fail to encourage the vaccination of children. In conclusion, the criticisms of evidence-based infant male circumcision policy are seriously flawed and should be dismissed as unhelpful to evidence-based development and implementation of pediatric policy intended to improve public health and individual wellbeing.

  4. Critical evaluation of unscientific arguments disparaging affirmative infant male circumcision policy

    PubMed Central

    Morris, Brian J; Krieger, John N; Klausner, Jeffrey D

    2016-01-01

    We evaluate recent claims opposing infant male circumcision, a procedure now supported by the evidence-based policy of the American Academy of Pediatrics. We find those criticisms depend on speculative claims about the foreskin and obfuscation of the strong scientific evidence supporting pediatric policy development. An argument that circumcision should be delayed to allow a boy to make up his own mind as an adult fails to appreciate the psychological, scheduling and financial burdens later circumcision entails, so reducing the likelihood that it will occur. In contrast, early infant circumcision is convenient, safer, quicker, lower risk, healing is faster, cosmetic outcome is routinely good and the lifetime benefits accrue immediately. Benefits include reduction in urinary tract infections, inflammatory skin conditions, foreskin problems, and, when older, substantial protection against sexually transmitted infections and genital cancers in the male and his female sexual partners. Some authorities regard the failure to offer parents early infant circumcision as unethical, just as it would be unethical to fail to encourage the vaccination of children. In conclusion, the criticisms of evidence-based infant male circumcision policy are seriously flawed and should be dismissed as unhelpful to evidence-based development and implementation of pediatric policy intended to improve public health and individual wellbeing.

  5. Critical evaluation of unscientific arguments disparaging affirmative infant male circumcision policy

    PubMed Central

    Morris, Brian J; Krieger, John N; Klausner, Jeffrey D

    2016-01-01

    We evaluate recent claims opposing infant male circumcision, a procedure now supported by the evidence-based policy of the American Academy of Pediatrics. We find those criticisms depend on speculative claims about the foreskin and obfuscation of the strong scientific evidence supporting pediatric policy development. An argument that circumcision should be delayed to allow a boy to make up his own mind as an adult fails to appreciate the psychological, scheduling and financial burdens later circumcision entails, so reducing the likelihood that it will occur. In contrast, early infant circumcision is convenient, safer, quicker, lower risk, healing is faster, cosmetic outcome is routinely good and the lifetime benefits accrue immediately. Benefits include reduction in urinary tract infections, inflammatory skin conditions, foreskin problems, and, when older, substantial protection against sexually transmitted infections and genital cancers in the male and his female sexual partners. Some authorities regard the failure to offer parents early infant circumcision as unethical, just as it would be unethical to fail to encourage the vaccination of children. In conclusion, the criticisms of evidence-based infant male circumcision policy are seriously flawed and should be dismissed as unhelpful to evidence-based development and implementation of pediatric policy intended to improve public health and individual wellbeing. PMID:27610340

  6. Critical evaluation of unscientific arguments disparaging affirmative infant male circumcision policy.

    PubMed

    Morris, Brian J; Krieger, John N; Klausner, Jeffrey D

    2016-08-01

    We evaluate recent claims opposing infant male circumcision, a procedure now supported by the evidence-based policy of the American Academy of Pediatrics. We find those criticisms depend on speculative claims about the foreskin and obfuscation of the strong scientific evidence supporting pediatric policy development. An argument that circumcision should be delayed to allow a boy to make up his own mind as an adult fails to appreciate the psychological, scheduling and financial burdens later circumcision entails, so reducing the likelihood that it will occur. In contrast, early infant circumcision is convenient, safer, quicker, lower risk, healing is faster, cosmetic outcome is routinely good and the lifetime benefits accrue immediately. Benefits include reduction in urinary tract infections, inflammatory skin conditions, foreskin problems, and, when older, substantial protection against sexually transmitted infections and genital cancers in the male and his female sexual partners. Some authorities regard the failure to offer parents early infant circumcision as unethical, just as it would be unethical to fail to encourage the vaccination of children. In conclusion, the criticisms of evidence-based infant male circumcision policy are seriously flawed and should be dismissed as unhelpful to evidence-based development and implementation of pediatric policy intended to improve public health and individual wellbeing. PMID:27610340

  7. Infant male circumcision and the autonomy of the child: two ethical questions.

    PubMed

    McMath, Akim

    2015-08-01

    Routine neonatal circumcision--the non-therapeutic circumcision of infant males--has generated considerable ethical controversy. In this article, I suggest that much of the disagreement results from conflicting ideas about the autonomy of the child. I examine two questions about autonomy. First, I ask whether we should be realists or idealists about the future autonomous choices of the child-that is, whether we should account for the fact that the child may not make the best choices in future, or whether we should assume that his future choices will reflect his best interests. Second, I ask whether the child has a right to autonomy with respect to circumcision, an interest in autonomy or neither--that is, whether respect for autonomy overrides considerations of interests, whether it counts as one interest among many or whether it counts for nothing. In response to the first question, I argue that we should be idealists when evaluating the child's own interests, but realists when evaluating public health justifications for circumcision. In response to the second question, I argue that the child has an interest in deciding whether or not to be circumcised, insofar as the decision is more likely to reflect his actual interests and his own values. Finally, I show how these findings may help to resolve some particular disputes over the ethics of infant male circumcision.

  8. Costs and Effectiveness of Neonatal Male Circumcision

    PubMed Central

    Kacker, Seema; Frick, Kevin D.; Gaydos, Charlotte A.; Tobian, Aaron A. R.

    2013-01-01

    Objective To evaluate the expected change in the prevalence of male circumcision (MC)–reduced infections and resulting health care costs associated with continued decreases in MC rates. During the past 20 years, MC rates have declined from 79% to 55%, alongside reduced insurance coverage. Design We used Markov-based Monte Carlo simulations to track men and women throughout their lifetimes as they experienced MC procedure-related events and MC-reduced infections and accumulated associated costs. One-way and probabilistic sensitivity analyses were used to evaluate the impact of uncertainty. Setting United States. Participants Birth cohort of men and women. Intervention Decreased MC rates (10% reflects the MC rate in Europe, where insurance coverage is limited). Outcomes Measured Lifetime direct medical cost (2011 US$) and prevalence of MC-reduced infections. Results Reducing the MC rate to 10% will increase lifetime health care costs by $407 per male and $43 per female. Net expenditure per annual birth cohort (including procedure and complication costs) is expected to increase by $505 million, reflecting an increase of $313 per forgone MC. Over 10 annual cohorts, net present value of additional costs would exceed $4.4 billion. Lifetime prevalence of human immunodeficiency virus infection among males is expected to increase by 12.2% (4843 cases), high- and low-risk human papillomavirus by 29.1% (57 124 cases), herpes simplex virus type 2 by 19.8% (124 767 cases), and infant urinary tract infections by 211.8% (26 876 cases). Among females, lifetime prevalence of bacterial vaginosis is expected to increase by 51.2% (538 865 cases), trichomoniasis by 51.2% (64 585 cases), high-risk human papillomavirus by 18.3% (33 148 cases), and low-risk human papillomavirus by 12.9% (25 837 cases). Increased prevalence of human immunodeficiency virus infection among males represents 78.9% of increased expenses. Conclusion Continued decreases in MC rates are associated with increased

  9. Male Circumcision and HIV Transmission; What Do We Know?

    PubMed Central

    Jayathunge, Parana H.M; McBride, William J.H; MacLaren, David; Kaldor, John; Vallely, Andrew; Turville, Stuart

    2014-01-01

    Male circumcision (MC) has been shown to be protective against heterosexual HIV transmission and is being explored in some parts of the world as a means of combating the epidemic. The World Health Organization (WHO) recommends that MC be considered as an important component of HIV prevention in high prevalence settings. We review evidence that demonstrates that the inner foreskin is likely to be the main portal of entry for the HIV virus in males. Whether removal of the inner foreskin accounts for all the protection afforded by circumcision is yet to be established. The proposed mechanisms of protection range from inherent immunohistological factors of foreskin such as difference in thickness of keratin layer and density of target cells for HIV between inner and outer foreskin to physiological mechanisms that follow male circumcision such as drying of secretions underneath foreskin after sexual intercourse, loss of microbiome that attract target cells to the genital mucosa and lack of priming the genital mucosa with less abundant sexual transmitted infections among circumcised men. The aim of this review is to give an updated account on the mechanisms proposed so far on the demonstrated 50-70% protection from HIV transmission through heterosexual intercourse, by male circumcision. PMID:25317221

  10. Circumcision

    MedlinePlus

    Circumcision is a surgical procedure to remove the foreskin, the skin that covers the tip of the ... AAP), there are medical benefits and risks to circumcision. Possible benefits include a lower risk of urinary ...

  11. Effects of circumcision on male sexual functions: a systematic review and meta-analysis.

    PubMed

    Tian, Ye; Liu, Wei; Wang, Jian-Zhong; Wazir, Romel; Yue, Xuan; Wang, Kun-Jie

    2013-09-01

    This meta-analysis was performed to assess sexual functions following adult male circumcision. We searched the Cochrane Central Register of Controlled Trials, PUBMED, EMBASE, the Cochrane Database of Systematic Review and Web of Science from their inception until January 2013 to identify all eligible studies that reported on men's sexual function after circumcision. The Cochrane Collaboration's RevMan 5.2 software was employed for data analysis, and the fixed or the random effect model was selected depending on the proportion of heterogeneity. We identified 10 studies, which described a total of 9317 circumcised and 9423 uncircumcised men who were evaluated for the association of circumcision with male sexual function. There were no significant differences in sexual desire (odds ratio (OR): 0.99; 95% confidence interval (CI): 0.92-1.06), dyspareunia (OR: 1.12; 95% CI: 0.52-2.44), premature ejaculation (OR: 1.13; 95% CI: 0.83-1.54), ejaculation latency time (OR: 1.33; 95% CI: 0.69-1.97), erectile dysfunctions (OR: 0.90; 95% CI: 0.65-1.25) and orgasm difficulties (OR: 0.97; 95% CI: 0.83-1.13). These findings suggest that circumcision is unlikely to adversely affect male sexual functions. However, these results should be evaluated in light of the low quality of the existing evidence and the significant heterogeneity across the various studies. Well-designed and prospective studies are required for a further understanding of this topic.

  12. Newborn Male Circumcision with Parental Consent, as Stated in the AAP Circumcision Policy Statement, Is Both Legal and Ethical.

    PubMed

    Brady, Michael T

    2016-06-01

    Newborn male circumcision is a minor surgical procedure that has generated significant controversy. Accumulating evidence supports significant health benefits, most notably reductions in urinary tract infections, acquisition of HIV and a number of other sexually transmitted infections, penile cancer, phimosis, paraphimosis, balanitis and lichen sclerosis. While circumcision, like any surgical procedure, has risks for complications, they occur in less than 1 in 500 infants circumcised and most are minor and require minimal intervention. The CDC and the American Academy of Pediatrics (AAP) believe that health benefits of circumcision outweigh the risks. For this reason, the AAP believes that parents should be allowed to make the decision concerning circumcision of their male infants after receiving non-biased information on health risks and health benefits.

  13. Newborn Male Circumcision with Parental Consent, as Stated in the AAP Circumcision Policy Statement, Is Both Legal and Ethical.

    PubMed

    Brady, Michael T

    2016-06-01

    Newborn male circumcision is a minor surgical procedure that has generated significant controversy. Accumulating evidence supports significant health benefits, most notably reductions in urinary tract infections, acquisition of HIV and a number of other sexually transmitted infections, penile cancer, phimosis, paraphimosis, balanitis and lichen sclerosis. While circumcision, like any surgical procedure, has risks for complications, they occur in less than 1 in 500 infants circumcised and most are minor and require minimal intervention. The CDC and the American Academy of Pediatrics (AAP) believe that health benefits of circumcision outweigh the risks. For this reason, the AAP believes that parents should be allowed to make the decision concerning circumcision of their male infants after receiving non-biased information on health risks and health benefits. PMID:27338601

  14. Perceptions and knowledge of voluntary medical male circumcision for HIV prevention in traditionally non-circumcising communities in South Africa.

    PubMed

    Hoffman, Jacob Robin; Arendse, Kirsten D; Larbi, Carl; Johnson, Naomi; Vivian, Lauraine M H

    2015-01-01

    Voluntary medical male circumcision (VMMC) has been recommended for the prevention of HIV transmission, particularly in sub-Saharan Africa. Uptake of the campaign has been relatively poor, particularly in traditionally non-circumcising regions. This study evaluates the knowledge, attitudes and practices of medical male circumcision (MC) of 104 community members exposed to promotional campaigns for VMMC for five years. Results show that 93% of participants have heard of circumcision and 72% have heard of some health benefit from the practice. However, detailed knowledge of the relationship with HIV infection is lacking: 12.2% mistakenly believed you could not get HIV after being circumcised, while 75.5% believe that a circumcised man is still susceptible and another 12.2% do not know of any relationship between HIV and MC. There are significant barriers to the uptake of the practice, including misperceptions and fear of complications commonly attributed to traditional, non-medical circumcision. However, 88.8% of participants believe circumcision is an acceptable practice, and community-specific promotional campaigns may increase uptake of the service.

  15. The perceptions on male circumcision as a preventive measure against HIV infection and considerations in scaling up of the services: a qualitative study among police officers in Dar es Salaam, Tanzania

    PubMed Central

    2012-01-01

    coverage at early childhood. The findings from this investigation provide contextual understanding that may assist in scaling-up male circumcision in Tanzania. PMID:22812484

  16. Ability and willingness to pay for voluntary medical male circumcision: a cross-sectional survey in Kisumu County, Kenya.

    PubMed

    Wandei, Stephen; Nangami, Mabel; Egesa, Omar

    2016-01-01

    Voluntary medical male circumcision is one of the most effective measures in preventing male acquisition of HIV during heterosexual intercourse. In Kenya, the voluntary medical male circumcision programme was launched in the year 2008 as part of a comprehensive national HIV prevention strategy. With the global challenge of funding HIV intervention programs, the sustainability of the programme beyond the donor periods need to be assessed. The purpose of this study was to determine the household ability and willingness to pay for voluntary medical male circumcision as an alternative method of funding the programme. The findings show that 62.2% of the households were "able" to pay for medical circumcision. However, 60.4% of them were not "willing" to pay for the service regardless of the cost. The findings indicate that ability to pay is not a significant predictor of willingness to pay for voluntary medical male circumcision within Kisumu County. Knowledge on the role of medical circumcision is a more important factor in determining willingness to pay for the service.

  17. Triggering the decision to undergo medical male circumcision: a qualitative study of adult men in Botswana.

    PubMed

    Wirth, Kathleen E; Semo, Bazghina-Werq; Ntsuape, Conrad; Ramabu, Nankie M; Otlhomile, Boyce; Plank, Rebeca M; Barnhart, Scott; Ledikwe, Jenny H

    2016-08-01

    In 2007, the World Health Organization endorsed voluntary medical male circumcision (VMMC) as part of comprehensive HIV-prevention strategies. A major challenge facing VMMC programs in sub-Saharan Africa remains demand creation; there is urgent need for data on key elements needed to trigger the decision among eligible men to seek VMMC. Using qualitative methods, we sought to better understand the circumcision decision-making process in Botswana related to VMMC. From July to November 2013, we conducted 27 focus group discussions in four purposively selected communities in Botswana with men (stratified by circumcision status and age), women (stratified by age) and community leaders. All discussions were facilitated by a trained same-sex interviewer, audio recorded, transcribed and translated to English, and analyzed for key themes using an inductive content analytic approach. Improved hygiene was frequently cited as a major benefit of circumcision and many participants believed that cleanliness was directly responsible for the protective effect of VMMC on HIV infection. While protection against HIV was frequently noted as a benefit of VMMC, the data indicate that increased sexual pleasure and perceived attractiveness, not fear of HIV infection, was an underlying reason why men sought VMMC. Data from this qualitative study suggest that more immediate benefits of VMMC, such as improved hygiene and sexual pleasure, play a larger role in the circumcision decision compared with protection from potential HIV infection. These findings have immediate implications for targeted demand creation and mobilization activities for increasing uptake of VMMC among adult men in Botswana.

  18. Achieving the HIV prevention impact of voluntary medical male circumcision: lessons and challenges for managing programs.

    PubMed

    Sgaier, Sema K; Reed, Jason B; Thomas, Anne; Njeuhmeli, Emmanuel

    2014-05-01

    Voluntary medical male circumcision (VMMC) is capable of reducing the risk of sexual transmission of HIV from females to males by approximately 60%. In 2007, the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended making VMMC part of a comprehensive HIV prevention package in countries with a generalized HIV epidemic and low rates of male circumcision. Modeling studies undertaken in 2009-2011 estimated that circumcising 80% of adult males in 14 priority countries in Eastern and Southern Africa within five years, and sustaining coverage levels thereafter, could avert 3.4 million HIV infections within 15 years and save US$16.5 billion in treatment costs. In response, WHO/UNAIDS launched the Joint Strategic Action Framework for accelerating the scale-up of VMMC for HIV prevention in Southern and Eastern Africa, calling for 80% coverage of adult male circumcision by 2016. While VMMC programs have grown dramatically since inception, they appear unlikely to reach this goal. This review provides an overview of findings from the PLOS Collection "Voluntary Medical Male Circumcision for HIV Prevention: Improving Quality, Efficiency, Cost Effectiveness, and Demand for Services during an Accelerated Scale-up." The use of devices for VMMC is also explored. We propose emphasizing management solutions to help VMMC programs in the priority countries achieve the desired impact of averting the greatest possible number of HIV infections. Our recommendations include advocating for prioritization and funding of VMMC, increasing strategic targeting to achieve the goal of reducing HIV incidence, focusing on programmatic efficiency, exploring the role of new technologies, rethinking demand creation, strengthening data use for decision-making, improving governments' program management capacity, strategizing for sustainability, and maintaining a flexible scale-up strategy informed by a strong monitoring, learning, and evaluation platform.

  19. Achieving the HIV prevention impact of voluntary medical male circumcision: lessons and challenges for managing programs.

    PubMed

    Sgaier, Sema K; Reed, Jason B; Thomas, Anne; Njeuhmeli, Emmanuel

    2014-05-01

    Voluntary medical male circumcision (VMMC) is capable of reducing the risk of sexual transmission of HIV from females to males by approximately 60%. In 2007, the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended making VMMC part of a comprehensive HIV prevention package in countries with a generalized HIV epidemic and low rates of male circumcision. Modeling studies undertaken in 2009-2011 estimated that circumcising 80% of adult males in 14 priority countries in Eastern and Southern Africa within five years, and sustaining coverage levels thereafter, could avert 3.4 million HIV infections within 15 years and save US$16.5 billion in treatment costs. In response, WHO/UNAIDS launched the Joint Strategic Action Framework for accelerating the scale-up of VMMC for HIV prevention in Southern and Eastern Africa, calling for 80% coverage of adult male circumcision by 2016. While VMMC programs have grown dramatically since inception, they appear unlikely to reach this goal. This review provides an overview of findings from the PLOS Collection "Voluntary Medical Male Circumcision for HIV Prevention: Improving Quality, Efficiency, Cost Effectiveness, and Demand for Services during an Accelerated Scale-up." The use of devices for VMMC is also explored. We propose emphasizing management solutions to help VMMC programs in the priority countries achieve the desired impact of averting the greatest possible number of HIV infections. Our recommendations include advocating for prioritization and funding of VMMC, increasing strategic targeting to achieve the goal of reducing HIV incidence, focusing on programmatic efficiency, exploring the role of new technologies, rethinking demand creation, strengthening data use for decision-making, improving governments' program management capacity, strategizing for sustainability, and maintaining a flexible scale-up strategy informed by a strong monitoring, learning, and evaluation platform. PMID:24800840

  20. Achieving the HIV Prevention Impact of Voluntary Medical Male Circumcision: Lessons and Challenges for Managing Programs

    PubMed Central

    Sgaier, Sema K.; Reed, Jason B.; Thomas, Anne; Njeuhmeli, Emmanuel

    2014-01-01

    Voluntary medical male circumcision (VMMC) is capable of reducing the risk of sexual transmission of HIV from females to males by approximately 60%. In 2007, the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended making VMMC part of a comprehensive HIV prevention package in countries with a generalized HIV epidemic and low rates of male circumcision. Modeling studies undertaken in 2009–2011 estimated that circumcising 80% of adult males in 14 priority countries in Eastern and Southern Africa within five years, and sustaining coverage levels thereafter, could avert 3.4 million HIV infections within 15 years and save US$16.5 billion in treatment costs. In response, WHO/UNAIDS launched the Joint Strategic Action Framework for accelerating the scale-up of VMMC for HIV prevention in Southern and Eastern Africa, calling for 80% coverage of adult male circumcision by 2016. While VMMC programs have grown dramatically since inception, they appear unlikely to reach this goal. This review provides an overview of findings from the PLOS Collection “Voluntary Medical Male Circumcision for HIV Prevention: Improving Quality, Efficiency, Cost Effectiveness, and Demand for Services during an Accelerated Scale-up.” The use of devices for VMMC is also explored. We propose emphasizing management solutions to help VMMC programs in the priority countries achieve the desired impact of averting the greatest possible number of HIV infections. Our recommendations include advocating for prioritization and funding of VMMC, increasing strategic targeting to achieve the goal of reducing HIV incidence, focusing on programmatic efficiency, exploring the role of new technologies, rethinking demand creation, strengthening data use for decision-making, improving governments' program management capacity, strategizing for sustainability, and maintaining a flexible scale-up strategy informed by a strong monitoring, learning, and evaluation platform. PMID:24800840

  1. Fournier’s gangrene after adult male circumcision

    PubMed Central

    2014-01-01

    Background In the advent of mass voluntary medical male circumcision (VMMC) for the partial prevention of HIV, previously rare adverse events associated with adult male circumcision are likely to be encountered with higher frequency. Fournier’s gangrene, defined as a polymicrobial necrotizing fasciitis of the perineal, perianal or genital areas, is one such rare and life-threatening adverse event. In this report, we present two cases that were identified in the context of a VMMC programme over a 3-year period during which approximately 100,000 adult circumcisions were performed. Case presentations Case 1: A 19-year-old male who had VMMC performed using the dorsal slit technique developed pain and blisters on the scrotal skin on the sixth postoperative day. He had no co-morbidities, and serology for HIV was negative. On examination, locally he had scrotal skin necrosis with an offensive odour and was dehydrated but afebrile. Repeated aggressive debridement was done while he stayed in a hospital for 3 weeks; at which point, he had healthy granulation tissue and was free of infection. The wound had closed spontaneously and completely by the fifth month. Case 2: A 52-year-old male who had VMMC performed with the sleeve resection method developed pain and swelling of the penis and scrotum on the fourth postoperative day. He had a low-grade fever of 37.6°C. He was not diabetic or immunosuppressed and had a negative HIV serology. He was admitted and was given IV antibiotics, and repeated aggressive debridement was performed. On the third week of hospitalization, he had healthy granulation tissue and received a split skin graft on the penile shaft. At 4 months, the scrotal defect had completely closed. Conclusion Fournier’s gangrene is a rare occurrence after adult male circumcision with associated high morbidity. These are the first descriptions in the VMMC era. PMID:25635197

  2. Traditional Male Circumcision in Uganda: A Qualitative Focus Group Discussion Analysis

    PubMed Central

    Sabet Sarvestani, Amir; Bufumbo, Leonard; Geiger, James D.; Sienko, Kathleen H.

    2012-01-01

    Background The growing body of evidence attesting to the effectiveness of clinical male circumcision in the prevention of HIV/AIDS transmission is prompting the majority of sub-Saharan African governments to move towards the adoption of voluntary medical male circumcision (VMMC). Even though it is recommended to consider collaboration with traditional male circumcision (TMC) providers when planning for VMMC, there is limited knowledge available about the TMC landscape and traditional beliefs. Methodology and Main Findings During 2010–11 over 25 focus group discussions (FGDs) were held with clan leaders, traditional cutters, and their assistants to understand the practice of TMC in four ethnic groups in Uganda. Cultural significance and cost were among the primary reasons cited for preferring TMC over VMMC. Ethnic groups in western Uganda circumcised boys at younger ages and encountered lower rates of TMC related adverse events compared to ethnic groups in eastern Uganda. Cutting styles and post-cut care also differed among the four groups. The use of a single razor blade per candidate instead of the traditional knife was identified as an important and recent change. Participants in the focus groups expressed interest in learning about methods to reduce adverse events. Conclusion This work reaffirmed the strong cultural significance of TMC within Ugandan ethnic groups. Outcomes suggest that there is an opportunity to evaluate the involvement of local communities that still perform TMC in the national VMMC roll-out plan by devising safer, more effective procedures through innovative approaches. PMID:23082112

  3. Need for Physician Education on the Benefits and Risks of Male Circumcision in the United States

    ERIC Educational Resources Information Center

    Carbery, Baevin; Zhu, Julia; Gust, Deborah A.; Chen, Robert T.; Kretsinger, Katrina; Kilmarx, Peter H.

    2012-01-01

    Physicians may be called upon to counsel male patients or parents of newborn males regarding their decision to circumcise their newborn sons. The purpose of the present study was to describe physicians who do not understand the benefits and risks associated with male circumcision well enough to counsel parents of newborn male infants and adult…

  4. Bodily Integrity and Male Circumcision: An Islamic Perspective

    PubMed Central

    Alahmad, Ghiath; Dekkers, Wim

    2012-01-01

    The notion of bodily integrity forms an important part of the value-structure of many religions and cultures. In this paper, we explore the notion of bodily integrity in Islam using male circumcision as the focus of the discussion. Our aim is to contribute to a better understanding of the Muslim perspective and of the differences and similarities between Western and Islamic ethical structures, in particular, regarding the concept of bodily integrity. PMID:23610746

  5. The Cost of Voluntary Medical Male Circumcision in South Africa

    PubMed Central

    Tchuenche, Michel; Palmer, Eurica; Haté, Vibhuti; Thambinayagam, Ananthy; Loykissoonlal, Dayanund; Forsythe, Steven

    2016-01-01

    Given compelling evidence associating voluntary medical male circumcision (VMMC) with men’s reduced HIV acquisition through heterosexual intercourse, South Africa in 2010 began scaling up VMMC. To project the resources needed to complete 4.3 million circumcisions between 2010 and 2016, we (1) estimated the unit cost to provide VMMC; (2) assessed cost drivers and cost variances across eight provinces and VMMC service delivery modes; and (3) evaluated the costs associated with mobilize and motivate men and boys to access VMMC services. Cost data were systematically collected and analyzed using a provider’s perspective from 33 Government and PEPFAR-supported (U.S. President's Emergency Plan for AIDS Relief) urban, rural, and peri-urban VMMC facilities. The cost per circumcision performed in 2014 was US$132 (R1,431): higher in public hospitals (US$158 [R1,710]) than in health centers and clinics (US$121 [R1,309]). There was no substantial difference between the cost at fixed circumcision sites and fixed sites that also offer outreach services. Direct labor costs could be reduced by 17% with task shifting from doctors to professional nurses; this could have saved as much as $15 million (R163.20 million) in 2015, when the goal was 1.6 million circumcisions. About $14.2 million (R154 million) was spent on medical male circumcision demand creation in South Africa in 2014—primarily on personnel, including community mobilizers (36%), and on small and mass media promotions (35%). Calculating the unit cost of VMMC demand creation was daunting, because data on the denominator (number of people reached with demand creation messages or number of people seeking VMMC as a result of demand creation) were not available. Because there are no “dose-response” data on demand creation ($X in demand creation will result in an additional Z% increase in VMMC clients), research is needed to determine the appropriate amount and allocation of demand creation resources. PMID:27783612

  6. On the impermissibility of infant male circumcision: a response to Mazor (2013).

    PubMed

    Ungar-Sargon, Eliyahu

    2015-02-01

    This is a response to Dr Joseph Mazor's paper 'The child's interests and the case for the permissibility of male infant circumcision.' I argue that Dr Mazor fails to prove that bodily integrity and self-determination are mere interests as opposed to genuine rights in the case of infant male circumcision. Moreover, I cast doubt on the interest calculus that Dr Mazor employs to arrive at his conclusions about circumcision.

  7. Attitudes, Perceptions and Potential Uptake of Male Circumcision among Older Men in Turkana County, Kenya Using Qualitative Methods

    PubMed Central

    Macintyre, Kate; Andrinopoulos, Katherine; Moses, Natome; Bornstein, Marta; Ochieng, Athanasius; Peacock, Erin; Bertrand, Jane

    2014-01-01

    Background In many communities, older men (i.e., over 25 years of age) have not come forward for Voluntary Medical Male Circumcision (VMMC) services. Reasons for low demand among this group of men are not well understood, and may vary across geographic and cultural contexts. This paper examines the facilitators and barriers to VMMC demand in Turkana County, Kenya, with a focus on older men. This is one of the regions targeted by the VMMC program in Kenya because the Turkana ethnic group does not traditionally circumcise, and the rates of HIV and STD transmission are high. Methods and Findings Twenty focus group discussions and 69 in-depth interviews were conducted with circumcised and uncircumcised men and their partners to elicit their attitudes and perceptions toward male circumcision. The interviews were conducted in urban, peri-urban, and rural communities across Turkana. Our results show that barriers to circumcision include stigma associated with VMMC, the perception of low risk for HIV for older men and their “protection by marriage,” cultural norms, and a lack of health infrastructure. Facilitators include stigma against not being circumcised (since circumcision is associated with modernity), protection against disease including HIV, and cleanliness. It was also noted that older men should adopt the practice to serve as role models to younger men. Conclusions Both men and women were generally supportive of VMMC, but overcoming barriers with appropriate communication messages and high quality services will be challenging. The justification of circumcision being a biomedical procedure for protection against HIV will be the most important message for any communication strategy. PMID:24802112

  8. Voluntary Medical Male Circumcision: Logistics, Commodities, and Waste Management Requirements for Scale-Up of Services

    PubMed Central

    Edgil, Dianna; Stankard, Petra; Forsythe, Steven; Rech, Dino; Chrouser, Kristin; Adamu, Tigistu; Sakallah, Sameer; Thomas, Anne Goldzier; Albertini, Jennifer; Stanton, David; Dickson, Kim Eva; Njeuhmeli, Emmanuel

    2011-01-01

    Background The global HIV prevention community is implementing voluntary medical male circumcision (VMMC) programs across eastern and southern Africa, with a goal of reaching 80% coverage in adult males by 2015. Successful implementation will depend on the accessibility of commodities essential for VMMC programming and the appropriate allocation of resources to support the VMMC supply chain. For this, the United States President’s Emergency Plan for AIDS Relief, in collaboration with the World Health Organization and the Joint United Nations Programme on HIV/AIDS, has developed a standard list of commodities for VMMC programs. Methods and Findings This list of commodities was used to inform program planning for a 1-y program to circumcise 152,000 adult men in Swaziland. During this process, additional key commodities were identified, expanding the standard list to include commodities for waste management, HIV counseling and testing, and the treatment of sexually transmitted infections. The approximate costs for the procurement of commodities, management of a supply chain, and waste disposal, were determined for the VMMC program in Swaziland using current market prices of goods and services. Previous costing studies of VMMC programs did not capture supply chain costs, nor the full range of commodities needed for VMMC program implementation or waste management. Our calculations indicate that depending upon the volume of services provided, supply chain and waste management, including commodities and associated labor, contribute between US$58.92 and US$73.57 to the cost of performing one adult male circumcision in Swaziland. Conclusions Experience with the VMMC program in Swaziland indicates that supply chain and waste management add approximately US$60 per circumcision, nearly doubling the total per procedure cost estimated previously; these additional costs are used to inform the estimate of per procedure costs modeled by Njeuhmeli et al. in “Voluntary Medical

  9. Age Targeting of Voluntary Medical Male Circumcision Programs Using the Decision Makers’ Program Planning Toolkit (DMPPT) 2.0

    PubMed Central

    Kripke, Katharine; Opuni, Marjorie; Schnure, Melissa; Sgaier, Sema; Castor, Delivette; Reed, Jason; Stover, John

    2016-01-01

    Background Despite considerable efforts to scale up voluntary medical male circumcision (VMMC) for HIV prevention in priority countries over the last five years, implementation has faced important challenges. Seeking to enhance the effect of VMMC programs for greatest and most immediate impact, the U. S. President’s Plan for AIDS Relief (PEPFAR) supported the development and application of a model to inform national planning in five countries from 2013–2014. Methods and Findings The Decision Makers’ Program Planning Toolkit (DMPPT) 2.0 is a simple compartmental model designed to analyze the effects of client age and geography on program impact and cost. The DMPPT 2.0 model was applied in Malawi, South Africa, Swaziland, Tanzania, and Uganda to assess the impact and cost of scaling up age-targeted VMMC coverage. The lowest number of VMMCs per HIV infection averted would be produced by circumcising males ages 20–34 in Malawi, South Africa, Tanzania, and Uganda and males ages 15–34 in Swaziland. The most immediate impact on HIV incidence would be generated by circumcising males ages 20–34 in Malawi, South Africa, Tanzania, and Uganda and males ages 20–29 in Swaziland. The greatest reductions in HIV incidence over a 15-year period would be achieved by strategies focused on males ages 10–19 in Uganda, 15–24 in Malawi and South Africa, 10–24 in Tanzania, and 15–29 in Swaziland. In all countries, the lowest cost per HIV infection averted would be achieved by circumcising males ages 15–34, although in Uganda this cost is the same as that attained by circumcising 15- to 49-year-olds. Conclusions The efficiency, immediacy of impact, magnitude of impact, and cost-effectiveness of VMMC scale-up are not uniform; there is important variation by age group of the males circumcised and countries should plan accordingly. PMID:27410966

  10. Feasibility and Effectiveness of a Peer Referral Incentive Intervention to Promote Male Circumcision Uptake in Zambia

    PubMed Central

    Bolton, Carolyn; Lyabola, Lane-Lee; Phiri, Gabriel; Samona, Alick; Kaonga, Albert; Thirumurthy, Harsha

    2016-01-01

    Background: Medical male circumcision is a promising HIV prevention tool in countries with generalized HIV epidemics, but demand creation interventions are needed to support scale-up. We piloted a peer referral intervention in which circumcision clients were offered incentives for referring their peers for circumcision. Methods: The intervention was implemented between June 2014 and February 2015 in 6 randomly selected health facilities in Southern Province, Zambia. For the first 5 months, circumcision clients ≥18 years of age were given referral vouchers that allowed them to refer up to 5 peers for circumcision within a 3-month period. An incentive of US$2 was offered for each referral. The primary outcome was the number of circumcisions performed per month in each facility. To assess the effect of the intervention, a difference-in-difference analysis was performed using longitudinal data from the intervention facilities and 22 nonintervention facilities. A questionnaire was also implemented to understand men's perceptions of the intervention. Results: During the 8-month intervention period, 1222 men over 18 years of age were circumcised in intervention facilities. In the first 5 months, 699 circumcision clients were enrolled and 385 clients brought a referral voucher given to them by an enrolled client. Difference-in-difference analyses did not show a significant increase in circumcisions performed in intervention facilities. However, circumcision clients reported that the referral incentive motivated them to encourage their friends to seek male circumcision. Peer referrals were also reported to be an important factor in men's decisions because 78% of clients who were referred reported that talking with a circumcised friend was important for their decision to get circumcised. Conclusions: The peer referral incentive intervention for male circumcision was feasible and acceptable. However, the intervention did not have a significant effect on demand for male

  11. Triggering the decision to undergo medical male circumcision: a qualitative study of adult men in Botswana.

    PubMed

    Wirth, Kathleen E; Semo, Bazghina-Werq; Ntsuape, Conrad; Ramabu, Nankie M; Otlhomile, Boyce; Plank, Rebeca M; Barnhart, Scott; Ledikwe, Jenny H

    2016-08-01

    In 2007, the World Health Organization endorsed voluntary medical male circumcision (VMMC) as part of comprehensive HIV-prevention strategies. A major challenge facing VMMC programs in sub-Saharan Africa remains demand creation; there is urgent need for data on key elements needed to trigger the decision among eligible men to seek VMMC. Using qualitative methods, we sought to better understand the circumcision decision-making process in Botswana related to VMMC. From July to November 2013, we conducted 27 focus group discussions in four purposively selected communities in Botswana with men (stratified by circumcision status and age), women (stratified by age) and community leaders. All discussions were facilitated by a trained same-sex interviewer, audio recorded, transcribed and translated to English, and analyzed for key themes using an inductive content analytic approach. Improved hygiene was frequently cited as a major benefit of circumcision and many participants believed that cleanliness was directly responsible for the protective effect of VMMC on HIV infection. While protection against HIV was frequently noted as a benefit of VMMC, the data indicate that increased sexual pleasure and perceived attractiveness, not fear of HIV infection, was an underlying reason why men sought VMMC. Data from this qualitative study suggest that more immediate benefits of VMMC, such as improved hygiene and sexual pleasure, play a larger role in the circumcision decision compared with protection from potential HIV infection. These findings have immediate implications for targeted demand creation and mobilization activities for increasing uptake of VMMC among adult men in Botswana. PMID:26754167

  12. Complications of circumcision in male neonates, infants and children: a systematic review

    PubMed Central

    2010-01-01

    Background Approximately one in three men are circumcised globally, but there are relatively few data on the safety of the procedure. The aim of this paper is to summarize the literature on frequency of adverse events following pediatric circumcision, with a focus on developing countries. Methods PubMed and other databasess were searched with keywords and MeSH terms including infant/newborn/pediatric/child, circumcision, complications and adverse events. Searches included all available years and were conducted on November 6th 2007 and updated on February 14th 2009. Additional searches of the Arabic literature included searches of relevant databases and University libraries for research theses on male circumcision. Studies were included if they contained data to estimate frequency of adverse events following neonatal, infant and child circumcision. There was no language restriction. A total of 1349 published papers were identified, of which 52 studies from 21 countries met the inclusion criteria. The Arabic literature searches identified 46 potentially relevant papers, of which six were included. Results Sixteen prospective studies evaluated complications following neonatal and infant circumcision. Most studies reported no severe adverse events (SAE), but two studies reported SAE frequency of 2%. The median frequency of any complication was 1.5% (range 0-16%). Child circumcision by medical providers tended to be associated with more complications (median frequency 6%; range 2-14%) than for neonates and infants. Traditional circumcision as a rite of passage is associated with substantially greater risks, more severe complications than medical circumcision or traditional circumcision among neonates. Conclusions Studies report few severe complications following circumcision. However, mild or moderate complications are seen, especially when circumcision is undertaken at older ages, by inexperienced providers or in non-sterile conditions. Pediatric circumcision will

  13. Acceptability of Voluntary Medical Male Circumcision (VMMC) among Male Sexually Transmitted Diseases Patients (MSTDP) in China.

    PubMed

    Wang, Zixin; Feng, Tiejian; Lau, Joseph T F; Kim, Yoona

    2016-01-01

    Voluntary Medical Male circumcision (VMMC) is an evidence-based, yet under-utilized biomedical HIV intervention in China. No study has investigated acceptability of VMMC among male sexually transmitted diseases patients (MSTDP) who are at high risk of HIV transmission. A cross-sectional survey interviewed 350 HIV negative heterosexual MSTDP in Shenzhen, China; 12.0% (n = 42) of them were circumcised at the time of survey. When the uncircumcised participants (n = 308) were informed that VMMC could reduce the risk of HIV infection via heterosexual intercourse by 50%, the prevalence of acceptability of VMMC in the next six months was 46.1%. Adjusted for significant background variables, significant factors of acceptability of VMMC included: 1) emotional variables: the Emotional Representation Subscale (adjusted odds ratios, AOR = 1.13, 95%CI: 1.06-1.18), 2) cognitive variables derived from Health Belief Model (HBM): perceived some chance of having sex with HIV positive women in the next 12 months (AOR = 2.48, 95%CI: 1.15-5.33) (perceived susceptibility), perceived severity of STD infection (AOR = 1.06, 95%CI: 1.02-1.10), perceived benefit of VMMC in risk reduction (AOR = 1.29, 95%CI: 1.16-1.42) and sexual performance (AOR = 1.45, 95%CI: 1.26-1.71), perceived barriers against taking up VMMC (AOR = 0.88, 95%CI: 0.81-0.95), and perceived cue to action (AOR = 1.41, 95%CI: 1.23-1.61) and self-efficacy (AOR = 1.38, 95%CI: 1.26-1.35) related to taking up VMMC. The association between perceived severity of STD infection and acceptability was fully mediated by emotional representation of STD infection. The relatively low prevalence of circumcision and high acceptability suggested that the situation was favorable for implementing VMMC as a means of HIV intervention among MSTDP in China. HBM is a potential suitable framework to guide the design of future VMMC promotion. Future implementation programs should be conducted in STD clinic settings, taking the important findings of

  14. Acceptability of Voluntary Medical Male Circumcision (VMMC) among Male Sexually Transmitted Diseases Patients (MSTDP) in China

    PubMed Central

    Lau, Joseph T. F.; Kim, Yoona

    2016-01-01

    Voluntary Medical Male circumcision (VMMC) is an evidence-based, yet under-utilized biomedical HIV intervention in China. No study has investigated acceptability of VMMC among male sexually transmitted diseases patients (MSTDP) who are at high risk of HIV transmission. A cross-sectional survey interviewed 350 HIV negative heterosexual MSTDP in Shenzhen, China; 12.0% (n = 42) of them were circumcised at the time of survey. When the uncircumcised participants (n = 308) were informed that VMMC could reduce the risk of HIV infection via heterosexual intercourse by 50%, the prevalence of acceptability of VMMC in the next six months was 46.1%. Adjusted for significant background variables, significant factors of acceptability of VMMC included: 1) emotional variables: the Emotional Representation Subscale (adjusted odds ratios, AOR = 1.13, 95%CI: 1.06–1.18), 2) cognitive variables derived from Health Belief Model (HBM): perceived some chance of having sex with HIV positive women in the next 12 months (AOR = 2.48, 95%CI: 1.15–5.33) (perceived susceptibility), perceived severity of STD infection (AOR = 1.06, 95%CI: 1.02–1.10), perceived benefit of VMMC in risk reduction (AOR = 1.29, 95%CI: 1.16–1.42) and sexual performance (AOR = 1.45, 95%CI: 1.26–1.71), perceived barriers against taking up VMMC (AOR = 0.88, 95%CI: 0.81–0.95), and perceived cue to action (AOR = 1.41, 95%CI: 1.23–1.61) and self-efficacy (AOR = 1.38, 95%CI: 1.26–1.35) related to taking up VMMC. The association between perceived severity of STD infection and acceptability was fully mediated by emotional representation of STD infection. The relatively low prevalence of circumcision and high acceptability suggested that the situation was favorable for implementing VMMC as a means of HIV intervention among MSTDP in China. HBM is a potential suitable framework to guide the design of future VMMC promotion. Future implementation programs should be conducted in STD clinic settings, taking the

  15. Acceptability of Voluntary Medical Male Circumcision (VMMC) among Male Sexually Transmitted Diseases Patients (MSTDP) in China.

    PubMed

    Wang, Zixin; Feng, Tiejian; Lau, Joseph T F; Kim, Yoona

    2016-01-01

    Voluntary Medical Male circumcision (VMMC) is an evidence-based, yet under-utilized biomedical HIV intervention in China. No study has investigated acceptability of VMMC among male sexually transmitted diseases patients (MSTDP) who are at high risk of HIV transmission. A cross-sectional survey interviewed 350 HIV negative heterosexual MSTDP in Shenzhen, China; 12.0% (n = 42) of them were circumcised at the time of survey. When the uncircumcised participants (n = 308) were informed that VMMC could reduce the risk of HIV infection via heterosexual intercourse by 50%, the prevalence of acceptability of VMMC in the next six months was 46.1%. Adjusted for significant background variables, significant factors of acceptability of VMMC included: 1) emotional variables: the Emotional Representation Subscale (adjusted odds ratios, AOR = 1.13, 95%CI: 1.06-1.18), 2) cognitive variables derived from Health Belief Model (HBM): perceived some chance of having sex with HIV positive women in the next 12 months (AOR = 2.48, 95%CI: 1.15-5.33) (perceived susceptibility), perceived severity of STD infection (AOR = 1.06, 95%CI: 1.02-1.10), perceived benefit of VMMC in risk reduction (AOR = 1.29, 95%CI: 1.16-1.42) and sexual performance (AOR = 1.45, 95%CI: 1.26-1.71), perceived barriers against taking up VMMC (AOR = 0.88, 95%CI: 0.81-0.95), and perceived cue to action (AOR = 1.41, 95%CI: 1.23-1.61) and self-efficacy (AOR = 1.38, 95%CI: 1.26-1.35) related to taking up VMMC. The association between perceived severity of STD infection and acceptability was fully mediated by emotional representation of STD infection. The relatively low prevalence of circumcision and high acceptability suggested that the situation was favorable for implementing VMMC as a means of HIV intervention among MSTDP in China. HBM is a potential suitable framework to guide the design of future VMMC promotion. Future implementation programs should be conducted in STD clinic settings, taking the important findings of

  16. [Male circumcision and HIV/AIDS: convincing evidence and their implication for the state of Israel].

    PubMed

    Schenker, Inon; Gross, Eitan

    2007-12-01

    The results of recent controlled trials documenting the protective effect of male circumcision on HIV infection in young adults pose significant challenges to a country like Israel. Circumcision is performed in close to 100% of new born males, mostly as a religious act in Judaism and Islam. Christian Israelis follow societal norms suggesting that circumcision contributes to better hygiene and cleanliness. Complications in infant circumcision in Israel are rare, despite the surgery being preformed most often by nonmedical circumcisers (a "Mohel") on the eighth day of birth. Reported complication rates are between 0.34% and 2%, with bleeding and infections being the most common. In the last 10 years and due to massive migration of Eastern Europeans into Israel, impressive experience was gained in Israel with adults seeking male circumcision for various reasons including: religious, societal pressure, sexual and economical. Over 21,800 adult male circumcisions have been monitored between 1998 and 2006 alone. Complication rates (mostly bleeding) were 1.75% on an average. This review matches the new data emerging from the African controlled trials with previous observational studies and the Jewish and Israeli experience. We present three challenges to policy makers in Israel: (a) the need to intensify education and information sharing on male circumcision and HIV/AIDS among healthcare workers; (b) developing an information campaign for non-circumcised migrants and adequate service to scale up on potential demand; (c) developing intensified educational campaigns for circumcised males so that they do not abandon other protective interventions (e.g. condoms) when needed for HIV prevention.

  17. Community and Healthcare Providers' Perspectives on Male Circumcision: A Multi-Centric Qualitative Study in India

    PubMed Central

    Sahay, Seema; Nagarajan, Karikalan; Mehendale, Sanjay; Deb, Sibnath; Gupta, Abhilasha; Bharat, Shalini; Bhatt, Shripad; Kumar, Athokpam Bijesh; Kanthe, Vidisha; Sinha, Anju; Chandhiok, Nomita

    2014-01-01

    Background Although male circumcision (MC) is recommended as an HIV prevention option, the religious, cultural and biomedical dimensions of its feasibility, acceptability and practice in India have not been explored till date. This study explores beliefs, experiences and understanding of the community and healthcare providers (HCPs) about adult MC as an HIV prevention option in India. Methods This qualitative study covered 134 in-depth interviews from Belgaum, Kolkata, Meerut and Mumbai cities of India. Of these, 62 respondents were the members of circumcising (CC)/non-circumcising communities (NCC); including medically and traditionally circumcised men, parents of circumcised children, spouses of circumcised men, and religious clerics. Additionally, 58 registered healthcare providers (RHCPs) such as general and pediatric surgeons, pediatricians, skin and venereal disease specialists, general practitioners, and operation theatre nurses were interviewed. Fourteen traditional circumcisers were also interviewed. The data were coded and analyzed in QSR NUD*IST ver. 6.0. The study has not explored the participants' views about neonatal versus adult circumcision. Results Members of CC/NCC, traditional circumcisers and RCHPs expressed sharp religious sensitivities around the issue of MC. Six themes emerged: Male circumcision as the religious rite; Multiple meanings of MC: MC for ‘religious identity/privilege/sacrifice’ or ‘hygiene’; MC inflicts pain and cost; Medical indications outweigh faith; Hesitation exists in accepting ‘foreign’ evidence supporting MC; and communication is the key for acceptance of MCs. Medical indications could make members of NCC accept MC following appropriate counseling. Majority of the RHCPs demanded local in-country evidence. Conclusion HCPs must educate high-risk groups regarding the preventive and therapeutic role of MC. Communities need to discuss and create new social norms about male circumcision for better societal acceptance

  18. Voluntary medical male circumcision: an HIV prevention priority for PEPFAR.

    PubMed

    Reed, Jason Bailey; Njeuhmeli, Emmanuel; Thomas, Anne Goldzier; Bacon, Melanie C; Bailey, Robert; Cherutich, Peter; Curran, Kelly; Dickson, Kim; Farley, Tim; Hankins, Catherine; Hatzold, Karin; Justman, Jessica; Mwandi, Zebedee; Nkinsi, Luke; Ridzon, Renee; Ryan, Caroline; Bock, Naomi

    2012-08-15

    As the science demonstrating strong evidence for voluntary medical male circumcision (VMMC) for HIV prevention has evolved, the President's Emergency Plan for AIDS Relief (PEPFAR) has collaborated with international agencies, donors, and partner country governments supporting VMMC programming. Mathematical models forecast that quickly reaching a large number of uncircumcised men with VMMC in strategically chosen populations may dramatically reduce community-level HIV incidence and save billions of dollars in HIV care and treatment costs. Because VMMC is a 1-time procedure that confers life-long partial protection against HIV, programs for adult men are vital short-term investments with long-term benefits. VMMC also provides a unique opportunity to reach boys and men with HIV testing and counseling services and referrals for other HIV services, including treatment. After formal recommendations by WHO in 2007, priority countries have pursued expansion of VMMC. More than 1 million males have received VMMC thus far, with the most notable successes coming from Kenya's Nyanza Province. However, a myriad of necessary cultural, political, and ethical considerations have moderated the pace of overall success. Because many millions more uncircumcised men would benefit from VMMC services now, US President Barack Obama committed PEPFAR to provide 4.7 million males with VMMC by 2014. Innovative circumcision methods-such as medical devices that remove the foreskin without injected anesthesia and/or sutures-are being rigorously evaluated. Incorporation of safe innovations into surgical VMMC programs may provide the opportunity to reach more men more quickly with services and dramatically reduce HIV incidence for all. PMID:22797745

  19. Voluntary medical male circumcision: an HIV prevention priority for PEPFAR.

    PubMed

    Reed, Jason Bailey; Njeuhmeli, Emmanuel; Thomas, Anne Goldzier; Bacon, Melanie C; Bailey, Robert; Cherutich, Peter; Curran, Kelly; Dickson, Kim; Farley, Tim; Hankins, Catherine; Hatzold, Karin; Justman, Jessica; Mwandi, Zebedee; Nkinsi, Luke; Ridzon, Renee; Ryan, Caroline; Bock, Naomi

    2012-08-15

    As the science demonstrating strong evidence for voluntary medical male circumcision (VMMC) for HIV prevention has evolved, the President's Emergency Plan for AIDS Relief (PEPFAR) has collaborated with international agencies, donors, and partner country governments supporting VMMC programming. Mathematical models forecast that quickly reaching a large number of uncircumcised men with VMMC in strategically chosen populations may dramatically reduce community-level HIV incidence and save billions of dollars in HIV care and treatment costs. Because VMMC is a 1-time procedure that confers life-long partial protection against HIV, programs for adult men are vital short-term investments with long-term benefits. VMMC also provides a unique opportunity to reach boys and men with HIV testing and counseling services and referrals for other HIV services, including treatment. After formal recommendations by WHO in 2007, priority countries have pursued expansion of VMMC. More than 1 million males have received VMMC thus far, with the most notable successes coming from Kenya's Nyanza Province. However, a myriad of necessary cultural, political, and ethical considerations have moderated the pace of overall success. Because many millions more uncircumcised men would benefit from VMMC services now, US President Barack Obama committed PEPFAR to provide 4.7 million males with VMMC by 2014. Innovative circumcision methods-such as medical devices that remove the foreskin without injected anesthesia and/or sutures-are being rigorously evaluated. Incorporation of safe innovations into surgical VMMC programs may provide the opportunity to reach more men more quickly with services and dramatically reduce HIV incidence for all.

  20. Voluntary Medical Male Circumcision: An HIV Prevention Priority for PEPFAR

    PubMed Central

    Reed, Jason Bailey; Njeuhmeli, Emmanuel; Thomas, Anne Goldzier; Bacon, Melanie C.; Bailey, Robert; Cherutich, Peter; Curran, Kelly; Dickson, Kim; Farley, Tim; Hankins, Catherine; Hatzold, Karin; Justman, Jessica; Mwandi, Zebedee; Nkinsi, Luke; Ridzon, Renee; Ryan, Caroline; Bock, Naomi

    2013-01-01

    As the science demonstrating strong evidence for voluntary medical male circumcision (VMMC) for HIV prevention has evolved, the President’s Emergency Plan for AIDS Relief (PEPFAR) has collaborated with international agencies, donors, and partner country governments supporting VMMC programming. Mathematical models forecast that quickly reaching a large number of uncircumcised men with VMMC in strategically chosen populations may dramatically reduce community-level HIV incidence and save billions of dollars in HIV care and treatment costs. Because VMMC is a 1-time procedure that confers life-long partial protection against HIV, programs for adult men are vital short-term investments with long-term benefits. VMMC also provides a unique opportunity to reach boys and men with HIV testing and counseling services and referrals for other HIV services, including treatment. After formal recommendations by WHO in 2007, priority countries have pursued expansion of VMMC. More than 1 million males have received VMMC thus far, with the most notable successes coming from Kenya’s Nyanza Province. However, a myriad of necessary cultural, political, and ethical considerations have moderated the pace of overall success. Because many millions more uncircumcised men would benefit from VMMC services now, US President Barack Obama committed PEPFAR to provide 4.7 million males with VMMC by 2014. Innovative circumcision methods—such as medical devices that remove the foreskin without injected anesthesia and/or sutures—are being rigorously evaluated. Incorporation of safe innovations into surgical VMMC programs may provide the opportunity to reach more men more quickly with services and dramatically reduce HIV incidence for all. PMID:22797745

  1. Use of Economic Compensation to Increase Demand for Voluntary Medical Male Circumcision in Kenya: Qualitative Interviews With Male Participants in a Randomized Controlled Trial and Their Partners

    PubMed Central

    Lanham, Michele; Murray, Kate; Rao, Samwel; Agot, Kawango; Omanga, Eunice; Thirumurthy, Harsha

    2016-01-01

    Background: Interventions to increase demand for medical male circumcision are urgently needed in eastern and southern Africa. Following promising evidence that providing economic compensation can increase male circumcision uptake in Kenya, there is a need to understand the role of this intervention in individuals' decision-making regarding circumcision and explore perceptions of the intervention and concerns such as coercion. Methods: As part of a randomized controlled trial in Kenya that found compensation in the form of food vouchers worth US $8.75–US $15.00 to be effective in increasing male circumcision uptake, we conducted qualitative in-depth interviews with 45 circumcised and uncircumcised male participants and 19 female partners to explore how compensation provision influenced the decision to get circumcised. Interview transcripts were coded and an inductive thematic analysis was conducted to identify patterns in decision-making. Results: Interviews revealed that compensation promoted circumcision uptake by addressing a major barrier to male circumcision uptake: lost wages during and after the circumcision procedure. Participants who did not get circumcised perceived the compensation amounts to be insufficient for offsetting their costs associated with getting circumcised or reported having nonfinancial barriers that were not addressed by the intervention, such as fear of pain. Participants also reported that they did not feel compelled to get circumcised for financial gain. Female partners of circumcised participants felt that the intervention helped to motivate their partners to get circumcised. Conclusions: The results suggest that the provision of economic compensation is an acceptable intervention that can address an important barrier to male circumcision uptake. Providing compensation to circumcision clients in the form of food vouchers warrants further consideration in voluntary medical male circumcision demand creation efforts. PMID:27404013

  2. The Effects of Providing Fixed Compensation and Lottery-Based Rewards on Uptake of Medical Male Circumcision in Kenya: A Randomized Trial

    PubMed Central

    Masters, Samuel H.; Rao, Samwel; Murray, Kate; Prasad, Ram; Zivin, Joshua G.; Omanga, Eunice; Agot, Kawango

    2016-01-01

    Background: Effective demand creation strategies are needed to increase uptake of medical male circumcision and reduce new HIV infections in eastern and southern Africa. Building on insights from behavioral economics, we assessed whether providing compensation for opportunity costs of time or lottery-based rewards can increase male circumcision uptake in Kenya. Methods: Uncircumcised men aged 21–39 years were randomized in 1:1:1 ratio to 2 intervention groups or a control group. One intervention group was offered compensation of US $12.50 conditional on circumcision uptake. Compensation was provided in the form of food vouchers. A second intervention group was offered the opportunity to participate in a lottery with high-value prizes on undergoing circumcision. The primary outcome was circumcision uptake within 3 months. Results: Among 903 participants enrolled, the group that received compensation of US $12.50 had the highest circumcision uptake (8.4%, 26/308), followed by the lottery-based rewards group (3.3%, 10/302), and the control group (1.3%, 4/299). Logistic regression analysis showed that compared with the control group, the fixed compensation group had significantly higher circumcision uptake [adjusted odds ratio 7.1; 95% CI: 2.4 to 20.8]. The lottery-based rewards group did not have significantly higher circumcision uptake than the control group (adjusted odds ratio 2.5; 95% CI: 0.8 to 8.1). Conclusions: Providing compensation was effective in increasing circumcision uptake among men over a short period. The results are consistent with studies showing that such interventions can modify health behaviors by addressing economic barriers and behavioral biases in decision making. Contrary to findings from studies of other health behaviors, lottery-based rewards did not significantly increase circumcision uptake. Trial Registration: Registry for International Development Impact Evaluations: RIDIE-STUDY-ID-530e60df56107. PMID:27404012

  3. Rural Zulu women's knowledge of and attitudes towards medical male circumcision

    PubMed Central

    Ross, Andrew; Ogbonnaya, Harbor

    2015-01-01

    Background Medical male circumcision (MMC) is a key strategy in the South African HIV infection prevention package. Women may have a potentially powerful role in supporting such a strategy. Circumcision is not a traditional part of Zulu society, and Zulu women may have limited knowledge and ambivalent or negative attitudes towards MMC. Aim This study employs quantitative data to expand insight into rural Zulu women's knowledge of and attitudes towards MMC, and is important as women could potentially yield a powerful positive or negative influence over the decisions of their partners and sons. Setting A hospital-based antenatal clinic in rural KwaZulu-Natal. Methods Participants were 590 pregnant, mostly isiZulu-speaking women. Data on their knowledge of and attitude towards MMC were collected using a questionnaire and were analysed descriptively. Results The majority of the women supported MMC; however, knowledge of the potential benefits was generally poor. Most would encourage their partners and sons to undergo MMC. The preferred place for the procedure was a hospital. Conclusion Zulu participants supported MMC and would support their partners and children being circumcised. Knowledge around potential benefits was worryingly poor, and further research into disseminating information is essential. The findings highlight the need for an expanded campaign of health education for women, and innovative means are suggested to enhance information accessibility. Reasons for preferring that MMC be carried out in hospital need to be explored further. PMID:26245595

  4. Modeling Costs and Impacts of Introducing Early Infant Male Circumcision for Long-Term Sustainability of the Voluntary Medical Male Circumcision Program.

    PubMed

    Njeuhmeli, Emmanuel; Stegman, Peter; Kripke, Katharine; Mugurungi, Owen; Ncube, Gertrude; Xaba, Sinokuthemba; Hatzold, Karin; Christensen, Alice; Stover, John

    2016-01-01

    Voluntary medical male circumcision (VMMC) has been shown to be an effective prevention strategy against HIV infection in males [1-3]. Since 2007, the President's Emergency Plan for AIDS Relief (PEPFAR) has supported VMMC programs in 14 priority countries in Africa. Today several of these countries are preparing to transition their VMMC programs from a scale-up and expansion phase to a maintenance phase. As they do so, they must consider the best approaches to sustain high levels of male circumcision in the population. The two alternatives under consideration are circumcising adolescents 10-14 years old over the long term or integrating early infant male circumcision (EIMC) into maternal and child health programs. The paper presents an analysis, using the Decision Makers Program Planning Tool, Version 2.0 (DMPPT 2.0), of the estimated cost and impact of introducing EIMC into existing VMMC programs in several countries in eastern and southern Africa. Limited cost data exist for the implementation of EIMC, but preliminary studies, such as the one detailed in Mangenah, et al. [4-5], suggest that the cost of EIMC may be less than that of adolescent and adult male circumcision. If this is the case, then adding EIMC to the VMMC program will increase the number of circumcisions that need to be performed but will not increase the total cost of the program over the long term. In addition, we found that a delayed or slow start-up of EIMC would not substantially reduce the impact of adding it to the program or increase cumulative long-term costs, which should make introduction of EIMC more feasible and attractive to countries contemplating such a program innovation.

  5. Modeling Costs and Impacts of Introducing Early Infant Male Circumcision for Long-Term Sustainability of the Voluntary Medical Male Circumcision Program

    PubMed Central

    Stegman, Peter; Kripke, Katharine; Mugurungi, Owen; Ncube, Gertrude; Xaba, Sinokuthemba; Hatzold, Karin; Christensen, Alice; Stover, John

    2016-01-01

    Voluntary medical male circumcision (VMMC) has been shown to be an effective prevention strategy against HIV infection in males [1–3]. Since 2007, the President’s Emergency Plan for AIDS Relief (PEPFAR) has supported VMMC programs in 14 priority countries in Africa. Today several of these countries are preparing to transition their VMMC programs from a scale-up and expansion phase to a maintenance phase. As they do so, they must consider the best approaches to sustain high levels of male circumcision in the population. The two alternatives under consideration are circumcising adolescents 10–14 years old over the long term or integrating early infant male circumcision (EIMC) into maternal and child health programs. The paper presents an analysis, using the Decision Makers Program Planning Tool, Version 2.0 (DMPPT 2.0), of the estimated cost and impact of introducing EIMC into existing VMMC programs in several countries in eastern and southern Africa. Limited cost data exist for the implementation of EIMC, but preliminary studies, such as the one detailed in Mangenah, et al. [4–5], suggest that the cost of EIMC may be less than that of adolescent and adult male circumcision. If this is the case, then adding EIMC to the VMMC program will increase the number of circumcisions that need to be performed but will not increase the total cost of the program over the long term. In addition, we found that a delayed or slow start-up of EIMC would not substantially reduce the impact of adding it to the program or increase cumulative long-term costs, which should make introduction of EIMC more feasible and attractive to countries contemplating such a program innovation. PMID:27410233

  6. Modeling Costs and Impacts of Introducing Early Infant Male Circumcision for Long-Term Sustainability of the Voluntary Medical Male Circumcision Program.

    PubMed

    Njeuhmeli, Emmanuel; Stegman, Peter; Kripke, Katharine; Mugurungi, Owen; Ncube, Gertrude; Xaba, Sinokuthemba; Hatzold, Karin; Christensen, Alice; Stover, John

    2016-01-01

    Voluntary medical male circumcision (VMMC) has been shown to be an effective prevention strategy against HIV infection in males [1-3]. Since 2007, the President's Emergency Plan for AIDS Relief (PEPFAR) has supported VMMC programs in 14 priority countries in Africa. Today several of these countries are preparing to transition their VMMC programs from a scale-up and expansion phase to a maintenance phase. As they do so, they must consider the best approaches to sustain high levels of male circumcision in the population. The two alternatives under consideration are circumcising adolescents 10-14 years old over the long term or integrating early infant male circumcision (EIMC) into maternal and child health programs. The paper presents an analysis, using the Decision Makers Program Planning Tool, Version 2.0 (DMPPT 2.0), of the estimated cost and impact of introducing EIMC into existing VMMC programs in several countries in eastern and southern Africa. Limited cost data exist for the implementation of EIMC, but preliminary studies, such as the one detailed in Mangenah, et al. [4-5], suggest that the cost of EIMC may be less than that of adolescent and adult male circumcision. If this is the case, then adding EIMC to the VMMC program will increase the number of circumcisions that need to be performed but will not increase the total cost of the program over the long term. In addition, we found that a delayed or slow start-up of EIMC would not substantially reduce the impact of adding it to the program or increase cumulative long-term costs, which should make introduction of EIMC more feasible and attractive to countries contemplating such a program innovation. PMID:27410233

  7. Innovative Methods of Male Circumcision for HIV Prevention—Getting the Right Evidence

    PubMed Central

    Hargreave, Timothy; Ridzon, Renee; Farley, Tim

    2016-01-01

    Abstract: World Health Organization recommends that countries with hyperendemic and generalized HIV epidemics implement voluntary medical male circumcision programs for HIV prevention. Innovative methods of male circumcision including devices have the potential to simplify the procedure, reduce time and cost, increase client acceptability, enhance safety, and expand the numbers of providers who may perform circumcision. We describe work led by World Health Organization and supported by global partners to define a pathway for the evaluation of efficacy and safety of male circumcision devices, to set priority criteria, and to establish a process to guide the use of devices in publicly funded voluntary medical male circumcision programs for HIV prevention. A device classification scheme, an expert Technical Advisory Group on Innovations in Male Circumcision, and a formal prequalification program have also guided considerations on safe use of devices. A rigorous approach was deemed appropriate given the intervention is for use among healthy men for public health purposes. The pathway and processes led to coordinated research, better standardization in research outcomes, and guidance that informed the research, introduction and implementation phases. The lessons learnt from this case study can inform evaluation and use of future public health innovations. PMID:27331591

  8. [Clinical studies of shang ring male circumcision in China and Africa].

    PubMed

    Cheng, Feng; Lü, Nian-Qing; Xu, Hao-Qin; Barone, Mark A; Lee, Richard; Goldstein, Marc; Li, Philip S

    2014-04-01

    HIV/STIs remain a major global public health problem. One of the global strategies for the prevention and control of HIV/STIs is to interrupt their transmission, which requires the public health methods based on scientific evidence and cost-effectiveness. The scale-up of male circumcision services in the priority countries of the HIV-prevention project in sub-Saharan Africa has been hampered by the scarcity of trained providers and relative technical difficulty of male circumcision techniques recommended by WHO and UNAIDS. Shang Ring is an innovative and disposable device for male circumcision, which has been safely used for over 600 000 males in China since 2006. Clinical studies of more than 3 000 cases of Shang Ring circumcision in China, Kenya, Zambia, and Uganda have demonstrated its safety, effectiveness, acceptability and ease of use. The most obvious advantages of Shang Ring include short procedure time (3-6 min), excellent postoperative cosmesis, low rate of complications, high acceptance by clients and providers, ease of use, and standardization for reliable performance. As an innovative technique, Shang Ring has a great potential for facilitating the safe and effective scale-up of circumcision services. This article comprehensively reviews the clinical studies of Shang Ring male circumcision in China and Africa.

  9. Innovative Methods of Male Circumcision for HIV Prevention-Getting the Right Evidence.

    PubMed

    Samuelson, Julia; Hargreave, Timothy; Ridzon, Renee; Farley, Tim

    2016-06-01

    World Health Organization recommends that countries with hyperendemic and generalized HIV epidemics implement voluntary medical male circumcision programs for HIV prevention. Innovative methods of male circumcision including devices have the potential to simplify the procedure, reduce time and cost, increase client acceptability, enhance safety, and expand the numbers of providers who may perform circumcision. We describe work led by World Health Organization and supported by global partners to define a pathway for the evaluation of efficacy and safety of male circumcision devices, to set priority criteria, and to establish a process to guide the use of devices in publicly funded voluntary medical male circumcision programs for HIV prevention. A device classification scheme, an expert Technical Advisory Group on Innovations in Male Circumcision, and a formal prequalification program have also guided considerations on safe use of devices. A rigorous approach was deemed appropriate given the intervention is for use among healthy men for public health purposes. The pathway and processes led to coordinated research, better standardization in research outcomes, and guidance that informed the research, introduction and implementation phases. The lessons learnt from this case study can inform evaluation and use of future public health innovations.

  10. Innovative Methods of Male Circumcision for HIV Prevention-Getting the Right Evidence.

    PubMed

    Samuelson, Julia; Hargreave, Timothy; Ridzon, Renee; Farley, Tim

    2016-06-01

    World Health Organization recommends that countries with hyperendemic and generalized HIV epidemics implement voluntary medical male circumcision programs for HIV prevention. Innovative methods of male circumcision including devices have the potential to simplify the procedure, reduce time and cost, increase client acceptability, enhance safety, and expand the numbers of providers who may perform circumcision. We describe work led by World Health Organization and supported by global partners to define a pathway for the evaluation of efficacy and safety of male circumcision devices, to set priority criteria, and to establish a process to guide the use of devices in publicly funded voluntary medical male circumcision programs for HIV prevention. A device classification scheme, an expert Technical Advisory Group on Innovations in Male Circumcision, and a formal prequalification program have also guided considerations on safe use of devices. A rigorous approach was deemed appropriate given the intervention is for use among healthy men for public health purposes. The pathway and processes led to coordinated research, better standardization in research outcomes, and guidance that informed the research, introduction and implementation phases. The lessons learnt from this case study can inform evaluation and use of future public health innovations. PMID:27331591

  11. Male circumcision as strategy for HIV prevention and sexually transmitted diseases. The potential role of traditional birth attendants in neonatal male circumcision.

    PubMed

    Dini, Catia

    2010-01-01

    In developing countries, it would be advisable to give priority to human immunodeficiency virus (HIV) prevention strategies, because of the high mortality caused by the rapid spread of the pandemic. Furthermore, HIV prevention could contribute to the mitigation of tuberculosis (TB) propagation, which is tightly correlated to acquired immune deficiency syndrome (AIDS). As demonstrated, male circumcision (MC) confers protection against HIV and sexually transmitted diseases (STD). The suggested strategy considers the neonatal MC advantageous, since it is safer, feasible, culturally more acceptable and less costly than adult MC. This approach is based on the assumption that, if newborn males are circumcised, within the next 15-20 years the sexually active population will be almost entirely circumcised and, consequently, the HIV transmission will be reduced. The employment of retrained traditional birth attendants is considered in order to implement the MC after the child birth and to facilitate its acceptance in those contexts where it is not traditionally performed.

  12. Understanding the Impact of Male Circumcision Interventions on the Spread of HIV in Southern Africa

    PubMed Central

    Hallett, Timothy B.; Singh, Kanwarjit; Smith, Jennifer A.; White, Richard G.; Abu-Raddad, Laith J.; Garnett, Geoff P.

    2008-01-01

    Background Three randomised controlled trials have clearly shown that circumcision of adult men reduces the chance that they acquire HIV infection. However, the potential impact of circumcision programmes – either alone or in combination with other established approaches – is not known and no further field trials are planned. We have used a mathematical model, parameterised using existing trial findings, to understand and predict the impact of circumcision programmes at the population level. Findings Our results indicate that circumcision will lead to reductions in incidence for women and uncircumcised men, as well as those circumcised, but that even the most effective intervention is unlikely to completely stem the spread of the virus. Without additional interventions, HIV incidence could eventually be reduced by 25–35%, depending on the level of coverage achieved and whether onward transmission from circumcised men is also reduced. However, circumcision interventions can act synergistically with other types of prevention programmes, and if efforts to change behaviour are increased in parallel with the scale-up of circumcision services, then dramatic reductions in HIV incidence could be achieved. In the long-term, this could lead to reduced AIDS deaths and less need for anti-retroviral therapy. Any increases in risk behaviours following circumcision , i.e. ‘risk compensation’, could offset some of the potential benefit of the intervention, especially for women, but only very large increases would lead to more infections overall. Conclusions Circumcision will not be the silver bullet to prevent HIV transmission, but interventions could help to substantially protect men and women from infection, especially in combination with other approaches. PMID:18493593

  13. Advertising for Demand Creation for Voluntary Medical Male Circumcision

    PubMed Central

    Wilson, Nicholas; Frade, Sasha; Rech, Dino

    2016-01-01

    Objective: To measure the effects of information, a challenge, and a conditional cash transfer on take-up of voluntary medical male circumcision (VMMC). Design: A randomized, controlled experiment with 4000 postcard recipients in Soweto (Johannesburg), South Africa. Methods: We examined differences in take-up of several decisions in the VMMC cascade between the control arm and each of several intervention arms using logistic regression. Results: Logistic regression analysis indicated that the group offered US $10 as compensation and the group challenged with “Are you tough enough?” had significantly higher take-up of the VMMC procedure than did the control group [odds ratios, respectively, 5.30 (CI: 2.20 to 12.76) and 2.70 (CI: 1.05 to 6.91)]. Similarly, the compensation group had significantly higher take-up of the VMMC counseling session than did the control group [odds ratio 3.76 (CI: 1.79 to 7.89)]. The analysis did not reveal significantly different take-up of either the VMMC counseling session or the procedure in the partner preference information group compared with the control group [odds ratios, respectively, 1.23 (CI: 0.51 to 2.97) and 1.67 (CI: 0.61 to 4.62)]. The analysis did not reveal significantly higher take-up of the VMMC nurse hotline in any intervention group compared with the control group [odds ratios for US $10, information, and challenge, respectively, 1.17 (CI: 0.67 to 2.07), 0.69 (CI: 0.36 to 1.32), and 0.60 (0.31 to 1.18)]. Conclusions: Among adult males in Soweto, South Africa, compensation of US $10 provided conditional on completing the VMMC counseling session compared with no compensation offer and a postcard with a challenge, “Are you tough enough?” compared with no challenge, resulted in moderate increases in take-up of circumcision. PMID:27404010

  14. Male circumcision and HIV prevention: a human rights and public health challenge.

    PubMed

    Csete, Joanne

    2007-05-01

    Three recent randomized clinical trials from Africa concluded that male circumcision can lead to a significant reduction in HIV risk for men. As a result, an exponential scale-up of services required to circumcise men is already figuring in the thinking of AIDS policy-makers at many levels. At this writing, the World Health Organization (WHO) is reviewing the three studies and other evidence, and is developing policy recommendations for making this HIV prevention intervention widely available. WHO says that this policy exercise"will need to take into account cultural and human rights considerations associated with promoting circumcision,"among other factors. In this article, Joanne Csete identifies some of the most important human rights questions that should be taken into account in the development of guidelines for national governments. The author argues that a scale-up of services to provide male circumcision provides an excellent opportunity to address issues concerning the subordination of women.

  15. Understanding and Addressing Socio-Cultural Barriers to Medical Male Circumcision in Traditionally Non-Circumcising Rural Communities in Sub-Saharan Africa

    PubMed Central

    Khumalo-Sakutukwa, Gertrude; Lane, Tim; van-Rooyen, Heidi; Chingono, Alfred; Humphries, Hilton; Timbe, Andrew; Fritz, Katherine; Chirowodza, Admire; Morin, Stephen F.

    2013-01-01

    Given the success of recent clinical trials establishing the safety and efficacy of adult medical male circumcision in Africa, attention has now shifted to barriers and facilitators to programmatic implementation in traditionally non-circumcising communities. In this study, we attempted to develop a fuller understanding of the role of cultural issues in the acceptance of adult circumcision. We conducted four focus group discussions with 28 participants in Mutoko in Zimbabwe, and 33 participants in Vulindlela, in KwaZulu-Natal, South Africa, as well as 19 key informant interviews in both settings. We found the concept of male circumcision to be an alien practice, particularly as expressed in the context of local languages. Cultural barriers included local concepts of ethnicity, social groups, masculinity, and sexuality. On the other hand, we found that concerns about the impact of HIV on communities resulted in willingness to consider adult male circumcision as an option if it would result in lowering the local burden of the epidemic. Adult medical male circumcision promotional messages that create a synergy between understandings of both traditional and medical circumcision will be more successful in these communities. PMID:23815101

  16. Do the Benefits of Male Circumcision Outweigh the Risks? A Critique of the Proposed CDC Guidelines

    PubMed Central

    Earp, Brian D.

    2015-01-01

    The Centers for Disease Control and Prevention (CDC) have announced a set of provisional guidelines concerning male circumcision, in which they suggest that the benefits of the surgery outweigh the risks. I offer a critique of the CDC position. Among other concerns, I suggest that the CDC relies more heavily than is warranted on studies from Sub-Saharan Africa that neither translate well to North American populations nor to circumcisions performed before an age of sexual debut; that it employs an inadequate conception of risk in its benefit vs. risk analysis; that it fails to consider the anatomy and functions of the penile prepuce (i.e., the part of the penis that is removed by circumcision); that it underestimates the adverse consequences associated with circumcision by focusing on short-term surgical complications rather than long-term harms; that it portrays both the risks and benefits of circumcision in a misleading manner, thereby undermining the possibility of obtaining informed consent; that it evinces a superficial and selective analysis of the literature on sexual outcomes associated with circumcision; and that it gives less attention than is desirable to ethical issues surrounding autonomy and bodily integrity. I conclude that circumcision before an age of consent is not an appropriate health-promotion strategy. PMID:25853108

  17. Voluntary medical male circumcision in resource-constrained settings.

    PubMed

    Tobian, Aaron A R; Adamu, Tigistu; Reed, Jason B; Kiggundu, Valerian; Yazdi, Youseph; Njeuhmeli, Emmanuel

    2015-12-01

    Throughout East and Southern Africa, the WHO recommends voluntary medical male circumcision (VMMC) to reduce heterosexual HIV acquisition. Evidence has informed policy and the implementation of VMMC programmes in these countries. VMMC has been incorporated into the HIV prevention portfolio and more than 9 million VMMCs have been performed. Conventional surgical procedures consist of forceps-guided, dorsal slit or sleeve resection techniques. Devices are also becoming available that might help to accelerate the scale-up of adult VMMC. The ideal device should make VMMC easier, safer, faster, sutureless, inexpensive, less painful, require less infrastructure, be more acceptable to patients and should not require follow-up visits. Elastic collar compression devices cause vascular obstruction and necrosis of foreskin tissue and do not require sutures or injectable anaesthesia. Collar clamp devices compress the proximal part of the foreskin to reach haemostasis; the distal foreskin is removed, but the device remains and therefore no sutures are required. Newer techniques and designs, such as tissue adhesives and a circular cutter with stapled anastomosis, are improvements, but none of these methods have achieved all desirable characteristics. Further research, design and development are needed to address this gap to enable the expansion of the already successful VMMC programmes for HIV prevention.

  18. Voluntary medical male circumcision in resource-constrained settings.

    PubMed

    Tobian, Aaron A R; Adamu, Tigistu; Reed, Jason B; Kiggundu, Valerian; Yazdi, Youseph; Njeuhmeli, Emmanuel

    2015-12-01

    Throughout East and Southern Africa, the WHO recommends voluntary medical male circumcision (VMMC) to reduce heterosexual HIV acquisition. Evidence has informed policy and the implementation of VMMC programmes in these countries. VMMC has been incorporated into the HIV prevention portfolio and more than 9 million VMMCs have been performed. Conventional surgical procedures consist of forceps-guided, dorsal slit or sleeve resection techniques. Devices are also becoming available that might help to accelerate the scale-up of adult VMMC. The ideal device should make VMMC easier, safer, faster, sutureless, inexpensive, less painful, require less infrastructure, be more acceptable to patients and should not require follow-up visits. Elastic collar compression devices cause vascular obstruction and necrosis of foreskin tissue and do not require sutures or injectable anaesthesia. Collar clamp devices compress the proximal part of the foreskin to reach haemostasis; the distal foreskin is removed, but the device remains and therefore no sutures are required. Newer techniques and designs, such as tissue adhesives and a circular cutter with stapled anastomosis, are improvements, but none of these methods have achieved all desirable characteristics. Further research, design and development are needed to address this gap to enable the expansion of the already successful VMMC programmes for HIV prevention. PMID:26526758

  19. Psychological and sexual effects of circumcision in adult males

    PubMed Central

    Aydogmus, Yasin; Semiz, Murat; Er, Okan; Bas, Okan; Atay, Irfan; Kilinc, Muhammet Fatih

    2016-01-01

    Introduction: Our aim was to investigate the psychological and sexual effects of circumcision in adult men, and analyze these changes following circumcision. Methods: We included 37 adults who applied to our clinic for circumcision and who did not have any psychiatric or urologic disorders and age-matched 30 controls in our study. Body Cathexis Scale (BCS), Liebowitz Social Anxiety Scale (LSAS), and Premature Ejaculation Diagnostic Tool (PEDT) were applied to the study group twice, once before and once three months after circumcision, and only once in the control group. Also, intravaginal ejaculation latency time (IELT) was noted and premature ejaculation (PE) evaluation was done. Intra- and intergroup comparisons were performed. Results: The two groups were similar with regard to demographic data. Comparison of preoperative BCS and LSAS scores with the scores of the control group showed significant differences (p=0.003, p<0.001, and p<0.001, respectively). However, postoperative scores were similar to the scores obtained in the control group (p=0.768, p>0.05, and p>0.05, respectively). Scores of all scales showed significant improvements postoperatively. Also, PEDT scores and IELT changes before and after circumcision were significant in the study group, but not when compared to the control group. Conclusions: Our results indicated that social anxiety and anxiety levels decreased after circumcision in adult Turkish men, and their body gratification increased. We found that not being circumcised might negatively affect individuals in adulthood when it comes to body image and sexual satisfaction, however, both improve after circumcision. PMID:27790295

  20. Modeling the Impact of Uganda’s Safe Male Circumcision Program: Implications for Age and Regional Targeting

    PubMed Central

    Kripke, Katharine; Vazzano, Andrea; Kirungi, William; Musinguzi, Joshua; Opio, Alex; Ssempebwa, Rhobbinah; Nakawunde, Susan; Kyobutungi, Sheila; Akao, Juliet N.; Magala, Fred; Mwidu, George; Castor, Delivette

    2016-01-01

    Background Uganda aims to provide safe male circumcision (SMC) to 80% of men ages 15–49 by 2016. To date, only 2 million men have received SMC of the 4.2 million men required. In response to age and regional trends in SMC uptake, the country sought to re-examine its targets with respect to age and subnational region, to assess the program’s progress, and to refine the implementation approach. Methods and Findings The Decision Makers’ Program Planning Tool, Version 2.0 (DMPPT 2.0), was used in conjunction with incidence projections from the Spectrum/AIDS Impact Module (AIM) to conduct this analysis. Population, births, deaths, and HIV incidence and prevalence were used to populate the model. Baseline male circumcision prevalence was derived from the 2011 AIDS Indicator Survey. Uganda can achieve the most immediate impact on HIV incidence by circumcising men ages 20–34. This group will also require the fewest circumcisions for each HIV infection averted. Focusing on men ages 10–19 will offer the greatest impact over a 15-year period, while focusing on men ages 15–34 offers the most cost-effective strategy over the same period. A regional analysis showed little variation in cost-effectiveness of scaling up SMC across eight regions. Scale-up is cost-saving in all regions. There is geographic variability in program progress, highlighting two regions with low baseline rates of circumcision where additional efforts will be needed. Conclusion Focusing SMC efforts on specific age groups and regions may help to accelerate Uganda’s SMC program progress. Policy makers in Uganda have already used model outputs in planning efforts, proposing males ages 10–34 as a priority group for SMC in the 2014 application to the Global Fund’s new funding model. As scale-up continues, the country should also consider a greater effort to expand SMC in regions with low MC prevalence. PMID:27410234

  1. Low frequency of male circumcision and unwillingness to be circumcised among MSM in Buenos Aires, Argentina: association with sexually transmitted infections

    PubMed Central

    Pando, María A; Balan, Ivan C; Dolezal, Curtis; Marone, Ruben; Barreda, Victoria; Carballo-Dieguez, Alex; Avila, María M

    2013-01-01

    Objective The aims of this study were to investigate the frequency of male circumcision among men who have sex with men (MSM) in Buenos Aires, Argentina; the association between circumcision and sexually transmitted infections (STIs); and, among those uncircumcised, the willingness to be circumcised. Methods A cross-sectional study was conducted among 500 MSM recruited through the respondent-driven sampling (RDS) technique. Participants underwent a consent process, responded to a Web-based survey that included questions on demographic information, sexual behaviour, and circumcision and provided biological samples. HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), Treponema pallidum, and human papiloma virus (HPV) diagnoses were performed using standard methodologies. For all analyses, data were weighted based on participants’ network size. Results Only 64 (13%) of the 500 MSM in our study reported being circumcised. Among uncircumcised men (n=418), 302 (70.4%) said that they would not be willing to get circumcised even if the procedure could reduce the risk of HIV infection. When considering all participants, circumcision status was not significantly associated with HIV, HBV, HCV, T. pallidum or HPV infections. However, when we restricted the sample to men who do not practice receptive anal intercourse (RAI) and compared circumcised to uncircumcised men, the former (N=33) had no cases of HIV infection, while 34 of 231 (14.8%) uncircumcised men were HIV positive (p=0.020). Regarding HPV, uncircumcised men had a significantly larger number of different HPV types compared with circumcised men (mean 1.83 vs. 1.09, p<0.001) and a higher frequency of high-risk-HPV genotypes (47.6% vs. 12.5%, p=0.012). Conclusions Consistent with international evidence, male circumcision appears to have a partial protective effect among MSM. The efficacy of circumcision in reducing risk of HIV infection among MSM appears to be correlated with sexual practices. Given the lack of

  2. Male Circumcision at Different Ages in Rwanda: A Cost-Effectiveness Study

    PubMed Central

    Binagwaho, Agnes; Pegurri, Elisabetta; Muita, Jane; Bertozzi, Stefano

    2010-01-01

    Background There is strong evidence showing that male circumcision (MC) reduces HIV infection and other sexually transmitted infections (STIs). In Rwanda, where adult HIV prevalence is 3%, MC is not a traditional practice. The Rwanda National AIDS Commission modelled cost and effects of MC at different ages to inform policy and programmatic decisions in relation to introducing MC. This study was necessary because the MC debate in Southern Africa has focused primarily on MC for adults. Further, this is the first time, to our knowledge, that a cost-effectiveness study on MC has been carried out in a country where HIV prevalence is below 5%. Methods and Findings A cost-effectiveness model was developed and applied to three hypothetical cohorts in Rwanda: newborns, adolescents, and adult men. Effectiveness was defined as the number of HIV infections averted, and was calculated as the product of the number of people susceptible to HIV infection in the cohort, the HIV incidence rate at different ages, and the protective effect of MC; discounted back to the year of circumcision and summed over the life expectancy of the circumcised person. Direct costs were based on interviews with experienced health care providers to determine inputs involved in the procedure (from consumables to staff time) and related prices. Other costs included training, patient counselling, treatment of adverse events, and promotion campaigns, and they were adjusted for the averted lifetime cost of health care (antiretroviral therapy [ART], opportunistic infection [OI], laboratory tests). One-way sensitivity analysis was performed by varying the main inputs of the model, and thresholds were calculated at which each intervention is no longer cost-saving and at which an intervention costs more than one gross domestic product (GDP) per capita per life-year gained. Results: Neonatal MC is less expensive than adolescent and adult MC (US$15 instead of US$59 per procedure) and is cost-saving (the cost

  3. “If You Are Not Circumcised, I Cannot Say Yes”: The Role of Women in Promoting the Uptake of Voluntary Medical Male Circumcision in Tanzania

    PubMed Central

    Osaki, Haika; Mshana, Gerry; Wambura, Mwita; Grund, Jonathan; Neke, Nyasule; Kuringe, Evodius; Plotkin, Marya; Mahler, Hally; Terris-Prestholt, Fern; Weiss, Helen; Changalucha, John

    2015-01-01

    Voluntary Medical Male Circumcision (VMMC) for HIV prevention in Tanzania was introduced by the Ministry of Health and Social Welfare in 2010 as part of the national HIV prevention strategy. A qualitative study was conducted prior to a cluster randomized trial which tested effective strategies to increase VMMC up take among men aged ≥20 years. During the formative qualitative study, we conducted in-depth interviews with circumcised males (n = 14), uncircumcised males (n = 16), and participatory group discussions (n = 20) with men and women aged 20–49 years in Njombe and Tabora regions of Tanzania. Participants reported that mothers and female partners have an important influence on men’s decisions to seek VMMC both directly by denying sex, and indirectly through discussion, advice and providing information on VMMC to uncircumcised partners and sons. Our findings suggest that in Tanzania and potentially other settings, an expanded role for women in VMMC communication strategies could increase adult male uptake of VMMC services. PMID:26402231

  4. Process Evaluation of a Sport-Based Voluntary Medical Male Circumcision Demand-Creation Intervention in Bulawayo, Zimbabwe

    PubMed Central

    Hershow, Rebecca B.; Kaufman, Zachary A.; Gannett, Katherine R.; Kombandeya, Thandanani; Chaibva, Cynthia; Ross, David A.; Harrison, Abigail

    2016-01-01

    Introduction: Grassroot Soccer (GRS) developed 2 brief and scalable voluntary medical male circumcision (VMMC) promotion interventions for males in Bulawayo, Zimbabwe, consisting of a 60-minute interactive, soccer-themed educational session with follow-up behavioral and logistical reinforcement. Both interventions were led by circumcised male community leaders (“coaches”) ages 18–30. “Make The Cut” (MTC) targeted adult males on soccer teams and “Make The Cut+” targeted boys in secondary schools. We conducted a process evaluation of MTC and Make The Cut+ to investigate perceptions of program impact, intervention components, and program delivery; participants' understandings of intervention content; and factors related to uptake. Methods: We conducted 17 interviews and 2 focus group discussions with coaches and 29 interviews with circumcised (n = 13) and uncircumcised participants (n = 16). Results: Findings demonstrate high program acceptability, highlighting the coach–participant relationship as a key factor associated with uptake. Specifically, participants valued the coaches' openness to discuss their personal experiences with VMMC and the accompaniment by their coaches to the VMMC clinic. Conclusions: Should the coach quality remain consistent at scale, MTC offers an effective approach toward generating VMMC demand among males. PMID:27749598

  5. HIV prevention: Making male circumcision the 'right' tool for the job.

    PubMed

    Bell, Kirsten

    2015-01-01

    In recent years, HIV/AIDS programming has been transformed by an ostensibly 'new' procedure: male circumcision. This article examines the rise of male circumcision as the 'right' HIV prevention tool. Treating this controversial topic as a 'matter of concern' rather than a 'matter of fact', I examine the reasons why male circumcision came to be seen as a partial solution to the problem of HIV transmission in the twenty-first century and to what effect. Grounded in a close reading of the primary literature, I suggest that the embrace of male circumcision in HIV prevention must be understood in relation to three factors: (1) the rise of evidence-based medicine as the dominant paradigm for conceptualising medical knowledge, (2) the fraught politics of HIV/AIDS research and funding, which made the possibility of a biomedical intervention attractive and (3) underlying assumptions about the nature of African 'culture' and 'sexuality'. I conclude by stressing the need to expand the parameters of the debate beyond the current polarised landscape, which presents us with a problematic either/or scenario regarding the efficacy of male circumcision.

  6. Effectiveness of and Financial Returns to Voluntary Medical Male Circumcision for HIV Prevention in South Africa: An Incremental Cost-Effectiveness Analysis

    PubMed Central

    Haacker, Markus; Gorgens, Marelize

    2016-01-01

    Background Empirical studies and population-level policy simulations show the importance of voluntary medical male circumcision (VMMC) in generalized epidemics. This paper complements available scenario-based studies (projecting costs and outcomes over some policy period, typically spanning decades) by adopting an incremental approach—analyzing the expected consequences of circumcising one male individual with specific characteristics in a specific year. This approach yields more precise estimates of VMMC’s cost-effectiveness and identifies the outcomes of current investments in VMMC (e.g., within a fiscal budget period) rather than of investments spread over the entire policy period. Methods/Findings The model has three components. We adapted the ASSA2008 model, a demographic and epidemiological model of the HIV epidemic in South Africa, to analyze the impact of one VMMC on HIV incidence over time and across the population. A costing module tracked the costs of VMMC and the resulting financial savings owing to reduced HIV incidence over time. Then, we used several financial indicators to assess the cost-effectiveness of and financial return on investments in VMMC. One circumcision of a young man up to age 20 prevents on average over 0.2 HIV infections, but this effect declines steeply with age, e.g., to 0.08 by age 30. Net financial savings from one VMMC at age 20 are estimated at US$617 at a discount rate of 5% and are lower for circumcisions both at younger ages (because the savings occur later and are discounted more) and at older ages (because male circumcision becomes less effective). Investments in male circumcision carry a financial rate of return of up to 14.5% (for circumcisions at age 20). The cost of a male circumcision is refinanced fastest, after 13 y, for circumcisions at ages 20 to 25. Principal limitations of the analysis arise from the long time (decades) over which the effects of VMMC unfold—the results are therefore sensitive to the

  7. [Ethical Evaluation of Non-Therapeutic Male Circumcision].

    PubMed

    İzgi, M Cumhur

    2015-01-01

    Elective circumcision for nonmedical reasons is a surgical approach which is historically long standing and accepted as the most performed procedure. The necessity of the procedure is usually for religious and traditional reasons alongside some medical ground related benefits to enable its social acceptability. The discussion of the subject from the aspect of ethics becomes necessary as there is no consensus about the benefits or harmfulness of nonmedical circumcision. Fundamental ethical discussions about circumcision, which contradicts legal acceptance criteria of any medical application, are related to the basic concepts of the existence of an individual such as sovereignty, the loss of bodily integrity, and privacy. The recent legal processes and the fact that the European Council and the American Academy of Pediatrics have put the issue on their agenda have increased the necessity of these ethical evaluations. The responsibility of consideration and evaluation of ethical permission of every circumcision procedure, besides discussing the necessity of circumcision for improvement and protection of health rests on the shoulders of the physicians because the dignity and intellectual identity of the profession require so.

  8. 'Boys will be boys': traditional Xhosa male circumcision, HIV and sexual socialisation in contemporary South Africa.

    PubMed

    Vincent, Louise

    2008-06-01

    Ritual male circumcision is among the most secretive and sacred of rites practiced by the Xhosa of South Africa. Recently, the alarming rate of death and injury among initiates has led to the spotlight of media attention and government regulation being focused on traditional circumcision. While many of the physical components of the ritual have been little altered by the centuries, its cultural and social meanings have not remained unchanged. This paper attempts to understand how some of these cultural and social meanings have shifted, particularly with respect to attitudes towards sex and the role that circumcision schools traditionally played in the sexual socialisation of Xhosa youth. Ritual circumcision is often defended on the basis of its usefulness as a mechanism for the maintenance of social order, particularly in relation to the perceived crisis in youth sexuality marked by extremely high levels of gender-based violence as well as HIV infection. However, the paper suggests two key ways in which traditional Xhosa circumcision has changed. These include the erosion of the role which circumcision schools once played in the sexual socialisation of young men and the emergence of the idea that initiation gives men the unlimited and unquestionable right to access to sex rather than marking the point at which sexual responsibility and restraint is introduced into the lifestyle of young men. PMID:18568868

  9. 'Boys will be boys': traditional Xhosa male circumcision, HIV and sexual socialisation in contemporary South Africa.

    PubMed

    Vincent, Louise

    2008-06-01

    Ritual male circumcision is among the most secretive and sacred of rites practiced by the Xhosa of South Africa. Recently, the alarming rate of death and injury among initiates has led to the spotlight of media attention and government regulation being focused on traditional circumcision. While many of the physical components of the ritual have been little altered by the centuries, its cultural and social meanings have not remained unchanged. This paper attempts to understand how some of these cultural and social meanings have shifted, particularly with respect to attitudes towards sex and the role that circumcision schools traditionally played in the sexual socialisation of Xhosa youth. Ritual circumcision is often defended on the basis of its usefulness as a mechanism for the maintenance of social order, particularly in relation to the perceived crisis in youth sexuality marked by extremely high levels of gender-based violence as well as HIV infection. However, the paper suggests two key ways in which traditional Xhosa circumcision has changed. These include the erosion of the role which circumcision schools once played in the sexual socialisation of young men and the emergence of the idea that initiation gives men the unlimited and unquestionable right to access to sex rather than marking the point at which sexual responsibility and restraint is introduced into the lifestyle of young men.

  10. Decreased incidence of syphilis in both men and women associated with male circumcision: a prospective study among HIV-1 serodiscordant heterosexual African couples

    PubMed Central

    Pintye, Jillian; Baeten, Jared M.; Manhart, Lisa; Celum, Connie; Ronald, Allan; Mugo, Nelly; Mujugira, Andrew; Cohen, Craig; Were, Edwin; Bukusi, Elizabeth; Kiarie, James; Heffron, Renee

    2014-01-01

    Background Male circumcision is a primary HIV-1 prevention intervention for men. It is uncertain whether male circumcision reduces the risk of syphilis among men and their female partners. Methods Using data from a prospective study among HIV-1 serodiscordant heterosexual couples from Kenya and Uganda, we assessed whether male circumcision was associated with incident syphilis in men and in their female partners. Multivariate Andersen-Gill survival methods were used, adjusted for age, sexual behavior, and plasma HIV-1 RNA levels of the HIV-1 infected partner. Findings 4716 HIV-1 serodiscordant couples (37·5% with an HIV-1 infected male) were followed for a median of 2·75 years. At enrollment, 1575 (53·5%) HIV-1 uninfected and 560 (32·4%) HIV-1 infected men were circumcised; an additional 69 (4·2%) HIV-1 infected and 132 (4·8%) HIV-1 uninfected men became circumcised during study follow up. 221 incident syphilis infections were observed: 46 among HIV-1 infected men (incidence 1·10 per 100 person-years), 76 among HIV-1 uninfected men (1·09 per 100 person-years), 54 among HIV-1 infected women (0·77 per 100 person-years) and 45 among HIV-1 uninfected women (1·11 per 100 person-years). Male circumcision was associated with a 42% reduction in incident syphilis in men (adjusted hazard ratio [aHR] 0.58 95% CI 0·37–0·91) including a 62% reduction among HIV-1 infected men (aHR 0·38, 95% CI 0·18–0·81) and a non-significant reduction in incident syphilis among HIV-1 uninfected men (aHR 0·64, 95% CI 0·36–1·11). Among women, circumcision of their male partners was associated with a 59% reduction in incident syphilis (aHR 0.41 95% CI 0.25–0.69), including a 75% reduction among HIV-1 uninfected women (aHR 0·25, 95% CI 0·08–0·76) and a 48% reduction among HIV-1 infected women (aHR 0·52, 95% CI 0·27–0·97). Interpretation In this large prospective cohort study among HIV-1 serodiscordant couples, male circumcision was associated with decreased risk

  11. Women's beliefs about male circumcision, HIV prevention, and sexual behaviors in Kisumu, Kenya.

    PubMed

    Riess, Thomas H; Achieng', Maryline M; Bailey, Robert C

    2014-01-01

    It is important to understand how women's sexual practices may be influenced by male circumcision (MC) as an HIV prevention effort. Women's beliefs about MC and sexual behaviour will likely influence the scale-up and uptake of medical MC. We conducted qualitative interviews with 30 sexually active women in Kisumu, Kenya. Women discussed MC related to perceived health benefits, condom use, sexual behaviour, knowledge of susceptibility to HIV and sexually transmitted infections (STIs), circumcision preference, and influence on circumcision uptake. Respondents had a good understanding of the partial protection of MC for acquisition of HIV for men. Women perceived circumcised men as cleaner, carrying fewer diseases, and taking more time to reach ejaculation. Male's circumcision status is a salient factor for women's sexual decision making, including partner choice, and condom use. It will be important that educational information affirms that MC provides only partial protection against female to male transmission of HIV and some STIs; that other HIV and STI prevention methods such as condoms need to be used in conjunction with MC; that MC does not preclude a man from having HIV; and that couples should develop plans for not having sex while the man is healing.

  12. Can Male Circumcision Have an Impact on the HIV Epidemic in Men Who Have Sex with Men?

    PubMed Central

    Goodreau, Steven M.; Carnegie, Nicole B.; Vittinghoff, Eric; Lama, Javier R.; Fuchs, Jonathan D.; Sanchez, Jorge; Buchbinder, Susan P.

    2014-01-01

    Background Three trials have demonstrated the prophylactic effect of male circumcision (MC) for HIV acquisition among heterosexuals, and MC interventions are underway throughout sub-Saharan Africa. Similar efforts for men who have sex with men (MSM) are stymied by the potential for circumcised MSM to acquire HIV easily through receptive sex and transmit easily through insertive sex. Existing work suggests that MC for MSM should reach its maximum potential in settings where sexual role segregation is historically high and relatively stable across the lifecourse; HIV incidence among MSM is high; reported willingness for prophylactic circumcision is high; and pre-existing circumcision rates are low. We aim to identify the likely public health impact that MC interventions among MSM would have in one setting that fulfills these conditions—Peru—as a theoretical upper bound for their effectiveness among MSM generally. Methods and Findings We use a dynamic, stochastic sexual network model based in exponential-family random graph modeling and parameterized from multiple behavioral surveys of Peruvian MSM. We consider three enrollment criteria (insertive during 100%, >80% or >60% of UAI) and two levels of uptake (25% and 50% of eligible men); we explore sexual role proportions from two studies and different frequencies of switching among role categories. Each scenario is simulated 10 times. We estimate that efficiency could reach one case averted per 6 circumcisions. However, the population-level impact of an optimistic MSM-MC intervention in this setting would likely be at most ∼5–10% incidence and prevalence reductions over 25 years. Conclusions Roll-out of MC for MSM in Peru would not result in a substantial reduction in new HIV infections, despite characteristics in this population that could maximize such effects. Additional studies are needed to confirm these results for other MSM populations, and providers may consider the individual health benefits of

  13. Cost Analysis of Integrating the PrePex Medical Device into a Voluntary Medical Male Circumcision Program in Zimbabwe

    PubMed Central

    Hatzold, Karin; Reed, Jason; Edgil, Dianna; Jaramillo, Juan; Castor, Delivette; Forsythe, Steven; Xaba, Sinokuthemba; Mugurungi, Owen

    2014-01-01

    Background Fourteen African countries are scaling up voluntary medical male circumcision (VMMC) for HIV prevention. Several devices that might offer alternatives to the three WHO-approved surgical VMMC procedures have been evaluated for use in adults. One such device is PrePex, which was prequalified by the WHO in May 2013. We utilized data from one of the PrePex field studies undertaken in Zimbabwe to identify cost considerations for introducing PrePex into the existing surgical circumcision program. Methods and Findings We evaluated the cost drivers and overall unit cost of VMMC at a site providing surgical VMMC as a routine service (“routine surgery site”) and at a site that had added PrePex VMMC procedures to routine surgical VMMC as part of a research study (“mixed study site”). We examined the main cost drivers and modeled hypothetical scenarios with varying ratios of surgical to PrePex circumcisions, different levels of site utilization, and a range of device prices. The unit costs per VMMC for the routine surgery and mixed study sites were $56 and $61, respectively. The two greatest contributors to unit price at both sites were consumables and staff. In the hypothetical scenarios, the unit cost increased as site utilization decreased, as the ratio of PrePex to surgical VMMC increased, and as device price increased. Conclusions VMMC unit costs for routine surgery and mixed study sites were similar. Low service utilization was projected to result in the greatest increases in unit price. Countries that wish to incorporate PrePex into their circumcision programs should plan to maximize staff utilization and ensure that sites function at maximum capacity to achieve the lowest unit cost. Further costing studies will be necessary once routine implementation of PrePex-based circumcision is established. PMID:24801515

  14. Women's Perceptions and Misperceptions of Male Circumcision: A Mixed Methods Study in Zambia.

    PubMed

    Haberland, Nicole A; Kelly, Christine A; Mulenga, Drosin M; Mensch, Barbara S; Hewett, Paul C

    2016-01-01

    Women's perceptions of male circumcision (MC) have implications for behavioral risk compensation, demand, and the impact of MC programs on women's health. This mixed methods study combines data from the first two rounds of a longitudinal study (n = 934) and in-depth interviews with a subsample of respondents (n = 45) between rounds. Most women correctly reported that MC reduces men's risk of HIV (64% R1, 82% R2). However, 30% of women at R1, and significantly more (41%) at R2, incorrectly believed MC is fully protective for men against HIV. Women also greatly overestimated the protection MC offers against STIs. The proportion of women who believed MC reduces a woman's HIV risk if she has sex with a man who is circumcised increased significantly (50% to 70%). Qualitative data elaborate women's misperception regarding MC. Programs should address women's informational needs and continue to emphasize that condoms remain critical, regardless of male partner's circumcision status. PMID:26937971

  15. Women's Perceptions and Misperceptions of Male Circumcision: A Mixed Methods Study in Zambia.

    PubMed

    Haberland, Nicole A; Kelly, Christine A; Mulenga, Drosin M; Mensch, Barbara S; Hewett, Paul C

    2016-01-01

    Women's perceptions of male circumcision (MC) have implications for behavioral risk compensation, demand, and the impact of MC programs on women's health. This mixed methods study combines data from the first two rounds of a longitudinal study (n = 934) and in-depth interviews with a subsample of respondents (n = 45) between rounds. Most women correctly reported that MC reduces men's risk of HIV (64% R1, 82% R2). However, 30% of women at R1, and significantly more (41%) at R2, incorrectly believed MC is fully protective for men against HIV. Women also greatly overestimated the protection MC offers against STIs. The proportion of women who believed MC reduces a woman's HIV risk if she has sex with a man who is circumcised increased significantly (50% to 70%). Qualitative data elaborate women's misperception regarding MC. Programs should address women's informational needs and continue to emphasize that condoms remain critical, regardless of male partner's circumcision status.

  16. Cost and Impact of Voluntary Medical Male Circumcision in South Africa: Focusing the Program on Specific Age Groups and Provinces

    PubMed Central

    Kripke, Katharine; Thambinayagam, Ananthy; Pillay, Yogan; Loykissoonlal, Dayanund; Bonnecwe, Collen; Barron, Peter; Kiwango, Eva; Castor, Delivette

    2016-01-01

    Background In 2012, South Africa set a goal of circumcising 4.3 million men ages 15–49 by 2016. By the end of March 2014, 1.9 million men had received voluntary medical male circumcision (VMMC). In an effort to accelerate progress, South Africa undertook a modeling exercise to determine whether circumcising specific client age groups or geographic locations would be particularly impactful or cost-effective. Results will inform South Africa’s efforts to develop a national strategy and operational plan for VMMC. Methods and Findings The study team populated the Decision Makers’ Program Planning Tool, Version 2.0 (DMPPT 2.0) with HIV incidence projections from the Spectrum/AIDS Impact Module (AIM), as well as national and provincial population and HIV prevalence estimates. We derived baseline circumcision rates from the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey. The model showed that circumcising men ages 20–34 offers the most immediate impact on HIV incidence and requires the fewest circumcisions per HIV infection averted. The greatest impact over a 15-year period is achieved by circumcising men ages 15–24. When the model assumes a unit cost increase with client age, men ages 15–29 emerge as the most cost-effective group. When we assume a constant cost for all ages, the most cost-effective age range is 15–34 years. Geographically, the program is cost saving in all provinces; differences in the VMMC program’s cost-effectiveness across provinces were obscured by uncertainty in HIV incidence projections. Conclusion The VMMC program’s impact and cost-effectiveness vary by age-targeting strategy. A strategy focusing on men ages 15–34 will maximize program benefits. However, because clients older than 25 access VMMC services at low rates, South Africa could consider promoting demand among men ages 25–34, without denying services to those in other age groups. Uncertainty in the provincial estimates makes them

  17. Safety and Acceptability of the PrePex Device When Used in Routine Male Circumcision Service Delivery During Active Surveillance in Zimbabwe

    PubMed Central

    Mavhu, Webster; Ncube, Getrude; Xaba, Sinokuthemba; Madidi, Ngonidzashe; Keatinge, Jo; Dhodho, Efison; Samkange, Christopher A.; Tshimanga, Mufuta; Mangwiro, Tonderayi; Mugurungi, Owen; Njeuhmeli, Emmanuel; Cowan, Frances M.

    2016-01-01

    Background: Male circumcision devices have the potential to accelerate voluntary medical male circumcision roll-out, with PrePex being one promising device. Here, we present findings on safety and acceptability from active surveillance of the implementation of PrePex among 1000 males circumcised in Zimbabwe. Methods: The first 1000 men consecutively circumcised using PrePex during routine service delivery were actively followed up. Outcome measures included PrePex uptake, attendance for postcircumcision visits, and adverse events (AEs). A survey was conducted among 500 consecutive active surveillance clients to assess acceptability and satisfaction with PrePex. Results: A total of 2156 men aged 18 years or older were circumcised across the 6 PrePex active surveillance sites. Of these, 1000 (46.4%) were circumcised using PrePex. Among them, 4 (0.4%) self-removals that required surgery (severe AEs) were observed. Six (0.6%) removals by providers (moderate AEs) did not require surgery. A further 280 (28%) AEs were mild or moderate pain during device removal. There were also 12 (1.2%) moderate AEs unrelated to pain. All AEs resolved without sequelae. There was high adherence to follow-up appointments, with 97.7% of clients attending the scheduled day 7 visit. Acceptability of PrePex was high among survey participants, 93% indicated willingness to recommend the device to peers. Of note, 95.8% of respondents reported experiencing pain when the device was being removed. Additionally, 85.2% reported experiencing odor while wearing the device or during removal. Conclusions: Active surveillance of the first 1000 men circumcised using PrePex suggests that the device is both safe and acceptable when used in routine service delivery. PMID:27331593

  18. Early Infant Male Circumcision in Cameroon and Senegal: Demand, Service Provision, and Cultural Context

    PubMed Central

    Kenu, Ernest; Sint, Tin Tin; Kamenga, Claude; Ekpini, Rene

    2016-01-01

    ABSTRACT Background: Male circumcision is almost universal in North and West Africa, and practiced for various reasons. Yet there is little documentation on service delivery, clinical procedures, policies, and programmatic strategies. The United Nations Children’s Fund (UNICEF) commissioned country program reviews in 2014 to shed light on the delivery of male circumcision services for infants in Cameroon and Senegal. Methods: We conducted a policy desk review, key informant interviews, and focus group discussions at health centers and in communities. Between December 2014 and January 2015, we conducted 21 key informant interviews (13 with regional and district officers, 5 with national officers, and 3 with UNICEF officials) and 36 focus group discussions (6 with men, 6 with women, 12 with adolescent boys, and 12 with service providers). Some of the men and women were parents of the adolescents who participated in the focus group discussions. In the French-speaking areas, the focus group discussions were conducted in French through an accredited translator, audio recorded, and transcribed into English. Results: All of the facilities we visited in Cameroon and Senegal offer medical male circumcision, with 10 out of 12 performing early infant male circumcision (EIMC) routinely. Neither country has policies, guidelines, or strategies for EIMC. The procedure is done mainly by untrained service providers, with some providers using modern circumcision devices. There are no key messages on EIMC for families; the increasing demand for EIMC is led by the community. Conclusion: Despite the absence of national policies and strategies, EIMC is routinely offered at all levels of the health care system in Cameroon and Senegal, mainly by untrained service providers. Improving circumcision services will require guidelines for EIMC and improvements in training, equipment, supply chains, recordkeeping, and demand creation. PMID:27413080

  19. Male circumcision for HIV prevention in India: emerging viewpoints and practices of health care providers.

    PubMed

    Sinha, Anju; Chandhiok, Nomita; Sahay, Seema; Deb, Sibnath; Bharat, Shalini; Gupta, Abhilasha; Bhatt, Sripad; Kanthe, Vidisha; Kumar, Bijesh; Joglekar, Neelam; Paranjape, Ramesh; Mehendale, Sanjay

    2015-01-01

    A compelling case for promoting male circumcision (MC) as an intervention for reducing the risk of heterosexually acquired HIV infection was made by dissemination of the results of three studies in Africa. The WHO/UNAIDS recommendation for MC for countries like India, where the epidemic in concentrated in high-risk groups, advocates MC for specific population groups such as men at higher risk for HIV acquisition. A multicentre qualitative study was conducted in four geographically distinct districts (Belgaum, Kolkata, Meerut and Mumbai) in India during June 2009 to June 2011. Two categories of health care providers: Registered Healthcare Providers (RHCPs) and traditional circumcisers were interviewed by trained research staff who had received master's level education using interview guides with probes and open-ended questions. Respondents were selected using purposive sampling. A comparative analysis of the perspectives of the RHCP vs. traditional circumcisers is presented. Representatives of both categories of providers expressed the need for Indian data on MC. Providers feared that promoting circumcision might jeopardize/undermine the progress already made in the field of condom promotion. Reservation was expressed regarding its adoption by Hindus. Behavioural disinhibition was perceived as an important limitation. A contrast in the practice of circumcision was apparent between the traditional and the trained providers. MC should be mentioned as a part of comprehensive HIV prevention services in India that includes HIV counselling and testing, condom distribution and diagnosis and treatment of sexually transmitted infections. It should become an issue of informed personal choice rather than ethnic identity.

  20. Safe male circumcision in Botswana: tension between traditional practices and biomedical marketing.

    PubMed

    Katisi, Masego; Daniel, Marguerite

    2015-01-01

    Botswana has been running Safe Male Circumcision (SMC) since 2009 and has not yet met its target. Donors like the US Centers for Disease Control and Prevention and Africa Comprehensive HIV/AIDS Partnership (funded by the Gates Foundation) in collaboration with Botswana's Ministry of Health have invested much to encourage HIV-negative men to circumcise. Demand creation strategies make use of media and celebrities. The objective of this paper is to explore responses to SMC in relation to circumcision as part of traditional initiation practices. More specifically, we present the views of two communities in Botswana on SMC consultation processes, implementation procedures and campaign strategies. The methods used include participant observation, in-depth interviews with key stakeholders (donors, implementers and Ministry officials), community leaders and men in the community. We observe that consultation with traditional leaders was done in a seemingly superficial, non-participatory manner. While SMC implementers reported pressure to deliver numbers to the World Health Organization, traditional leaders promoted circumcision through their routine traditional initiation ceremonies at breaks of two-year intervals. There were conflicting views on public SMC demand creation campaigns in relation to the traditional secrecy of circumcision. In conclusion, initial cooperation of local chiefs and elders turned into resistance.

  1. Safe male circumcision in Botswana: tension between traditional practices and biomedical marketing.

    PubMed

    Katisi, Masego; Daniel, Marguerite

    2015-01-01

    Botswana has been running Safe Male Circumcision (SMC) since 2009 and has not yet met its target. Donors like the US Centers for Disease Control and Prevention and Africa Comprehensive HIV/AIDS Partnership (funded by the Gates Foundation) in collaboration with Botswana's Ministry of Health have invested much to encourage HIV-negative men to circumcise. Demand creation strategies make use of media and celebrities. The objective of this paper is to explore responses to SMC in relation to circumcision as part of traditional initiation practices. More specifically, we present the views of two communities in Botswana on SMC consultation processes, implementation procedures and campaign strategies. The methods used include participant observation, in-depth interviews with key stakeholders (donors, implementers and Ministry officials), community leaders and men in the community. We observe that consultation with traditional leaders was done in a seemingly superficial, non-participatory manner. While SMC implementers reported pressure to deliver numbers to the World Health Organization, traditional leaders promoted circumcision through their routine traditional initiation ceremonies at breaks of two-year intervals. There were conflicting views on public SMC demand creation campaigns in relation to the traditional secrecy of circumcision. In conclusion, initial cooperation of local chiefs and elders turned into resistance. PMID:25866013

  2. Safe male circumcision in Botswana: Tension between traditional practices and biomedical marketing

    PubMed Central

    Katisi, Masego; Daniel, Marguerite

    2015-01-01

    Botswana has been running Safe Male Circumcision (SMC) since 2009 and has not yet met its target. Donors like the US Centers for Disease Control and Prevention and Africa Comprehensive HIV/AIDS Partnership (funded by the Gates Foundation) in collaboration with Botswana's Ministry of Health have invested much to encourage HIV-negative men to circumcise. Demand creation strategies make use of media and celebrities. The objective of this paper is to explore responses to SMC in relation to circumcision as part of traditional initiation practices. More specifically, we present the views of two communities in Botswana on SMC consultation processes, implementation procedures and campaign strategies. The methods used include participant observation, in-depth interviews with key stakeholders (donors, implementers and Ministry officials), community leaders and men in the community. We observe that consultation with traditional leaders was done in a seemingly superficial, non-participatory manner. While SMC implementers reported pressure to deliver numbers to the World Health Organization, traditional leaders promoted circumcision through their routine traditional initiation ceremonies at breaks of two-year intervals. There were conflicting views on public SMC demand creation campaigns in relation to the traditional secrecy of circumcision. In conclusion, initial cooperation of local chiefs and elders turned into resistance. PMID:25866013

  3. Complications of traditional circumcision amongst young Xhosa males seen at St Lucy's Hospital, Tsolo, Eastern Cape, South Africa

    PubMed Central

    Anike, Ugochukwu; Ndimande, John V.; Tumbo, John

    2013-01-01

    Abstract Background Traditional circumcision of males is common amongst many societies in sub-Saharan Africa. Circumcision amongst the Xhosa people of South Africa represents a rite of passage to manhood. Traditional male circumcision has an increased risk for complications that include sepsis, genital mutilation, gangrenous penis, excessive bleeding, dehydration, renal failure and death. The aim of this study was to describe the complications of traditional circumcisions amongst Xhosa men as seen at St. Lucy's Hospital in the Eastern Cape Province. Method A cross-sectional descriptive quantitative study was conducted in 2008. Records of 105 males admitted to St. Lucy's Hospital with complications following traditional circumcision were reviewed. Data collected included age, education level, race, reasons for circumcision, complications, the period of circumcision, duration of hospital stay and the outcomes. Descriptive data analysis was performed using statistical software SPSS 17.0. Results The ages ranged from 15–35 years with 68 (64.8%) between 15–19 years. 83 (79%) had a secondary level of education, 16 (15.2%) primary, 5 (4.8%) tertiary and 1% had no education. 60 (57%) were circumcised as initiation to manhood, 21 (20.0%) due to peer pressure, 20 (19.0%) for cultural reasons, and 1 (1.0%) was forced. The complications were sepsis (59 [56.2%]), genital mutilation (28 [26.7%]), dehydration (12 [11.4%]) and amputation of genitalia (6 [5.7%]).Fifty-nine (56.2%) patients were circumcised in winter. 79 (75.2%) were circumcised in the forest, and 25 (23.8%) in initiation centres. Fifty-eight (55.2%) were circumcised by traditionalists, and 47 (44.8%) by tribal elders (initiators). Hospital stays ranged from 8 to 28 days. 66% were healed and discharged, and 29 (27.6%) were referred to higher centres of care. Conclusion Genital sepsis was the most common complication of traditional male circumcision. Complications were related to the circumciser, advanced age of

  4. Acceptability of Early Infant Male Circumcision as an HIV Prevention Intervention in Zimbabwe: A Qualitative Perspective

    PubMed Central

    Mavhu, Webster; Hatzold, Karin; Laver, Susan M.; Sherman, Judith; Tengende, Brenda R.; Mangenah, Collin; Langhaug, Lisa F.; Hart, Graham; Cowan, Frances M.

    2012-01-01

    Background Early infant male circumcision (EIMC) is simpler, safer and more cost-effective than adult circumcision. In sub-Saharan Africa, there are concerns about acceptability of EIMC which could affect uptake. In 2009 a quantitative survey of 2,746 rural Zimbabweans (aged 18–44) indicated that 60% of women and 58% of men would be willing to have their newborn son circumcised. Willingness was associated with knowledge of HIV and male circumcision. This qualitative study was conducted to better understand this issue. Methods In 2010, 24 group discussions were held across Zimbabwe with participants from seven ethnic groups. Additionally, key informant interviews were held with private paediatricians who offer EIMC (n = 2) plus one traditional leader. Discussions were audio-recorded, transcribed, translated into English (where necessary), coded using NVivo 8 and analysed using grounded theory principles. Results Knowledge of the procedure was poor. Despite this, acceptability of EIMC was high among parents from most ethnic groups. Discussions suggested that fathers would make the ultimate decision regarding EIMC although mothers and extended family can have (often covert) influence. Participants' concerns centred on: safety, motive behind free service provision plus handling and disposal of the discarded foreskin. Older men from the dominant traditionally circumcising population strongly opposed EIMC, arguing that it separates circumcision from adolescent initiation, as well as allowing women (mothers) to nurse the wound, considered taboo. Conclusions EIMC is likely to be an acceptable HIV prevention intervention for most populations in Zimbabwe, if barriers to uptake are appropriately addressed and fathers are specifically targeted by the programme. PMID:22384258

  5. Perceptions about medical male circumcision and sexual behaviours of adults in rural Uganda: a cross sectional study

    PubMed Central

    Mukama, Trasias; Ndejjo, Rawlance; Musinguzi, Geofrey; Musoke, David

    2015-01-01

    Introduction Medical male circumcision is currently recognized as an additional important HIV preventive intervention to reduce the risk of heterosexually acquired HIV infection in men. However, sexual behaviours after medical circumcision can potentially reduce the expected benefits of the practice. This study explored the perceptions about medical male circumcision and sexual behaviours of adults in Kayunga district, Uganda. Methods A cross-sectional study was carried out among 393 respondents using a semi structured questionnaire. In addition, four focus group discussions were conducted. Quantitative data was analysed using STATA 12. Univariate, bivariate and multivariate analyses were carried out. Qualitative data was analysed thematically. Results The study established various perceptions about medical male circumcision and sexual behaviours. Majority 247 (64.5%) did not perceive circumcision as a practice that can lead men to have multiple sexual partners. Males were 3 times more likely to think that circumcision would lead to having multiple sexual partners than females (AOR=2.99, CI: 1.93-4.61). Only 89 (23.2%) believed that circumcision would lead to complacency and compromise the use of condoms to prevent against infection with HIV. Respondents who had education above primary were less likely to think that circumcision would compromise the use of condoms (AOR=0.49, CI: 0.31- 0.79). The perception that circumcised youths were less likely to abstain from sexual intercourse was less held among those with education above primary (AOR=0.58, CI: 0.37-0.91) and those older than 30 years (AOR=0.59, CI: 0.38-0.92). Conclusion There were gaps in knowledge and negative perceptions about MMC in the study community. Measures are needed to avert the negative perceptions by equipping communities with sufficient, accurate and consistent information about medical male circumcision and sexual behaviour. PMID:26985272

  6. Acceptance of Male Circumcision Among Male Rural-to-Urban Migrants in Western China

    PubMed Central

    Jiang, Junjun; Huang, Jiegang; Yang, Xiaobo; Ye, Li; Wei, Bo; Deng, Wei; Wei, Suosu; Qin, Bo; Upur, Halmurat; Zhong, Chaohui; Wang, Qianqiu; Wang, Qian; Ruan, Yuhua; Wei, Fumei; Xu, Na; Xie, Peiyan

    2013-01-01

    Abstract To describe the acceptability of male circumcision (MC) and explore potential factors associated with MC acceptability among male rural-to-urban migrants in western China, a cross-sectional survey of MC acceptability was conducted with 1,904 subjects in three western provinces with high HIV prevalence (Guangxi, Chongqing, and Xinjiang) in China between June 2009 and November 2009. Through face-to-face interviews, the participants completed a self-administered questionnaire about demographics, MC knowledge, willingness and reasons to accept or refuse MC, sexual behaviors, and other psychosocial variables. Factors associated with acceptability of MC were identified by multiple logistic regression analysis. Of the participants (n=1,904), 710 men were willing to accept MC (37.3%); the reasons included promotion of the partners' genital hygiene (54.9%), redundant prepuce or phimosis (43.1%), enhancement of sexual pleasure (40.6%), prevention of penile inflammation or cancer (35.5%), and protection against HIV and sexual transmitted diseases (STDs)(31.1%). A multivariable logistic regression showed that four factors were associated with acceptability of MC, including education level (OR=1.286, 95% CI=1.025∼1.614), redundant prepuce or phimosis (OR=13.751, 95% CI=10.087∼18.745), having one or more circumcised friends (OR=2.468, 95% CI=1.953∼3.119), and having sexual intercourse with a temporary partner in the past year (OR=1.543, 95% CI=1.101∼2.162). Compared with previously published data among the general population in China or worldwide, the acceptability of MC (37.3%) was low among the male rural-to-urban migrants in western China. Nevertheless, appropriate education could greatly improve the acceptability of MC. More public campaigns and health education on MC are needed to increase the rate of MC in China. PMID:23931654

  7. Acceptance of male circumcision among male rural-to-urban migrants in western China.

    PubMed

    Jiang, Junjun; Huang, Jiegang; Yang, Xiaobo; Ye, Li; Wei, Bo; Deng, Wei; Wei, Suosu; Qin, Bo; Upur, Halmurat; Zhong, Chaohui; Wang, Qianqiu; Wang, Qian; Ruan, Yuhua; Wei, Fumei; Xu, Na; Xie, Peiyan; Liang, Hao

    2013-12-01

    To describe the acceptability of male circumcision (MC) and explore potential factors associated with MC acceptability among male rural-to-urban migrants in western China, a cross-sectional survey of MC acceptability was conducted with 1,904 subjects in three western provinces with high HIV prevalence (Guangxi, Chongqing, and Xinjiang) in China between June 2009 and November 2009. Through face-to-face interviews, the participants completed a self-administered questionnaire about demographics, MC knowledge, willingness and reasons to accept or refuse MC, sexual behaviors, and other psychosocial variables. Factors associated with acceptability of MC were identified by multiple logistic regression analysis. Of the participants (n=1,904), 710 men were willing to accept MC (37.3%); the reasons included promotion of the partners' genital hygiene (54.9%), redundant prepuce or phimosis (43.1%), enhancement of sexual pleasure (40.6%), prevention of penile inflammation or cancer (35.5%), and protection against HIV and sexual transmitted diseases (STDs)(31.1%). A multivariable logistic regression showed that four factors were associated with acceptability of MC, including education level (OR=1.286, 95% CI=1.025~1.614), redundant prepuce or phimosis (OR=13.751, 95% CI=10.087~18.745), having one or more circumcised friends (OR=2.468, 95% CI=1.953~3.119), and having sexual intercourse with a temporary partner in the past year (OR=1.543, 95% CI=1.101~2.162). Compared with previously published data among the general population in China or worldwide, the acceptability of MC (37.3%) was low among the male rural-to-urban migrants in western China. Nevertheless, appropriate education could greatly improve the acceptability of MC. More public campaigns and health education on MC are needed to increase the rate of MC in China. PMID:23931654

  8. Acceptability of Male Circumcision for the Prevention of HIV/AIDS in the Dominican Republic

    PubMed Central

    Brito, Maximo O.; Caso, Lilliam M.; Balbuena, Hannabell; Bailey, Robert C.

    2009-01-01

    Background Male circumcision (MC) is an effective strategy to prevent HIV infection in heterosexual men. To our knowledge, there are no studies of the acceptability of this procedure in the Dominican Republic (DR). The main objective of this study was to assess the acceptability of MC to prevent HIV transmission among men ages 18 to 50 years in the Altagracia Province in the Dominican Republic. Because differences in culture and beliefs between Haitians and Dominicans could potentially influence their acceptability of MC, we conducted a comparative analysis based on national origin. Methods A survey was administered to a convenience sample of 368 men. The questionnaire was divided in 3 sections: 1) Background demographics (including national origin), 2) Male circumcision and 3) Sexual health. Stratified and logistic multivariate regression analyses were performed to identify factors associated with the acceptability of MC. Results The sample consisted of 238 (65%) Dominicans and 130 (35%) Haitian immigrants. Almost all participants were uncircumcised (95%) and about half (52%) were single. The overall acceptability of MC was 29%. The number of men willing to be circumcised increased to 67% after an information session explaining the benefits of the procedure. 74% of men reported that they would be willing to circumcise their sons after hearing that information. In multivariate analysis, Haitian nationality (OR = 1.86, 95% CI 1.01–3.41), knowing that circumcision improves hygiene (OR = 2.78, 95% CI 1.29–6.0) and not believing that circumcision decreases sexual pleasure (OR = 2.18, 95% CI 1.20–3.94) were associated with a higher acceptability of the procedure. Although age was not significantly associated with the willingness to be circumcised in the multivariate analysis, stratified analysis based on national origin suggested that younger Dominicans (<30 years of age) are more likely to accept the procedure when compared to their older counterparts

  9. Factors contributing to the low uptake of medical male circumcision in Mutare Rural District, Zimbabwe

    PubMed Central

    Chiringa, Irene O.; Mashau, Ntsieni S.

    2016-01-01

    Background Medical male circumcision (MMC) has become a significant dimension of HIV prevention interventions, after the results of three randomised controlled trials in Uganda, South Africa and Kenya demonstrated that circumcision has a protective effect against contracting HIV of up to 60%. Following recommendations by the World Health Organization, Zimbabwe in 2009 adopted voluntary MMC as an additional HIV prevention strategy to the existing ABC behaviour change model. Purpose The purpose of this study is thus to investigate the factors contributing to the low uptake of MMC. Methods The study was a quantitative cross-sectional survey conducted in Mutare rural district, Zimbabwe. Questionnaires with open- and closed-ended questions were administered to the eligible respondents. The target population were male participants aged 15–29 who met the inclusion criteria. The households were systematically selected with a sample size of 234. Statistical Package for the Social Sciences was used to analyse the data. Results Socioculturally, circumcised men are viewed as worthless (37%), shameful (30%) and are tainted as promiscuous (20%), psychological factors reported were infection and delayed healing (39%), being ashamed and dehumanised (58%), stigmatised and discriminated (40.2%) and fear of having an erection during treatment period (89.7%) whilst socio-economic factors were not having time, as it will take their time from work (58%) and complications may arise leading to spending money on treatment (84%). Conclusion Knowledge deficits regarding male medical circumcision lead to low uptake, education on male medical circumcision and its benefits. Comprehensive sexual health education should target men and dispel negative attitudes related to the use of health services. PMID:27380850

  10. Prospective investigation of penile length with newborn male circumcision and second to fourth digit ratio

    PubMed Central

    Park, Jong Kwan; Doo, A. Ram; Kim, Joo Heung; Park, Hyung Sub; Do, Jung Mo; Choi, Hwang; Park, Seung Chol; Kim, Myung Ki; Jeong, Young Beom; Kim, Hyung Jim; Kim, Young Gon; Shin, Yu Seob

    2016-01-01

    Introduction: We prospectively investigated the relationship between newborn male circumcision (NMC) and second to fourth digit ratio with penile length. Methods: As participants for our study, we identified already circumcised young patients who visited our hospital for urological treatment. The age at which the circumcision had been done was assessed. The patients’ height and weight were measured. Second to fourth digit ratio was calculated by measuring the second and fourth digit lengths. The flaccid and erectile penile lengths were measured from the base of the penis to the tip of the glans in standing position. Results: A total of 248 patients were included in our study. In univariate analysis, height, second to fourth digit ratio, flaccid penile length, and age of circumcision were associated with erectile penile length. Among these variables, second to fourth digit ratio, flaccid penile length, and age of circumcision were significant predictive factors for erectile penile length in multivariate analysis. The subjects were divided into two groups, including 72 patients in the NMC group and 176 patients in the non-NMC group. No significant difference was found in height, weight, and second to fourth digit ratio between both groups. However, flaccid (p<0.001) and erectile (p=0.001) penile lengths were shorter in the NMC group than in the non-NMC group. Conclusions: Despite the small number of subjects, this study shows that NMC was associated with shorter penile length. Second to fourth digit ratio, flaccid penile length, and age of circumcision were also significant predictive factors for erectile penile length. Further multicentre studies with larger number of subjects and biochemical analyses are needed for potential clinical applicability. PMID:27695583

  11. Prospective investigation of penile length with newborn male circumcision and second to fourth digit ratio

    PubMed Central

    Park, Jong Kwan; Doo, A. Ram; Kim, Joo Heung; Park, Hyung Sub; Do, Jung Mo; Choi, Hwang; Park, Seung Chol; Kim, Myung Ki; Jeong, Young Beom; Kim, Hyung Jim; Kim, Young Gon; Shin, Yu Seob

    2016-01-01

    Introduction: We prospectively investigated the relationship between newborn male circumcision (NMC) and second to fourth digit ratio with penile length. Methods: As participants for our study, we identified already circumcised young patients who visited our hospital for urological treatment. The age at which the circumcision had been done was assessed. The patients’ height and weight were measured. Second to fourth digit ratio was calculated by measuring the second and fourth digit lengths. The flaccid and erectile penile lengths were measured from the base of the penis to the tip of the glans in standing position. Results: A total of 248 patients were included in our study. In univariate analysis, height, second to fourth digit ratio, flaccid penile length, and age of circumcision were associated with erectile penile length. Among these variables, second to fourth digit ratio, flaccid penile length, and age of circumcision were significant predictive factors for erectile penile length in multivariate analysis. The subjects were divided into two groups, including 72 patients in the NMC group and 176 patients in the non-NMC group. No significant difference was found in height, weight, and second to fourth digit ratio between both groups. However, flaccid (p<0.001) and erectile (p=0.001) penile lengths were shorter in the NMC group than in the non-NMC group. Conclusions: Despite the small number of subjects, this study shows that NMC was associated with shorter penile length. Second to fourth digit ratio, flaccid penile length, and age of circumcision were also significant predictive factors for erectile penile length. Further multicentre studies with larger number of subjects and biochemical analyses are needed for potential clinical applicability.

  12. Female Sex Workers, Male Circumcision and HIV: A Qualitative Study of Their Understanding, Experience, and HIV Risk in Zambia

    PubMed Central

    Abbott, Sharon A.; Haberland, Nicole A.; Mulenga, Drosin M.; Hewett, Paul C.

    2013-01-01

    Several sub-Saharan African countries, including Zambia, have initiated national voluntary medical male circumcision (MC) programs to reduce HIV incidence. In-depth interviews were conducted with twenty female sex workers (FSWs) in Lusaka to examine their understanding of MC and experiences with circumcised clients. Knowledge of MC was derived primarily through informal sources, with very few FSWs reporting exposure to MC educational campaigns. MC was not widely believed to be protective against HIV, however it was viewed by some as protective against STIs. Three FSWs reported having sex with recently circumcised clients, and most reported that men often used their MC status to try to convince FSWs to forego condoms. Findings suggest that FSWs, already at high risk for HIV infection, may face additional pressure toward higher risk behavior as a result of MC. As MC services are expanded, programs should support FSWs' efforts to protect themselves by providing information about what MC can - and cannot - offer for HIV/STI infection prevention. PMID:23349745

  13. Doubt, defiance, and identity: Understanding resistance to male circumcision for HIV prevention in Malawi.

    PubMed

    Parkhurst, Justin O; Chilongozi, David; Hutchinson, Eleanor

    2015-06-01

    Global policy recommendations to scale up of male circumcision (MC) for HIV prevention tend to frame the procedure as a simple and efficacious public health intervention. However, there has been variable uptake of MC in countries with significant HIV epidemics. Kenya, for example, has embraced MC and has been dubbed a 'leader' by the global health community, while Malawi has been branded a 'laggard' in its slow adoption of a national programme, with a strong political discourse of resistance forming around MC. Regardless of any epidemiological or technical evidence, the uptake of international recommendations will be shaped by how a policy, and the specific artefacts that constitute that policy, intersect with local concerns. MC holds particular significance within many ethnic and religious groups, serving as an important rite of passage, but also designating otherness or enabling the identification of the social and political self. Understanding how the artefact of MC intersects with local social, economic, and political contexts, is therefore essential to understand the acceptance or resistance of global policy recommendations. In this paper we present an in-depth analysis of Malawi's political resistance to MC, finding that ethnic and religious divisions dominating recent political movements aligned well with differing circumcision practices. Political resistance was further found to manifest through two key narratives: a 'narrative of defiance' around the need to resist donor manipulation, and a 'narrative of doubt' which seized on a piece of epidemiological evidence to refute global claims of efficacy. Further, we found that discussions over MC served as an additional arena through which ethnic identities and claims to power could themselves be negotiated, and therefore used to support claims of political legitimacy.

  14. Neonatal circumcision.

    PubMed

    Lerman, S E; Liao, J C

    2001-12-01

    The merits of neonatal circumcision continue to be debated hotly. Some argue that circumcision is a "uniquely American medical enigma." Most of the world's male population remains uncircumcised; however, most boys born in the United States continue to undergo neonatal circumcision. Review of existing literature supports that most children who are uncircumcised do well from a medical standpoint and, thus, the question of whether US health care practitioners are subjecting neonates to an unnecessary surgical procedure remains. The medical benefits of circumcision are multiple, but most are small. The clearest medical benefit of circumcision is the relative reduction in the risk for a UTI, especially in early infancy. Although this risk [figure: see text] is real, the absolute numbers are small (risk ranges from 1 in 100 to 1 in 1000), and one investigator has estimated that it may take approximately 80 neonatal circumcisions to prevent one UTI. In the case of a patient with known urologic abnormalities that predispose to UTI, neonatal circumcision has a clearer role in terms of medical benefit to the patient. Most of the other medical benefits of circumcision probably can be realized without circumcision as long as access to clean water and proper penile hygiene are achieved. Proper penile hygiene should all but eliminate the risk for foreskin-related medical problems that will require circumcision. Moreover, proper hygiene and access to clean water has been shown to reduce the rate of development of squamous cell carcinoma of the penis in the uncircumcised population. Proper techniques on the care of the foreskin are illustrated in the American Academy of Pediatrics pamphlet titled "How to care for the uncircumcised penis." Regarding the relationship between STDs and circumcision, patient education and the practice of low-risk sexual behavior make a far greater impact than does routine circumcision in hopes of reducing the spread of HIV and other STDs. Nevertheless

  15. Circumcision Status and Risk of HIV Acquisition during Heterosexual Intercourse for Both Males and Females: A Meta-Analysis

    PubMed Central

    WEI, Qiang; YANG, Lu; SONG, Tu run; YUAN, Hai chao; LV, Xiao; HAN, Ping

    2015-01-01

    In this study, we evaluated if male circumcision was associated with lower HIV acquisition for HIV (−) males and HIV (−) females during normal sexual behavior. We performed a systematic literature search of PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases to identify studies that compared HIV acquisition for the circumcised and uncircumcised groups. The reference lists of the included and excluded studies were also screened. Fifteen studies (4 RCTs and 11 prospective cohort studies) were included, and the related data were extracted and analyzed in a meta-analysis. Our study revealed strong evidence that male circumcision was associated with reduced HIV acquisition for HIV(−) males during sexual intercourse with females [pooled adjusted risk ratio (RR): 0.30, 95% CI 0.24 0.38, P < 0.00001] and provided a 70% protective effect. In contrast, no difference was detected in HIV acquisition for HIV (−) females between the circumcised and uncircumcised groups (pooled adjusted RR after sensitivity analysis: 0.68, 95%CI 0.40–1.15, P = 0.15). In conclusion, male circumcision could significantly protect males but not females from HIV acquisition at the population level. Male circumcision may serve as an additional approach toward HIV control, in conjunction with other strategies such as HIV counseling and testing, condom promotion, and so on. PMID:25942703

  16. Mass safe male circumcision: early lessons from a Ugandan urban site - a case study

    PubMed Central

    Galukande, Moses; Sekavuga, Denis Bbaale; Duffy, Kevin; Wooding, Nicholas; Rackara, Sam; Nakaggwa, Florence; Nagaddya, Teddy; Elobu, Alex Emmanuel; Coutinho, Alex

    2012-01-01

    Introduction It has been proven in several randomized clinical trials that HIV transmission from female to male is reduced by 60% and more among circumcised males. The national target for Uganda by 2015 is to circumcise 4.2 million adult males, an unprecedented number requiring a pragmatic approach and effective model(s) to deliver this target. The objective of the study was to describe early lessons learnt at a start up of a mass safe male circumcision (SMC) program in an urban Ugandan site, implemented through task shifting and a private public partnership approach. Methods A case study of an urban SMC site in Uganda's capital, Kampala with a catchment population of approximately 0.8 million adult males aged between 15 and 49 years. Client enrollment was voluntary; mobilization was by word of mouth and through the media. Non Physician clinicians (NPC) carried out the majority of the SMCs. The SMC and voluntary counseling and testing (VCT), adverse events (AE) management and follow up were done as per set national guidelines. The supervision was by a public and private service provider. All clients were consented. Results A total of 3000 males were circumcised in 27 days spread over four months. The AE rate was 2.1% all AEs were mild and reversible. No deaths occurred. The work rate was 111 SMCs per day. There was sufficient demand for SMC despite minimal mobilization effort. The bulk of the SMC work was successfully carried out by the NPCs. Conclusion Private Public Partnership and task shifting approaches were successful at the start up phase and we anticipate will be feasible for the scale up. PMID:23396906

  17. Factors Associated with the Acceptability of Male Circumcision among Men in Jamaica

    PubMed Central

    Walcott, Melonie M.; Jolly, Pauline E.; Ehiri, John E.; Funkhouser, Ellen; Kempf, Mirjam C.; Hickman, Deborah; Aung, Maung; Zhang, Kui

    2013-01-01

    Objectives To determine the prevalence of male circumcision (MC) among men in the western region of Jamaica, and to identify factors associated with acceptability of MC for self, infants (<1 year) and older sons (1-17 years). Methods A cross-sectional, interviewer-administered questionnaire survey of 549 men aged 19-54 years was conducted in the western region of Jamaica. The survey included questions about the acceptance of MC for self, infants, and sons before and after an information session about the benefits of MC in preventing HIV/STI transmission. Logistic regression models were used to identify factors that were associated with acceptability of MC. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated from the models. Results Fourteen percent of the men reported that they were circumcised. In the multivariable model, which adjusted for age, education, religion and income, there were increased odds of accepting MC for infants/sons among uncircumcised men who accepted MC for self (AOR=8.1; 95% CI = 4.1-15.9), believed they would experience more pleasure during sex if circumcised (AOR=4.0; 95% CI = 2.0-8.2), and reported having no concerns regarding MC (AOR=3.0; 95% CI = 1.8-4.8). Similarly, uncircumcised men who reported no concerns about MC or who believed that they would experience more pleasure during sex if circumcised were more likely to accept MC for self. Conclusion Providing men with information about MC increased acceptance of MC for self, infants (<17 years) and sons (1-17 years). Since targeted education on the benefits of male circumcision for prevention of HIV/STI can be effective in increasing acceptability of MC, health professionals should be trained, and willing to discuss MC with men in healthcare facilities and in the community. PMID:24066164

  18. After Cologne: male circumcision and the law. Parental right, religious liberty or criminal assault?

    PubMed

    Merkel, Reinhard; Putzke, Holm

    2013-07-01

    Non-therapeutic circumcision violates boys' right to bodily integrity as well as to self-determination. There is neither any verifiable medical advantage connected with the intervention nor is it painless nor without significant risks. Possible negative consequences for the psychosexual development of circumcised boys (due to substantial loss of highly erogenous tissue) have not yet been sufficiently explored, but appear to ensue in a significant number of cases. According to standard legal criteria, these considerations would normally entail that the operation be deemed an 'impermissible risk'-neither justifiable on grounds of parental rights nor of religious liberty: as with any other freedom right, these end where another person's body begins. Nevertheless, after a resounding decision by a Cologne district court that non-therapeutic circumcision constitutes bodily assault, the German legislature responded by enacting a new statute expressly designed to permit male circumcision even outside of medical settings. We first criticise the normative foundations upon which such a legal concession seems to rest, and then analyse two major flaws in the new German law which we consider emblematic of the difficulty that any legal attempt to protect medically irrelevant genital cutting is bound to face.

  19. Factors Associated with Knowledge of and Willingness for Adult Male Circumcision in Changsha, China

    PubMed Central

    Zeng, Mingqiang; Wang, Ling; Chen, Caifang; Zeng, Fanchang; Huang, Liang; Xue, Ruizhi; Chen, Junjie; Gao, Benmin; Tang, Zhengyan

    2016-01-01

    Background Male circumcision (MC) has been shown to reduce the risk of male genital diseases. MC is not commonly practiced among Chinese males and little is known about the factors associated with their knowledge of and willingness for MC. This study was to explore the knowledge regarding the foreskin among Chinese males and to identify factors associated with their willingness to undergo circumcision. Methods A total of 237 patients with redundant prepuce/phimosis were interviewed through face-to-face interviews. The items on the questionnaire included: demographics, an objective scale assessing knowledge about the foreskin, willingness to have MC, the attitudes of sexual partners and doctors toward redundant prepuce/phimosis, and the approaches that patients used to acquire knowledge regarding the prepuce. Univariate analysis and multiple logistic regression analysis were performed to identify factors that are associated with willingness to be circumcised (WTC). Results A total of 212 patients completed the interview. Multivariable logistic regression showed that three factors were significantly associated with WTC: being married (OR = 0.43), perceiving redundant prepuce/phimosis as a disease (OR = 1.93), and if a patient’s partner supported MC (OR = 1.39). 58% (n = 122) had received information about the foreskin from another party: 18% (n = 37) from school, 8% (n = 17) from family, 17% (n = 36) from friends, 27% (n = 57) from health care providers. About 4% (n = 8) believed that their partners disliked their redundant prepuce/phimosis. 20% (n = 42) had received doctors’ advice to undergo circumcision. Conclusion Knowledge about the foreskin was low among Chinese males. Our study elucidates the factors associated with WTC and suggests that more education of the population about the foreskin can help improve the recognition of a correctible abnormality and help patients assess the potential role of MC in their health. PMID:26859292

  20. Scaling-up voluntary medical male circumcision - what have we learned?

    PubMed

    Ledikwe, Jenny H; Nyanga, Robert O; Hagon, Jaclyn; Grignon, Jessica S; Mpofu, Mulamuli; Semo, Bazghina-Werq

    2014-01-01

    In 2007, the World Health Organization (WHO) and the joint United Nations agency program on HIV/AIDS (UNAIDS) recommended voluntary medical male circumcision (VMMC) as an add-on strategy for HIV prevention. Fourteen priority countries were tasked with scaling-up VMMC services to 80% of HIV-negative men aged 15-49 years by 2016, representing a combined target of 20 million circumcisions. By December 2012, approximately 3 million procedures had been conducted. Within the following year, there was marked improvement in the pace of the scale-up. During 2013, the total number of circumcisions performed nearly doubled, with approximately 6 million total circumcisions conducted by the end of the year, reaching 30% of the initial target. The purpose of this review article was to apply a systems thinking approach, using the WHO health systems building blocks as a framework to examine the factors influencing the scale-up of the VMMC programs from 2008-2013. Facilitators that accelerated the VMMC program scale-up included: country ownership; sustained political will; service delivery efficiencies, such as task shifting and task sharing; use of outreach and mobile services; disposable, prepackaged VMMC kits; external funding; and a standardized set of indicators for VMMC. A low demand for the procedure has been a major barrier to achieving circumcision targets, while weak supply chain management systems and the lack of adequate financial resources with a heavy reliance on donor support have also adversely affected scale-up. Health systems strengthening initiatives and innovations have progressively improved VMMC service delivery, but an understanding of the contextual barriers and the facilitators of demand for the procedure is critical in reaching targets. There is a need for countries implementing VMMC programs to share their experiences more frequently to identify and to enhance best practices by other programs. PMID:25336991

  1. Factors associated with uptake of voluntary medical male circumcision, Mazowe District, Zimbabwe, 2014

    PubMed Central

    Rupfutse, Maxwell; Tshuma, Cremence; Tshimanga, Mufuta; Gombe, Notion; Bangure, Donewell; Wellington, Maureen

    2014-01-01

    Introduction Voluntary Medical Male Circumcision (VMMC) is the surgical removal of the foreskin by a trained health worker. VMMC was introduced in Zimbabwe in 2009. It is of concern that the programme performance has been below expectations nationally and in Mazowe district. Zimbabwe is unlikely to meet its 2015 target of circumcising 1 200 000 men aged between 15 and 29 years and unlikely to enjoy maximum benefits of VMMC which include prevention of HIV, sexually transmitted infections and cervical cancer. We therefore broadly aimed at identifying factors influencing the level of VMMC uptake in Mazowe district. Methods An analytic cross-sectional study was carried out in Mazowe district. A multi-stage probability sampling strategy was used to select 300 men aged between 18 and 49 years. Pretested interviewer administered questionnaires, key informant interviews and focus group discussions were used to collect data. Quantitative data was analysed using Epi info where odds ratios and p-values were calculated. Qualitative data was analysed thematically. Results Being of Shona origin (AOR= 7.69 (95%CI 1.78-33.20)), fear of pain (AOR= 7.09 (95%CI 2.58-19.47)) and fear of poor wound healing (AOR= 2.68 (95%CI 1.01-7.08)) were independently associated with being uncircumcised while having a circumcised friend and encouragement by a friend or relative were independently associated with being circumcised. Conclusion Fear of pain, fear of poor wound healing and encouragement by a friend or relative were associated with circumcision status. Widening use of surgical devices and third part referrals may assist in scaling up the programme. PMID:25918577

  2. Male circumcision and its association with HIV infection and sexually transmitted diseases: evidence from 18 demographic and health surveys in sub-Saharan Africa.

    PubMed

    Gebremedhin, Samson

    2011-01-01

    The study aimed to assess the association between male circumcision and HIV infection and STDs. The issue is controversial as various studies reported conflicting findings. A cross-sectional comparative study based on the secondary data of 18 Demographic Health Surveys (DHS), carried out in Sub-Saharan Africa starting from 2003, was conducted. From all surveys, information on 70 554 males aged 15 - 59 years was extracted. The association between male circumcision and HIV infection and STD symptoms (genital discharge or genital ulcer/sore) was assessed using binary logistic regression. Adjustment was made for sexual history and basic socio-demographic variables. The weighted prevalence of HIV among men 15 - 59 years was 3.1%. In the bivariate analysis uncircumcised status was significantly associated with risk of HIV, with odds ratio (OR) of 4.12 (95% CI: 3.85 - 4.42). The association was even more significant (4.95 (95% CI: 4.57-5.36)) after adjustment for number of lifetime sexual partners and socio-demographic variables. The risk associated with uncircumcised status is significantly lower among younger men aged 15 - 29 years than those in 30 - 59-year age category. About 5.5% of the study subjects reported either genital discharge or genital sore/ulcer in the preceding 12 months of the surveys. Circumcision status was not significantly associated with either of the symptoms, with adjusted OR of 1.07 (95% CI: 0.99 - 1.15). The study concludes that there is a strong association between uncircumcised status and HIV infection. Hence, male circumcision can be considered as a possible way of reducing the spread of HIV infection in areas where the practice is rare. A comprehensive study to assess the association between circumcision and different types of STDs is recommended.

  3. Comparative Cost Analysis of Surgical and PrePex Device Male Circumcision in Zimbabwe and Mozambique

    PubMed Central

    Schutte, Carl; Tshimanga, M; Mugurungi, Owen; Come, Iotamo; Necochea, Edgar; Mahomed, Mehebub; Xaba, Sinokuthemba; Bossemeyer, Debora; Ferreira, Thais; Macaringue, Lucinda; Chatikobo, Pessanai; Gundididza, Patricia

    2016-01-01

    Background: The PrePex device has proven to be safe for voluntary medical male circumcision (VMMC) in adults in several African countries. Costing studies were conducted as part of a PrePex/Surgery comparison study in Zimbabwe and a pilot implementation study in Mozambique. Methods: The studies calculated per male circumcision unit costs using a cost–analysis approach. Both direct costs (consumable and nonconsumable supplies, device, personnel, associated staff training) and selected indirect costs (capital and support personnel costs) were calculated. Results: The cost comparison in Zimbabwe showed a unit cost per VMMC of $45.50 for PrePex and $53.08 for surgery. The unit cost difference was based on higher personnel and consumable supplies costs for the surgical procedure, which used disposable instrument kits. In Mozambique, the costing analysis estimated a higher unit cost for PrePex circumcision ($40.66) than for surgery ($20.85) because of higher consumable costs, particularly the PrePex device and lower consumable supplies costs for the surgical procedure using reusable instruments. Supplies and direct staff costs contributed 87.2% for PrePex and 65.8% for surgical unit costs in Mozambique. Discussion: PrePex device male circumcision could potentially be cheaper than surgery in Zimbabwe, especially in settings that lack the infrastructure and personnel required for surgical VMMC, and this might result in programmatic cost savings. In Mozambique, the surgical procedure seems to be less costly compared with PrePex mainly because of higher consumable supplies costs. With reduced device unit costs, PrePex VMMC could become more cost-efficient and considered as complementary for Mozambique's VMMC scale-up program. PMID:27331599

  4. Effect of Providing Conditional Economic Compensation on Uptake of Voluntary Medical Male Circumcision in Kenya

    PubMed Central

    Thirumurthy, Harsha; Masters, Samuel H.; Rao, Samwel; Bronson, Megan A.; Lanham, Michele; Omanga, Eunice; Evens, Emily; Agot, Kawango

    2014-01-01

    IMPORTANCE Novel strategies are needed to increase the uptake of voluntary medical male circumcision (VMMC) in sub-Saharan Africa and enhance the effectiveness of male circumcision as an HIV prevention strategy. OBJECTIVE To determine whether small economic incentives could increase circumcision prevalence by addressing reported economic barriers to VMMC and behavioral factors such as present-biased decision making. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted between June 22, 2013, and February 4, 2014, among 1504 uncircumcised men aged 25 to 49 years in Nyanza region, Kenya. VMMC services were provided free of charge and participants were randomized to 1 of 3 intervention groups or a control group. INTERVENTIONS Participants in the 3 intervention groups received varying amounts of compensation conditional on undergoing circumcision at 1 of 9 study clinics within 2 months of enrollment. Compensation took the form of food vouchers worth 200 Kenya shillings (≈US $2.50), 700 Kenya shillings (≈US $8.75), or 1200 Kenya shillings (≈US $15.00), which reflected a portion of transportation costs and lost wages associated with getting circumcised. The control group received no compensation. MAIN OUTCOMES AND MEASURES VMMC uptake within 2 months. RESULTS Analysis of data for 1502 participants with complete data showed that VMMC uptake within 2 months was higher in the US $8.75 group (6.6%; 95% CI, 4.3%–9.5% [25 of 381]) and the US $15.00 group (9.0%; 95% CI, 6.3%–12.4% [34 of 377]) than in the US $2.50 group (1.9%; 95% CI, 0.8%–3.8% [7 of 374]) and the control group (1.6%; 95% CI, 0.6%–3.5% [6 of 370]). In logistic regression analysis, the US $8.75 group had significantly higher VMMC uptake than the control group (adjusted odds ratio [AOR] 4.3; 95% CI, 1.7–10.7), as did the US $15.00 group (AOR 6.2; 95% CI, 2.6–15.0). Effect sizes for the US $8.75 and US $15.00 groups did not differ significantly (P = .20). CONCLUSIONS AND RELEVANCE

  5. Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta‐analysis

    PubMed Central

    Weiss, H A; Thomas, S L; Munabi, S K; Hayes, R J

    2006-01-01

    Objectives Male circumcision is associated with reduced risk of HIV infection. This may be partly because of a protective effect of circumcision on other sexually transmitted infections (STI), especially those causing genital ulcers, but evidence for such protection is unclear. Our objective was to conduct a systematic review and meta‐analyses of the associations between male circumcision and infection with herpes simplex virus type 2 (HSV‐2), Treponema pallidum, or Haemophilus ducreyi. Methods Electronic databases (1950–2004) were searched using keywords and text terms for herpes simplex, syphilis, chancroid, ulcerative sexually transmitted diseases, or their causative agents, in conjunction with terms to identify epidemiological studies. References of key articles were hand searched, and data were extracted using standardised forms. Random effects models were used to summarise relative risk (RR) where appropriate. Results 26 articles met the inclusion criteria. Most syphilis studies reported a substantially reduced risk among circumcised men (summary RR = 0.67, 95% confidence interval (CI) 0.54 to 0.83), although there was significant between study heterogeneity (p = 0.01). The reduced risk of HSV‐2 infection was of borderline statistical significance (summary RR = 0.88, 95% CI 0.77 to 1.01). Circumcised men were at lower risk of chancroid in six of seven studies (individual study RRs: 0.12 to 1.11). Conclusions This first systematic review of male circumcision and ulcerative STI strongly indicates that circumcised men are at lower risk of chancroid and syphilis. There is less association with HSV‐2. Potential male circumcision interventions to reduce HIV in high risk populations may provide additional benefit by protecting against other STI. PMID:16581731

  6. The 2010 Royal Australasian College of Physicians' policy statement 'Circumcision of infant males' is not evidence based.

    PubMed

    Morris, B J; Wodak, A D; Mindel, A; Schrieber, L; Duggan, K A; Dilley, A; Willcourt, R J; Lowy, M; Cooper, D A

    2012-07-01

    Infant male circumcision (MC) is an important issue guided by Royal Australasian College of Physicians (RACP) policy. Here we analytically review the RACP's 2010 policy statement 'Circumcision of infant males'. Comprehensive evaluation in the context of published research was used. We find that the Statement is not a fair and balanced representation of the literature on MC. It ignores, downplays, obfuscates or misrepresents the considerable evidence attesting to the strong protection MC affords against childhood urinary tract infections, sexually transmitted infections (human immunodeficiency virus, human papilloma virus, herpes simplex virus type 2, trichomonas and genital ulcer disease), thrush, inferior penile hygiene, phimosis, balanoposthitis and penile cancer, and in women protection against human papilloma virus, herpes simplex virus type 2, bacterial vaginosis and cervical cancer. The Statement exaggerates the complication rate. Assertions that 'the foreskin has a functional role' and 'is a primary sensory part of the penis' are not supported by research, including randomised controlled trials. Instead of citing these and meta-analyses, the Statement selectively cites poor quality studies. Its claim, without support from a literature-based risk-benefit analysis, that the currently available evidence does 'not warrant routine infant circumcision in Australia and New Zealand' is misleading. The Statement fails to explain that performing MC in the neonatal period using local anaesthesia maximises benefits, safety, convenience and cost savings. Because the RACP's policy statement is not a fair and balanced representation of the current literature, it should not be used to guide policy. In the interests of public health and individual well-being, an extensive, comprehensive, balanced review of the scientific literature and a risk-benefit analysis should be conducted to formulate policy. PMID:22805686

  7. Early infant male circumcision for human immunodeficiency virus prevention: knowledge and attitudes of women attending a rural hospital in Swaziland, Southern Africa.

    PubMed

    Jarrett, Prudence; Kliner, Merav; Walley, John

    2014-01-01

    Swaziland has the highest prevalence of human immunodeficiency virus (HIV) in the world at 26% of the adult population. Medical male circumcision (MMC) has been shown to reduce the risk of acquiring HIV from heterosexual sex by up to 60% and the Government of Swaziland has been promoting adult male circumcision. Infant circumcision commenced in 2013 so it is important to understand the knowledge and views of women as potential mothers, around infant circumcision for medical purposes to inform the development of the service. This study interviewed 14 women of reproductive age attending the outpatient department of Good Shepherd Mission Hospital (GSMH), a rural district hospital, on their knowledge of and attitudes to early infant male circumcision (EIMC). Participants were highly knowledgeable about the health benefits of medical circumcision, although knowledge of the comparative risks and benefits of EIMC to adult circumcision was poor. All participants would have a son circumcised; the preferred age varied from early infancy to adolescence. Complications and pain were the main barriers whilst religious and cultural reasons were mentioned both for and against circumcision. A variety of family members are important in the decision to circumcise a young boy. Acceptability of medical circumcision was high in this study, but concerns about safety, pain, autonomy and cultural factors reduce the acceptability of infant circumcision more specifically. It will be important to provide accurate, culturally sensitive information about infant circumcision to mothers, fathers and grandparents using existing hospital and community services provided at GSMH and throughout Swaziland. Where possible services for MMC should be available to males of all ages so that families and young men may choose the most favourable age for circumcision.

  8. Early infant male circumcision for human immunodeficiency virus prevention: knowledge and attitudes of women attending a rural hospital in Swaziland, Southern Africa

    PubMed Central

    Jarrett, Prudence; Kliner, Merav; Walley, John

    2014-01-01

    Abstract Swaziland has the highest prevalence of human immunodeficiency virus (HIV) in the world at 26% of the adult population. Medical male circumcision (MMC) has been shown to reduce the risk of acquiring HIV from heterosexual sex by up to 60% and the Government of Swaziland has been promoting adult male circumcision. Infant circumcision commenced in 2013 so it is important to understand the knowledge and views of women as potential mothers, around infant circumcision for medical purposes to inform the development of the service. This study interviewed 14 women of reproductive age attending the outpatient department of Good Shepherd Mission Hospital (GSMH), a rural district hospital, on their knowledge of and attitudes to early infant male circumcision (EIMC). Participants were highly knowledgeable about the health benefits of medical circumcision, although knowledge of the comparative risks and benefits of EIMC to adult circumcision was poor. All participants would have a son circumcised; the preferred age varied from early infancy to adolescence. Complications and pain were the main barriers whilst religious and cultural reasons were mentioned both for and against circumcision. A variety of family members are important in the decision to circumcise a young boy. Acceptability of medical circumcision was high in this study, but concerns about safety, pain, autonomy and cultural factors reduce the acceptability of infant circumcision more specifically. It will be important to provide accurate, culturally sensitive information about infant circumcision to mothers, fathers and grandparents using existing hospital and community services provided at GSMH and throughout Swaziland. Where possible services for MMC should be available to males of all ages so that families and young men may choose the most favourable age for circumcision. PMID:24957082

  9. Women’s Perceptions and Misperceptions of Male Circumcision: A Mixed Methods Study in Zambia

    PubMed Central

    Haberland, Nicole A.; Kelly, Christine A.; Mulenga, Drosin M.; Mensch, Barbara S.; Hewett, Paul C.

    2016-01-01

    Women’s perceptions of male circumcision (MC) have implications for behavioral risk compensation, demand, and the impact of MC programs on women’s health. This mixed methods study combines data from the first two rounds of a longitudinal study (n = 934) and in-depth interviews with a subsample of respondents (n = 45) between rounds. Most women correctly reported that MC reduces men’s risk of HIV (64% R1, 82% R2). However, 30% of women at R1, and significantly more (41%) at R2, incorrectly believed MC is fully protective for men against HIV. Women also greatly overestimated the protection MC offers against STIs. The proportion of women who believed MC reduces a woman’s HIV risk if she has sex with a man who is circumcised increased significantly (50% to 70%). Qualitative data elaborate women’s misperception regarding MC. Programs should address women’s informational needs and continue to emphasize that condoms remain critical, regardless of male partner’s circumcision status. PMID:26937971

  10. Acceptability of male circumcision for prevention of HIV infection among men and women in Uganda.

    PubMed

    Albert, Lisa M; Akol, Angela; L'Engle, Kelly; Tolley, Elizabeth E; Ramirez, Catalina B; Opio, Alex; Tumwesigye, Nazarius M; Thomsen, Sarah; Neema, Stella; Baine, Sebastian O

    2011-12-01

    In the last decade, three randomized controlled trials in Kenya, South Africa, and Uganda have shown that medical male circumcision (MMC) reduces the sexual transmission of HIV from women to men. Objectives of this assessment were to measure acceptability of adult MMC and circumcision of children to inform policies regarding whether and how to promote MMC as an HIV prevention strategy. This mixed-method study, conducted across four Ugandan districts, included a two-stage household survey of 833 adult males and 842 adult females, focus group discussions, and a health provider survey. Respondents' acceptability of MMC was positive and substantial after being informed about the results of recent randomized trials. In uncircumcised men, between 40% and 62% across the districts would consider getting circumcised. Across the four districts between 60% and 86% of fathers and 49% and 95% of mothers were supportive of MMC for sons. Widespread support exists among men and women in this study for promoting MMC as part of Uganda's current 'ABC + ' HIV prevention strategy. PMID:21732902

  11. Barriers and Motivators to Voluntary Medical Male Circumcision Uptake among Different Age Groups of Men in Zimbabwe: Results from a Mixed Methods Study

    PubMed Central

    Hatzold, Karin; Mavhu, Webster; Jasi, Phineas; Chatora, Kumbirai; Cowan, Frances M.; Taruberekera, Noah; Mugurungi, Owen; Ahanda, Kim; Njeuhmeli, Emmanuel

    2014-01-01

    Background We conducted quantitative and qualitative studies to explore barriers and motivating factors to VMMC for HIV prevention, and to assess utilization of existing VMMC communication channels. Methods and Findings A population-based survey was conducted with 2350 respondents aged 15–49. Analysis consisted of descriptive statistics and bivariate analysis between circumcision and selected demographics. Logistic regression was used to determine predictors of male circumcision uptake compared to intention to circumcise. Focus group discussions (FGDs) were held with men purposively selected to represent a range of ethnicities. 68% and 53% of female/male respondents, respectively, had heard about VMMC for HIV prevention, mostly through the radio (71%). Among male respondents, 11.3% reported being circumcised and 49% reported willingness to undergo VMMC. Factors which men reported motivated them to undergo VMMC included HIV/STI prevention (44%), improved hygiene (26%), enhanced sexual performance (6%) and cervical cancer prevention for partner (6%). Factors that deterred men from undergoing VMMC included fear of pain (40%), not believing that they were at risk of HIV (18%), lack of partner support (6%). Additionally, there were differences in motivators and barriers by age. FGDs suggested additional barriers including fear of HIV testing, partner refusal, reluctance to abstain from sex and myths and misconceptions. Conclusions VMMC demand-creation messages need to be specifically tailored for different ages and should emphasize non-HIV prevention benefits, such as improved hygiene and sexual appeal, and need to address men's fear of pain. Promoting VMMC among women is crucial as they appear to have considerable influence over men's decision to get circumcised. PMID:24802746

  12. Scaling Up Early Infant Male Circumcision: Lessons From the Kingdom of Swaziland

    PubMed Central

    Fitzgerald, Laura; Benzerga, Wendy; Mirira, Munamato; Adamu, Tigistu; Shissler, Tracey; Bitchong, Raymond; Malaza, Mandla; Mamba, Makhosini; Mangara, Paul; Curran, Kelly; Khumalo, Thembisile; Mlambo, Phumzile; Njeuhmeli, Emmanuel; Maziya, Vusi

    2016-01-01

    ABSTRACT Background: The government of the Kingdom of Swaziland recognizes that it must urgently scale up HIV prevention interventions, such as voluntary medical male circumcision (VMMC). Swaziland has adopted a 2-phase approach to male circumcision scale-up. The catch-up phase prioritizes VMMC services for adolescents and adults, while the sustainability phase involves the establishment of early infant male circumcision (EIMC). Swaziland does not have a modern-day tradition of circumcision, and the VMMC program has met with client demand challenges. However, since the launch of the EIMC program in 2010, Swaziland now leads the Eastern and Southern Africa region in the scale-up of EIMC. Here we review Swaziland’s program and its successes and challenges. Methods: From February to May 2014, we collected data while preparing Swaziland’s “Male Circumcision Strategic and Operational Plan for HIV Prevention 2014–2018.” We conducted structured stakeholder focus group discussions and in-depth interviews, and we collected EIMC service delivery data from an implementing partner responsible for VMMC and EIMC service delivery. Data were summarized in consolidated narratives. Results: Between 2010 and 2014, trained providers performed more than 5,000 EIMCs in 11 health care facilities in Swaziland, and they reported no moderate or severe adverse events. According to a broad group of EIMC program stakeholders, an EIMC program needs robust support from facility, regional, and national leadership, both within and outside of HIV prevention coordination bodies, to promote institutionalization and ownership. Providers and health care managers in 3 of Swaziland’s 4 regional hospitals suggest that when EIMC is introduced into reproductive, maternal, newborn, and child health platforms, dedicated staff attention can help ensure that EIMC is performed amid competing priorities. Creating informed demand from communities also supports EIMC as a service delivery priority

  13. Does Male Circumcision Protect against Sexually Transmitted Infections? Arguments and Meta-Analyses to the Contrary Fail to Withstand Scrutiny

    PubMed Central

    Morris, Brian J.; Hankins, Catherine A.; Tobian, Aaron A. R.; Krieger, John N.; Klausner, Jeffrey D.

    2014-01-01

    We critically evaluate a recent article by Van Howe involving 12 meta-analyses that concludes, contrary to current evidence, that male circumcision increases the risk of various common sexually transmitted infections (STIs). Our detailed scrutiny reveals that these meta-analyses (1) failed to include results of all relevant studies, especially data from randomized controlled trials, (2) introduced bias through use of inappropriate control groups, (3) altered original data, in the case of human papillomavirus (HPV), by questionable adjustments for “sampling bias,” (4) failed to control for confounders through use of crude odds ratios, and (5) used unnecessarily complicated methods without adequate explanation, so impeding replication by others. Interventions that can reduce the prevalence of STIs are important to international health. Of major concern is the global epidemic of oncogenic types of HPV that contribute to the burden of genital cancers. Meta-analyses, when well conducted, can better inform public health policy and medical practice, but when seriously flawed can have detrimental consequences. Our critical evaluation leads us to reject the findings and conclusions of Van Howe on multiple grounds. Our timely analysis thus reaffirms the medical evidence supporting male circumcision as a desirable intervention for STI prevention. PMID:24944836

  14. Does Male Circumcision Protect against Sexually Transmitted Infections? Arguments and Meta-Analyses to the Contrary Fail to Withstand Scrutiny.

    PubMed

    Morris, Brian J; Hankins, Catherine A; Tobian, Aaron A R; Krieger, John N; Klausner, Jeffrey D

    2014-01-01

    We critically evaluate a recent article by Van Howe involving 12 meta-analyses that concludes, contrary to current evidence, that male circumcision increases the risk of various common sexually transmitted infections (STIs). Our detailed scrutiny reveals that these meta-analyses (1) failed to include results of all relevant studies, especially data from randomized controlled trials, (2) introduced bias through use of inappropriate control groups, (3) altered original data, in the case of human papillomavirus (HPV), by questionable adjustments for "sampling bias," (4) failed to control for confounders through use of crude odds ratios, and (5) used unnecessarily complicated methods without adequate explanation, so impeding replication by others. Interventions that can reduce the prevalence of STIs are important to international health. Of major concern is the global epidemic of oncogenic types of HPV that contribute to the burden of genital cancers. Meta-analyses, when well conducted, can better inform public health policy and medical practice, but when seriously flawed can have detrimental consequences. Our critical evaluation leads us to reject the findings and conclusions of Van Howe on multiple grounds. Our timely analysis thus reaffirms the medical evidence supporting male circumcision as a desirable intervention for STI prevention.

  15. A critical evaluation of arguments opposing male circumcision for HIV prevention in developed countries

    PubMed Central

    Morris, Brian J.; Bailey, Robert C.; Klausner, Jeffrey D.; Leibowitz, Arleen; Wamai, Richard G.; Waskett, Jake H.; Banerjee, Joya; Halperin, Daniel T.; Zoloth, Laurie; Weiss, Helen A.; Hankins, Catherine A.

    2013-01-01

    A potential impediment to evidence-based policy development on medical male circumcision (MC) for HIV prevention in all countries worldwide is the uncritical acceptance by some of arguments used by opponents of this procedure. Here we evaluate recent opinion-pieces of 13 individuals opposed to MC. We find that these statements misrepresent good studies, selectively cite references, some containing fallacious information, and draw erroneous conclusions. In marked contrast, the scientific evidence shows MC to be a simple, low-risk procedure with very little or no adverse long-term effect on sexual function, sensitivity, sensation during arousal or overall satisfaction. Unscientific arguments have been recently used to drive ballot measures aimed at banning MC of minors in the USA, eliminate insurance coverage for medical MC for low-income families, and threaten large fines and incarceration for health care providers. Medical MC is a preventative health measure akin to immunisation, given its protective effect against HIV infection, genital cancers and various other conditions. Protection afforded by neonatal MC against a diversity of common medical conditions starts in infancy with urinary tract infections and extends throughout life. Besides protection in adulthood against acquiring HIV, MC also reduces morbidity and mortality from multiple other sexually transmitted infections (STIs) and genital cancers in men and their female sexual partners. It is estimated that over their lifetime one-third of uncircumcised males will suffer at least one foreskin-related medical condition. The scientific evidence indicates that medical MC is safe and effective. Its favourable risk/benefit ratio and cost/benefit support the advantages of medical MC. PMID:22452415

  16. Associations between Male Anogenital Human Papillomavirus Infection and Circumcision by Anatomic Site Sampled and Lifetime Number of Female Sex Partners

    PubMed Central

    Nielson, Carrie M.; Schiaffino, Melody K.; Dunne, Eileen F.; Salemi, Jason L.; Giuliano, Anna R.

    2016-01-01

    Background Male circumcision may lower men’s risk of human papillomavirus (HPV) infection and reduce transmission to sex partners. Reported associations between circumcision and HPV infection in men have been inconsistent. Methods Four hundred sixty-three men in 2 US cities were tested at 6 anogenital sites and in semen for 37 types of HPV. Men were eligible if they reported sex with a woman within the past year, no history of genital warts or penile or anal cancer, and no current diagnosis of a sexually transmitted infection. Participants completed a self-administered questionnaire. Circumcision status was assessed by the study clinician. Logistic regression was used to examine associations between circumcision and HPV detection at each site and in semen, with adjustment for potential confounders. Results Seventy-four men (16.0%) were uncircumcised. Adjusted odds ratios (AORs) for any HPV genotype and circumcision were 0.53 (95% confidence interval [CI], 0.28–0.99) for any anatomic site/specimen, 0.17 (95% CI, 0.05–0.56) for the urethra, 0.44 (95% CI, 0.23–0.82) for the glans/corona, and 0.53 (95% CI, 0.28–0.99) for the penile shaft. AORs were <1.0 but not statistically significant for the scrotum, semen, anal canal, and perianal area. Conclusions Circumcision may be protective against HPV infection of the urethra, glans/corona, and penile shaft. PMID:19086813

  17. Reach and Cost-Effectiveness of the PrePex Device for Safe Male Circumcision in Uganda

    PubMed Central

    Duffy, Kevin; Galukande, Moses; Wooding, Nick; Dea, Monica; Coutinho, Alex

    2013-01-01

    Introduction Modelling, supported by the USAID Health Policy Initiative and UNAIDS, performed in 2011, indicated that Uganda would need to perform 4.2 million medical male circumcisions (MMCs) to reach 80% prevalence. Since 2010 Uganda has completed 380,000 circumcisions, and has set a national target of 1 million for 2013. Objective To evaluate the relative reach and cost-effectiveness of PrePex compared to the current surgical SMC method and to determine the effect that this might have in helping to achieve the Uganda national SMC targets. Methods A cross-sectional descriptive cost-analysis study conducted at International Hospital Kampala over ten weeks from August to October 2012. Data collected during the performance of 625 circumcisions using PrePex was compared to data previously collected from 10,000 circumcisions using a surgical circumcision method at the same site. Ethical approval was obtained. Results The moderate adverse events (AE) ratio when using the PrePex device was 2% and no severe adverse events were encountered, which is comparable to the surgical method, thus the AE rate has no effect on the reach or cost-effectiveness of PrePex. The unit cost to perform one circumcision using PrePex is $30.55, 35% ($7.90) higher than the current surgical method, but the PrePex method improves operator efficiency by 60%, meaning that a team can perform 24 completed circumcisions compared to 15 by the surgical method. The cost-effectiveness of PrePex, comparing the cost of performing circumcisions to the future cost savings of potentially averted HIV infections, is just 2% less than the current surgical method, at a device cost price of $20. Conclusion PrePex is a viable SMC tool for scale-up with unrivalled potential for superior reach, however national targets can only be met with effective demand creation and availability of trained human resource. PMID:23717402

  18. To mutilate in the name of Jehovah or Allah: legitimization of male and female circumcision.

    PubMed

    Abu-Sahlieh, S A

    1994-01-01

    Female circumcison is practised in Sudan, Somalia, Egypt and a few other Arab and Muslim countries. It has triggered a passionate public debate in the West. This debate has found somewhat of an echo in the Arab and Muslim world, but some Muslim religious circles such as Al-Azhar (Egypt), the most important Islamic centre in the world, try to justify it on the basis of sunnah (that is, to conform with the tradition of the prophet Mohammed). Male circumcision is practised by all Muslims and Jews and also by some Christians in Egypt, in the United States and Canada). For different reasons, the debate on this topic is still taboo in Western and in Arab and Muslim countries. The object of this study is to define the role of Islamic law and Muslim religious leaders in female and male circumcision. On purpose, it avoids any use of the word 'Islam', and concentrates on the written sources of Islamic law and the opinions of contemporary Arab authors, mostly of Egyptian origin. Juridical logic cannot acknowledge the distinction between female and male circumcision, both being the mutilation of healthy organs which is damaging to the physical integrity of the child, whatever the underlying religious motivations. Furthermore, both practices violate the Koran: 'Our Lord, You did not create all this in vain' (3:191), and '[He] perfected everything He created' (32:7). In our opinion, a god who demands that his believers be mutilated and branded on their genitals the same as cattle, is a god of questionable ethics. To mutilate children, boys or girls, under the pretext that it is for their own good, shows the influence of cynicism and fanaticism. PMID:7731348

  19. HIV prevalence is strongly associated with geographical variations in male circumcision and foreskin cutting in Papua New Guinea: an ecological study

    PubMed Central

    MacLaren, David J; McBride, W John H; Kelly, Gerard C; Muller, Reinhold; Tommbe, Rachael; Kaldor, John M; Vallely, Andrew J

    2015-01-01

    Objective To examine the correlation between HIV prevalence and male circumcision and other foreskin cutting practices across the four regions of Papua New Guinea (PNG). Design An ecological substudy using unique data from an interdisciplinary research programme to evaluate the acceptability, sociocultural context and public health impact of male circumcision for HIV prevention in PNG. Methods Published data describing (a) self-reported circumcision status by region from the ‘Acceptability and Feasibility of Male Circumcision for HIV prevention in PNG’ study and (b) HIV prevalence by region from PNG National Department of Health were used to correlate male circumcision and other foreskin cutting practices and HIV prevalence. Maps were constructed to visually represent variations across the four regions of PNG. Results Regions of PNG with the highest HIV prevalence had the lowest prevalence of male circumcision and other forms of foreskin cutting and vice versa. Male circumcision and dorsal longitudinal cuts were strongly associated with HIV prevalence and able to explain 99% of the observed geographical variability in HIV prevalence in PNG (p<0.01). Conclusions The regional prevalence of HIV infection in PNG appears to be closely correlated with the regional distribution of male circumcision and dorsal longitudinal foreskin cuts. Further research is warranted to investigate causality of this correlation as well as the potential of dorsal longitudinal cuts to confer protection against HIV acquisition in heterosexual men. PMID:26126529

  20. Recommendation by a law body to ban infant male circumcision has serious worldwide implications for pediatric practice and human rights

    PubMed Central

    2013-01-01

    Background Recent attempts in the USA and Europe to ban the circumcision of male children have been unsuccessful. Of current concern is a report by the Tasmanian Law Reform Institute (TLRI) recommending that non-therapeutic circumcision be prohibited, with parents and doctors risking criminal sanctions except where the parents have strong religious and ethnic ties to circumcision. The acceptance of this recommendation would create a precedent for legislation elsewhere in the world, thereby posing a threat to pediatric practice, parental responsibilities and freedoms, and public health. Discussion The TLRI report ignores the scientific consensus within medical literature about circumcision. It contains legal and ethical arguments that are seriously flawed. Dispassionate ethical arguments and the United Nations Convention on the Rights of the Child are consistent with parents being permitted to authorize circumcision for their male child. Uncritical acceptance of the TLRI report’s recommendations would strengthen and legitimize efforts to ban childhood male circumcision not just in Australia, but in other countries as well. The medical profession should be concerned about any attempt to criminalize a well-accepted and evidence-based medical procedure. The recommendations are illogical, pose potential dangers and seem unworkable in practice. There is no explanation of how the State could impose criminal charges against doctors and parents, nor of how such a punitive apparatus could be structured, nor how strength of ethnic or religious ties could be determined. The proposal could easily be used inappropriately, and discriminates against parents not tied to the religions specified. With time, religious exemptions could subsequently be overturned. The law, governments and the medical profession should reject the TLRI recommendations, especially since the recent affirmative infant male circumcision policy statement by the American Academy of Pediatrics attests to the

  1. Safety, Feasibility, and Acceptability of the PrePex Device for Adult Male Circumcision in Malawi

    PubMed Central

    Tippett Barr, Beth A.; Kang'ombe, Anderson; Hofstee, Carola; Kilembe, Franklin; Galagan, Sean; Chilongozi, David; Namate, Dorothy; Machaya, Medson; Kabwere, Khuliena; Mwale, Mwawi; Msunguma, Wezi; Reed, Jason; Chimbwandira, Frank

    2016-01-01

    Introduction: Nonsurgical adult male circumcision devices present an alternative to surgery where health resources are limited. This study aimed to assess the safety, feasibility, and acceptability of the PrePex device for adult male circumcision in Malawi. Methods: A prospective single-arm cohort study was conducted at 3 sites (1 urban static, 1 rural static, 1 rural tent) in Malawi. Adverse event (AE) outcomes were stratified to include/exclude pain, and confidence intervals (CIs) were corrected for clinic-level clustering. Results: Among 935 men screened, 131 (14.0%) were not eligible, 13 (1.4%) withdrew before placement, and 791 (84.6%) received the device. Moderate and severe AEs totaled 7.1% including pain [95% CI: 3.4–14.7] and 4.0% excluding pain (95% CI: 2.6 to 6.4). Severe AEs included pain (n = 3), insufficient skin removal (n = 4), and early removal (n = 4). Among early removals, 1 had immediate surgical circumcision, 1 had surgery after 48 hours of observation, 1 declined surgery, and 1 did not return to our site although presented at a nearby clinic. More than half of men (51.9%) reported odor; however, few (2.2%) stated they would not recommend the device to others because of odor. Median levels of reported pain (scale, 1–10) were 2 (interquartile range, 2–4) during application and removal, and 0 (interquartile range, 0–2) at all other time points. Conclusions: Severe AEs were rare and similar to other programs. Immediate provision of surgical services after displacement or early removal proved a challenge. Cases of insufficient skin removal were linked to poor technique, suggesting provider training requires reinforcement and supervision. PMID:27331590

  2. Cost Drivers for Voluntary Medical Male Circumcision Using Primary Source Data from Sub-Saharan Africa

    PubMed Central

    Bollinger, Lori; Adesina, Adebiyi; Forsythe, Steven; Godbole, Ramona; Reuben, Elan; Njeuhmeli, Emmanuel

    2014-01-01

    Background As voluntary medical male circumcision (VMMC) programs scale up, there is a pressing need for information about the important cost drivers, and potential efficiency gains. We examine those cost drivers here, and estimate the potential efficiency gains through an econometric model. Methods and Findings We examined the main cost drivers (i.e., personnel and consumables) associated with providing VMMC in sub-Saharan Africa along a number of dimensions, including facility type and service provider. Primary source facility level data from Kenya, Namibia, South Africa, Tanzania, Uganda, and Zambia were utilized throughout. We estimated the efficiency gains by econometrically estimating a cost function in order to calculate the impact of scale and other relevant factors. Personnel and consumables were estimated at 36% and 28%, respectively, of total costs across countries. Economies of scale (EOS) is estimated to be eight at the median volume of VMMCs performed, and EOS falls from 23 at the 25th percentile volume of VMMCs performed to 5.1 at the 75th percentile. Conclusions The analysis suggests that there is significant room for efficiency improvement as indicated by declining EOS as VMMC volume increases. The scale of the fall in EOS as VMMC volume increases suggests that we are still at the ascension phase of the scale-up of VMMC, where continuing to add new sites results in additional start-up costs as well. A key aspect of improving efficiency is task sharing VMMC procedures, due to the large percentage of overall costs associated with personnel costs. In addition, efficiency improvements in consumables are likely to occur over time as prices and distribution costs decrease. PMID:24802593

  3. Voluntary medical male circumcision for HIV prevention in fishing communities in Uganda: the influence of local beliefs and practice.

    PubMed

    Mbonye, Martin; Kuteesa, Monica; Seeley, Janet; Levin, Jonathan; Weiss, Helen; Kamali, Anatoli

    2016-09-01

    Local beliefs and practices about voluntary medical male circumcision (VMMC) may influence uptake and effectiveness. Data were gathered through interviews with 40 people from four ethnically mixed fishing communities in Uganda. Some men believed that wound healing could be promoted by contact with vaginal fluids while sex with non-regular partners could chase away spirits - practices which encouraged unsafe sexual practices. Information given by providers stressed that VMMC did not afford complete protection from sexually-transmitted infections, however, a number of male community members held the view that they were fully protected once circumcised. Both men and women said that VMMC was good not just for HIV prevention but also as a way of maintaining hygiene among the men. The implementation of VMMC in high-HIV prevalence settings needs to take account of local beliefs about circumcision, working with local religious/social group leaders, women and peers in the roll-out of the intervention.

  4. Voluntary medical male circumcision for HIV prevention in fishing communities in Uganda: the influence of local beliefs and practice.

    PubMed

    Mbonye, Martin; Kuteesa, Monica; Seeley, Janet; Levin, Jonathan; Weiss, Helen; Kamali, Anatoli

    2016-09-01

    Local beliefs and practices about voluntary medical male circumcision (VMMC) may influence uptake and effectiveness. Data were gathered through interviews with 40 people from four ethnically mixed fishing communities in Uganda. Some men believed that wound healing could be promoted by contact with vaginal fluids while sex with non-regular partners could chase away spirits - practices which encouraged unsafe sexual practices. Information given by providers stressed that VMMC did not afford complete protection from sexually-transmitted infections, however, a number of male community members held the view that they were fully protected once circumcised. Both men and women said that VMMC was good not just for HIV prevention but also as a way of maintaining hygiene among the men. The implementation of VMMC in high-HIV prevalence settings needs to take account of local beliefs about circumcision, working with local religious/social group leaders, women and peers in the roll-out of the intervention. PMID:27450591

  5. [Long-term benefit of male circumcision to the reduction of urinary tract infections and genitourinary cancers in China].

    PubMed

    Zhao, Fu-jun; Li, Philip S; Lü, Nian-qing; Lee, Richard; Peng, Yi-feng; Cheng, Feng; Li, Zheng; Xu, Hao-qin; Barone, Mark; Goldstein, Marc; Xia, Shu-jia

    2014-11-01

    Increasingly accumulated results from randomized controlled trials and other clinical studies have demonstrated that male circumcision reduces the risks of acquisition and transmission of HIV, HPV, HSV-2, and other sexually transmitted infections, and thus has a potential role in preventing cervical cancer, penile cancer and prostate cancer. The prevalence of male circumcision in China is currently less than 5%. The clinical evaluation studies and randomized controlled trials of the Shang Ring device showed excellent safety profiles, extremely high acceptability, and satisfaction among the participants and service providers in Africa and China. Given the recent recommendations by the World Health Organization and the Joint United Nations Program on HIV/AIDS (UNAIDS), voluntary medical male circumcision should be promoted in China at the national level as an important alternative intervention to reduce reproductive tract infections and prevent both males and females from reproductive tract cancers. More emphasis is required on the studies of the long-term health benefits of male circumcision in uro-andrology.

  6. The Economic and Epidemiological Impact of Focusing Voluntary Medical Male Circumcision for HIV Prevention on Specific Age Groups and Regions in Tanzania

    PubMed Central

    2016-01-01

    Background Since its launch in 2010, the Tanzania National Voluntary Medical Male Circumcision (VMMC) Program has focused efforts on males ages 10–34 in 11 priority regions. Implementers have noted that over 70% of VMMC clients are between the ages of 10 and 19, raising questions about whether additional efforts would be required to recruit men age 20 and above. This analysis uses mathematical modeling to examine the economic and epidemiological consequences of scaling up VMMC among specific age groups and priority regions in Tanzania. Methods and Findings Analyses were conducted using the Decision Makers’ Program Planning Tool Version 2.0 (DMPPT 2.0), a compartmental model implemented in Microsoft Excel 2010. The model was populated with population, mortality, and HIV incidence and prevalence projections from external sources, including outputs from Spectrum/AIDS Impact Module (AIM). A separate DMPPT 2.0 model was created for each of the 11 priority regions. Tanzania can achieve the most immediate impact on HIV incidence by circumcising males ages 20–34. This strategy would also require the fewest VMMCs for each HIV infection averted. Circumcising men ages 10–24 will have the greatest impact on HIV incidence over a 15-year period. The most cost-effective approach (lowest cost per HIV infection averted) targets men ages 15–34. The model shows the VMMC program is cost saving in all 11 priority regions. VMMC program cost-effectiveness varies across regions due to differences in projected HIV incidence, with the most cost-effective programs in Njombe and Iringa. Conclusions The DMPPT 2.0 results reinforce Tanzania’s current VMMC strategy, providing newfound confidence in investing in circumcising adolescents. Tanzanian policy makers and program implementers will continue to focus scale-up of VMMC on men ages 10–34 years, seeking to maximize program impact and cost-effectiveness while acknowledging trends in demand among the younger and older age groups

  7. What Do People Actually Learn from Public Health Campaigns? Incorrect Inferences About Male Circumcision and Female HIV Infection Risk Among Men and Women in Malawi.

    PubMed

    Maughan-Brown, Brendan; Godlonton, Susan; Thornton, Rebecca; Venkataramani, Atheendar S

    2015-07-01

    Qualitative studies and polling data from sub-Saharan Africa indicate that many individuals may mistakenly believe that male circumcision directly protects women from contracting HIV. This study examines whether individuals who learn that male circumcision reduces female-to-male HIV transmission also erroneously infer a reduction in direct male-to-female transmission risk (i.e. from an HIV-positive man to an uninfected woman). We used data on Malawian men (n = 917) randomized to receive information about voluntary medical male circumcision (VMMC) and HIV risk in 2008 and a random sample of their wives (n = 418). We found that 72 % of men and 82 % of women who believed that male circumcision reduces HIV risk for men also believed that it reduces HIV risk for women. Regression analyses indicated that men randomly assigned to receive information about the protective benefits of circumcision were more likely to adopt the erroneous beliefs, and that the underlying mechanism was the formation of the belief that male circumcision reduces HIV risk for men. The results suggest the need for VMMC campaigns to make explicit that male circumcision does not directly protect women from HIV-infection.

  8. Notes from the Field: Tetanus Cases After Voluntary Medical Male Circumcision for HIV Prevention--Eastern and Southern Africa, 2012-2015.

    PubMed

    Grund, Jonathan M; Toledo, Carlos; Davis, Stephanie M; Ridzon, Renee; Moturi, Edna; Scobie, Heather; Naouri, Boubker; Reed, Jason B; Njeuhmeli, Emmanuel; Thomas, Anne G; Benson, Francis Ndwiga; Sirengo, Martin W; Muyenzi, Leon Ngeruka; Lija, Gissenge J I; Rogers, John H; Mwanasalli, Salli; Odoyo-June, Elijah; Wamai, Nafuna; Kabuye, Geoffrey; Zulu, James Exnobert; Aceng, Jane Ruth; Bock, Naomi

    2016-01-22

    Voluntary medical male circumcision (VMMC) decreases the risk for female-to-male HIV transmission by approximately 60%, and the President's Emergency Plan for AIDS Relief (PEPFAR) is supporting the scale-up of VMMC for adolescent and adult males in countries with high prevalence of human immunodeficiency virus (HIV) and low coverage of male circumcision. As of September 2015, PEPFAR has supported approximately 8.9 million VMMCs.

  9. Male circumcision, alcohol use and unprotected sex among patrons of bars and taverns in rural areas of North-West province, South Africa.

    PubMed

    Nkosi, Sebenzile; Sikweyiya, Yandisa; Kekwaletswe, Connie T; Morojele, Neo K

    2015-01-01

    Strong research evidence has shown that medical male circumcision significantly reduces heterosexual HIV acquisition among men. However, its effectiveness is enhanced by behavioural factors such as condom use. Currently, little is known of unprotected sex associated with male circumcision (MC) among alcohol-drinking tavern-going men, or whether engagement in unprotected sex may differ between men who have been traditionally circumcised and those who have been medically circumcised. The study sought to determine the relative importance of alcohol consumption and MC as correlates of unprotected sex and to compare the risk of engaging in unprotected sex between traditionally circumcised and medically circumcised tavern-going men from two rural villages in North-West province, South Africa. Data from 314 adult men (≥18 years) were analysed. The men were recruited from four bars/taverns using systematic sampling. They responded to questions regarding their demographic characteristics, alcohol consumption, circumcision status and method (where applicable), and engagement in unprotected sex. Descriptive analyses and bivariate and multivariate logistic regression analyses were conducted. Age, education, relationship status, alcohol consumption and traditional male circumcision (TMC) were independently and significantly associated with unprotected sex. Specifically, probable alcohol dependence and traditional circumcision were independent risk factors for engaging in unprotected sex among tavern-going men. Traditionally circumcised men had a higher risk of engaging in unprotected sex than medically circumcised men. Interventions aimed at reducing alcohol consumption, encouraging protective behaviour among men who have undergone TMC, and increasing condom use are needed in bar/tavern settings. HIV prevention education must be urgently incorporated into TMC programmes.

  10. [Legal aspects of ritual circumcision].

    PubMed

    Schreiber, M; Schott, G E; Rascher, W; Bender, A W

    2009-12-01

    Female circumcision (genital mutilation) is a criminal violation of human rights under German law. Even with consent of the person to be circumcised and/or her legal representative this procedure must not be carried out since a consent to female circumcision is unethical and therefore void. As much consent as there is on female circumcision the legal situation with ritual male circumcision is very unclear. In practice and unnoticed by the public male circumcision is carried out - be it for medical or ritual reasons - without deeper-going reflexions on the clearness of the medical indication or the legal situation with ritual circumcision. From the medical aspect there are big differences between female and male circumcision but also certain parallels. Various reasons, partly founded in prejudice and misinformation, make people refrain from regarding circumcision of boys also as illegal. Contrary to the prevailing opinion male circumcision also represents a bodily harm which a doctor can only carry out after a preoperative interview and with the consent of the affected person. Since ritual male circumcision does not serve the wellbeing of a child it is not possible for the parents to give their consent to the circumcision in lieu of the child. Male circumcision is only permitted if the child has given his consent and is thus only legally permitted if the child has reached an age at which he is mature enough to understand the meaning and extent of such an action which is hardly the case before he has completed his 16 (th) year.

  11. Circumcision: pros and cons.

    PubMed

    Burgu, Berk; Aydogdu, Ozgu; Tangal, Semih; Soygur, Tarkan

    2010-01-01

    Circumcision is possibly the most frequently performed elective surgical procedure in men. It can simply be described as the excision of the preputium. There have been several studies about the association between circumcision and urinary tract infections (UTI). Many studies have demonstrated that the frequency of UTI increase in uncircumcised males, especially in the first year of life. This review discusses the embryology of the preputium, epidemiology, indications, complications and benefits of circumcision, as well as operation and anesthesiology techniques. It especially examines the association between UTI and circumcision and the importance of circumcision in congenital urinary system anomalies. In addition, this review examines the associations between circumcision and sexually transmitted diseases, including HIV, and the protective role of circumcision on penile cancer.

  12. Circumcision: Pros and cons

    PubMed Central

    Burgu, Berk; Aydogdu, Ozgu; Tangal, Semih; Soygur, Tarkan

    2010-01-01

    Circumcision is possibly the most frequently performed elective surgical procedure in men. It can simply be described as the excision of the preputium. There have been several studies about the association between circumcision and urinary tract infections (UTI). Many studies have demonstrated that the frequency of UTI increase in uncircumcised males, especially in the first year of life. This review discusses the embryology of the preputium, epidemiology, indications, complications and benefits of circumcision, as well as operation and anesthesiology techniques. It especially examines the association between UTI and circumcision and the importance of circumcision in congenital urinary system anomalies. In addition, this review examines the associations between circumcision and sexually transmitted diseases, including HIV, and the protective role of circumcision on penile cancer. PMID:20535279

  13. Comparative Cost of Early Infant Male Circumcision by Nurse-Midwives and Doctors in Zimbabwe

    PubMed Central

    Mangenah, Collin; Mavhu, Webster; Hatzold, Karin; Biddle, Andrea K; Ncube, Getrude; Mugurungi, Owen; Ticklay, Ismail; Cowan, Frances M; Thirumurthy, Harsha

    2016-01-01

    ABSTRACT Background: The 14 countries that are scaling up voluntary male medical circumcision (VMMC) for HIV prevention are also considering early infant male circumcision (EIMC) to ensure longer-term reductions in HIV incidence. The cost of implementing EIMC is an important factor in scale-up decisions. We conducted a comparative cost analysis of EIMC performed by nurse-midwives and doctors using the AccuCirc device in Zimbabwe. Methods: Between August 2013 and July 2014, nurse-midwives performed EIMC on 500 male infants using AccuCirc in a field trial. We analyzed the overall unit cost and identified key cost drivers of EIMC performed by nurse-midwives and compared these with costing data previously collected during a randomized noninferiority comparison trial of 2 devices (AccuCirc and the Mogen clamp) in which doctors performed EIMC. We assessed direct costs (consumable and nonconsumable supplies, device, personnel, associated staff training, and waste management costs) and indirect costs (capital and support personnel costs). We performed one-way sensitivity analyses to assess cost changes when we varied key component costs. Results: The unit costs of EIMC performed by nurse-midwives and doctors in vertical programs were US$38.87 and US$49.77, respectively. Key cost drivers of EIMC were consumable supplies, personnel costs, and the device price. In this cost analysis, major cost drivers that explained the differences between EIMC performed by nurse-midwives and doctors were personnel and training costs, both of which were lower for nurse-midwives. Conclusions: EIMC unit costs were lower when performed by nurse-midwives compared with doctors. To minimize costs, countries planning to scale up EIMC should consider using nurse-midwives, who are in greater supply than doctors and are the main providers at the primary health care level, where most infants are born. PMID:27413085

  14. Bringing Early Infant Male Circumcision Information Home to the Family: Demographic Characteristics and Perspectives of Clients in a Pilot Project in Tanzania

    PubMed Central

    Amuri, Mbaraka; Msemo, Georgina; Plotkin, Marya; Christensen, Alice; Boyee, Dorica; Mahler, Hally; Phafoli, Semakaleng; Njozi, Mustafa; Hellar, Augustino; Mlanga, Erick; Yansaneh, Aisha; Njeuhmeli, Emmanuel; Lija, Jackson

    2016-01-01

    ABSTRACT Iringa region of Tanzania has had great success reaching targets for voluntary medical male circumcision (VMMC). Looking to sustain high coverage of male circumcision, the government introduced a pilot project to offer early infant male circumcision (EIMC) in Iringa in 2013. From April 2013 to December 2014, a total of 2,084 male infants were circumcised in 8 health facilities in the region, representing 16.4% of all male infants born in those facilities. Most circumcisions took place 7 days or more after birth. The procedure proved safe, with only 3 mild and 3 moderate adverse events (0.4% overall adverse event rate). Overall, 93% of infants were brought back for a second-day visit and 71% for a seventh-day visit. These percentages varied significantly by urban and rural residence (97.4% urban versus 84.6% rural for day 2 visit; 82.2% urban versus 49.9% rural for day 7 visit). Mothers were more likely than fathers to have received information about EIMC. However, fathers tended to be key decision makers regarding circumcision of their sons. This suggests the importance of addressing fathers with behavioral change communication about EIMC. Successes in scaling up VMMC services in Iringa did not translate into immediate acceptability of EIMC. EIMC programs will require targeted investments in demand creation to expand and thrive in traditionally non-circumcising settings such as Iringa. PMID:27413081

  15. Bringing Early Infant Male Circumcision Information Home to the Family: Demographic Characteristics and Perspectives of Clients in a Pilot Project in Tanzania.

    PubMed

    Amuri, Mbaraka; Msemo, Georgina; Plotkin, Marya; Christensen, Alice; Boyee, Dorica; Mahler, Hally; Phafoli, Semakaleng; Njozi, Mustafa; Hellar, Augustino; Mlanga, Erick; Yansaneh, Aisha; Njeuhmeli, Emmanuel; Lija, Jackson

    2016-07-01

    Iringa region of Tanzania has had great success reaching targets for voluntary medical male circumcision (VMMC). Looking to sustain high coverage of male circumcision, the government introduced a pilot project to offer early infant male circumcision (EIMC) in Iringa in 2013. From April 2013 to December 2014, a total of 2,084 male infants were circumcised in 8 health facilities in the region, representing 16.4% of all male infants born in those facilities. Most circumcisions took place 7 days or more after birth. The procedure proved safe, with only 3 mild and 3 moderate adverse events (0.4% overall adverse event rate). Overall, 93% of infants were brought back for a second-day visit and 71% for a seventh-day visit. These percentages varied significantly by urban and rural residence (97.4% urban versus 84.6% rural for day 2 visit; 82.2% urban versus 49.9% rural for day 7 visit). Mothers were more likely than fathers to have received information about EIMC. However, fathers tended to be key decision makers regarding circumcision of their sons. This suggests the importance of addressing fathers with behavioral change communication about EIMC. Successes in scaling up VMMC services in Iringa did not translate into immediate acceptability of EIMC. EIMC programs will require targeted investments in demand creation to expand and thrive in traditionally non-circumcising settings such as Iringa.

  16. Bringing Early Infant Male Circumcision Information Home to the Family: Demographic Characteristics and Perspectives of Clients in a Pilot Project in Tanzania.

    PubMed

    Amuri, Mbaraka; Msemo, Georgina; Plotkin, Marya; Christensen, Alice; Boyee, Dorica; Mahler, Hally; Phafoli, Semakaleng; Njozi, Mustafa; Hellar, Augustino; Mlanga, Erick; Yansaneh, Aisha; Njeuhmeli, Emmanuel; Lija, Jackson

    2016-07-01

    Iringa region of Tanzania has had great success reaching targets for voluntary medical male circumcision (VMMC). Looking to sustain high coverage of male circumcision, the government introduced a pilot project to offer early infant male circumcision (EIMC) in Iringa in 2013. From April 2013 to December 2014, a total of 2,084 male infants were circumcised in 8 health facilities in the region, representing 16.4% of all male infants born in those facilities. Most circumcisions took place 7 days or more after birth. The procedure proved safe, with only 3 mild and 3 moderate adverse events (0.4% overall adverse event rate). Overall, 93% of infants were brought back for a second-day visit and 71% for a seventh-day visit. These percentages varied significantly by urban and rural residence (97.4% urban versus 84.6% rural for day 2 visit; 82.2% urban versus 49.9% rural for day 7 visit). Mothers were more likely than fathers to have received information about EIMC. However, fathers tended to be key decision makers regarding circumcision of their sons. This suggests the importance of addressing fathers with behavioral change communication about EIMC. Successes in scaling up VMMC services in Iringa did not translate into immediate acceptability of EIMC. EIMC programs will require targeted investments in demand creation to expand and thrive in traditionally non-circumcising settings such as Iringa. PMID:27413081

  17. Herpes Simplex [corrected] Virus Type 2 Shedding From Male Circumcision Wounds in Rakai, Uganda.

    PubMed

    Grabowski, Mary K; Kigozi, Godfrey; Gray, Ronald H; Armour, Benjamin; Manucci, Jordyn; Serwadda, David; Redd, Andrew D; Nalugoda, Fred; Patel, Eshan U; Wawer, Maria J; Quinn, Thomas C; Tobian, Aaron A R

    2015-11-15

    A prospective observational study of 176 men coinfected with human immunodeficiency virus and herpes simplex virus type 2 (HSV-2) was conducted to assess whether their sexual partners may be at an increased risk of HSV-2 from male circumcision (MC) wounds. Preoperative and weekly penile lavage samples were tested for penile HSV-2 shedding. Prevalence risk ratios (PRRs) were estimated using Poisson regression. Detectable penile HSV-2 shedding was present in 9.7% of men (17 of 176) before MC, compared with 12.9% (22 of 170) at 1 week (PRR, 1.33; 95% confidence interval [CI], .74-2.38) and 14.8% (23 of 155) at 2 weeks (PRR, 1.50; 95% CI, .86-2.62) after MC. HSV-2 shedding was lower among men with healed MC wounds (adjusted PRR, 0.62; 95% CI, .35-1.08). Men undergoing MC should be counseled on sexual abstinence and condom use.

  18. Innovative Demand Creation for Voluntary Medical Male Circumcision Targeting a High Impact Male Population: A Pilot Study Engaging Pregnant Women at Antenatal Clinics in Kampala, Uganda

    PubMed Central

    Semeere, Aggrey S.; Castelnuovo, Barbara; Bbaale, Denis S.; Kiragga, Agnes N.; Kigozi, Joanita; Muganzi, Alex M.; Coutinho, Alex G.

    2016-01-01

    Background: Circumcision has been shown to be an effective method of HIV prevention; however, only 28% of Ugandan men aged 15–49 years are circumcised. There is a paucity of data on the role of intimate partners in generating demand for voluntary medical male circumcision (VMMC). We conducted a pilot study to assess the feasibility of a partner-focused intervention targeting males >25 years. Methods: Among pregnant women in their third trimester attending antenatal care we evaluated the impact of a pilot behavior change intervention on VMMC through a quasi-experimental approach. We observed VMMC numbers among spouses of women as per standard practice (comparison phase), and after introducing a behavioral change communication package (intervention phase). Logistic regression was used to compare the odds of VMMC uptake between comparison and intervention phases. We used qualitative methods to evaluate the casual chain using a thematic approach. Results: Of the 601 women studied, 90% articulated the health benefits of VMMC and 99% expressed interest in their spouse getting circumcised. Women's knowledge was not increased by the intervention. Four men were circumcised in the comparison and 7 in the intervention phase. The intervention was not associated with higher odds of circumcision (odds ratio 1.5, 95% CI: 0.3 to 6.0, P = 0.65). We interviewed 117 individuals overall with the main enablers for VMMC being: free VMMC, transport reimbursement, and health benefits. Deterrents included misconceptions, lost wages and fear of pain. Most of the uncircumcised men interviewed reported interest in VMMC. Conclusions: Our pilot intervention had no significant impact on increasing VMMC demand. The study demonstrated the feasibility of pregnant women engaging their spouses to discuss VMMC. PMID:27404008

  19. Estimating Client Out-of-Pocket Costs for Accessing Voluntary Medical Male Circumcision in South Africa

    PubMed Central

    Tchuenche, Michel; Haté, Vibhuti; McPherson, Dacia; Palmer, Eurica; Thambinayagam, Ananthy; Loykissoonlal, Dayanund; Forsythe, Steven

    2016-01-01

    In 2010, South Africa launched a countrywide effort to scale up its voluntary medical male circumcision (VMMC) program on the basis of compelling evidence that circumcision reduces men’s risk of acquiring HIV through heterosexual intercourse. Even though VMMC is free there, clients can incur indirect out-of-pocket costs (for example transportation cost or foregone income). Because these costs can be barriers to increasing the uptake of VMMC services, we assessed them from a client perspective, to inform VMMC demand creation policies. Costs (calculated using a bottom-up approach) and demographic data were systematically collected through 190 interviews conducted in 2015 with VMMC clients or (for minors) their caregivers at 25 VMMC facilities supported by the government and the President’s Emergency Plan for AIDS Relief in eight of South Africa’s nine provinces. The average age of VMMC clients was 22 years and nearly 92% were under 35 years of age. The largest reported out-of-pocket expenditure was transportation, at an average of US$9.20 (R 100). Only eight clients (4%) reported lost days of work. Indirect expenditures were childcare costs (one client) and miscellaneous items such as food or medicine (20 clients). Given competing household expense priorities, spending US$9.20 (R100) per person on transportation to access VMMC services could be a significant burden on clients and households, and a barrier to South Africa’s efforts to create demand for VMMC. Thus, we recommend a more focused analysis of clients’ transportation costs to access VMMC services. PMID:27783635

  20. A Cross Sectional Study of the Prevalence of Preputial and Penile Scrotal Abnormalities among Clients Undergoing Voluntary Medical Male Circumcision in Soweto, South Africa

    PubMed Central

    Mukudu, Hillary; Otwombe, Kennedy; Laher, Fatima; Lazarus, Erica; Manentsa, Mmatsie; Lebina, Limakatso; Mapulanga, Victor; Bowa, Kasonde; Martinson, Neil

    2016-01-01

    Objective Medical device use is currently approved for males without preputial or major penile scrotal abnormalities for voluntary medical male circumcision (VMMC). We determined the prevalence of preputial abnormalities at a busy VMMC centre in Soweto, South Africa. Methods This was a cross-sectional record review at a high-volume VMMC centre in South Africa. We collated pre-circumcision demographic and genital examination findings from clients 8 years and older who had undergone VMMC from 01 May 2013 to 30 April 2014. Logistic regression was used to determine factors associated with preputial abnormalities. Findings During the review period, 6861 circumcisions were conducted and 37.1% (n = 2543) were 8–13 year olds. Median age was 15 years (IQR: 12–23 years). Fifteen percent (n = 1030) had preputial abnormalities or major penile scrotal abnormalities. Age-specific prevalence of preputial or major genital abnormalities were 27.3%, 10.6% and 6.0% in 8–13, 14–18 and > 18 year olds respectively. The odds of preputial or major penile scrotal abnormality were higher in younger clients aged 8–13 years (OR = 5.9; 95% CI = 4.8–7.1) and 14–18 years (OR = 1.9; 95% CI = 1.5–2.4) compared to older clients above18 years and in those testing for HIV outside our clinic network (OR = 1.9; 95% CI = 1.4–2.7). Conclusion The high prevalence of preputial and penile scrotal abnormalities observed suggests a need for VMMC sites to provide for both open surgical and devices methods in the provision of VMMC services. This is especially so among young male subjects presenting themselves for VMMC services at the various sites being developed in sub Saharan African countries. PMID:27253372

  1. Safety, Acceptability, and Feasibility of Early Infant Male Circumcision Conducted by Nurse-Midwives Using the AccuCirc Device: Results of a Field Study in Zimbabwe

    PubMed Central

    Mavhu, Webster; Larke, Natasha; Hatzold, Karin; Ncube, Getrude; Weiss, Helen A; Mangenah, Collin; Chonzi, Prosper; Mugurungi, Owen; Mufuka, Juliet; Samkange, Christopher A; Gwinji, Gerald; Cowan, Frances M; Ticklay, Ismail

    2016-01-01

    ABSTRACT Background: For prevention of HIV, early infant male circumcision (EIMC) needs to be scaled up in countries with high HIV prevalence. Routine EIMC will maintain the HIV prevention gains anticipated from current adult male circumcision initiatives. We present here the results of a field study of EIMC conducted in Zimbabwe. Methods: The study was observational and based on the World Health Organization (WHO) framework for clinical evaluation of male circumcision devices. We recruited parents of newborn male infants between August 2013 and July 2014 from 2 clinics. Nurse-midwives used the AccuCirc device to circumcise eligible infants. We followed participants for 14 days after EIMC. Outcome measures were EIMC safety, acceptability, and feasibility. Results: We enrolled 500 male infants in the field study (uptake 11%). The infants were circumcised between 6 and 60 days postpartum. The procedure took a median of 17 minutes (interquartile range of 5 to 18 minutes). Mothers’ knowledge of male circumcision was extensive. Of the 498 mothers who completed the study questionnaire, 91% knew that male circumcision decreases the risk of HIV acquisition, and 83% correctly stated that this prevention is partial. Asked about their community’s perception of EIMC, 40% felt that EIMC will likely be viewed positively in their community; 13% said negatively; and 47% said the perception could be both ways. We observed 7 moderate or severe adverse events (1.4%; 95% confidence interval, 0.4% to 2.4%). All resolved without lasting effects. Nearly all mothers (99%) reported great satisfaction with the outcome, would recommend EIMC to other parents, and would circumcise their next sons. Conclusion: This first field study in sub-Saharan Africa of the AccuCirc device for EIMC demonstrated that EIMC conducted by nurse-midwives with this device is safe, feasible, and acceptable to parents. PMID:27413083

  2. Veracity and rhetoric in paediatric medicine: a critique of Svoboda and Van Howe's response to the AAP policy on infant male circumcision.

    PubMed

    Morris, Brian J; Tobian, Aaron A R; Hankins, Catherine A; Klausner, Jeffrey D; Banerjee, Joya; Bailis, Stefan A; Moses, Stephen; Wiswell, Thomas E

    2014-07-01

    In a recent issue of the Journal of Medical Ethics,Svoboda and Van Howe commented on the 2012 changein the American Academy of Pediatrics (AAP) policy on newborn male circumcision, in which the AAP stated that benefits of the procedure outweigh the risks. Svoboda and Van Howe disagree with the AAP conclusions. We show here that their arguments against male circumcision are based on a poor understanding of epidemiology,erroneous interpretation of the evidence, selective citation of the literature, statistical manipulation of data, and circular reasoning. In reality, the scientific evidence indicates that male circumcision, especially when performed in the newborn period, is an ethically and medically sound low-risk preventive health procedure conferring a lifetime of benefits to health and well-being.Policies in support of parent-approved elective newborn circumcision should be embraced by the medical,scientific and wider communities.

  3. Strength of Evidence on Demand Creation for Voluntary Medical Male Circumcision From 7 Impact Evaluations in Southern and Eastern Africa

    PubMed Central

    Brown, Annette N.

    2016-01-01

    Background: Seven new impact evaluations of pilot programs for increasing the demand for voluntary medical male circumcision (VMMC) provide evidence of what works and what does not. The study findings suggest that financial compensation designed to relieve the opportunity or transportation costs from undergoing the procedure can increase the uptake of VMMC. There is also evidence that programs using peer influence can be effective, although so far only sports-based programs demonstrate a strong effect. We explore the strength of evidence in each of these 7 studies to better interpret the findings for policy making. Methods: We perform a risk of bias assessment and conduct power calculations using actual values for each of the 7 studies. Results: Three of the 7 studies have a medium risk of bias, whereas the other 4 have a low risk of bias. All but 2 of the studies have adequate power to detect meaningful effects. In the 2 with insufficient power, the estimated effects are large but statistically insignificant. Conclusion: The positive evidence that financial incentives presented as compensation for opportunity costs to men seeking and obtaining VMMC can increase uptake comes from strong studies, which have high power and low to medium risk of bias. The positive evidence that a comprehensive sports-based program for young men can increase uptake also comes from a strong study. The strength of the studies further validates these findings. PMID:27749599

  4. Safety Profile of PrePex Male Circumcision Device and Client Satisfaction With Adolescent Males Aged 13–17 Years in Zimbabwe

    PubMed Central

    Tshimanga, Mafuta; Mugurungi, Owen; Mangwiro, Tonderayi; Ncube, Getrude; Xaba, Sinokuthemba; Chatikobo, Pesanai; Gundidza, Patricia; Samkange, Christopher; Dhlamini, Roy; Murwira, Munyaradzi; Gwinji, Gerald

    2016-01-01

    Background: The safety and efficacy of the PrePex device for voluntary medical male circumcision (VMMC) has been demonstrated in studies in Rwanda, Uganda, and Zimbabwe, leading to the conditional prequalification of the device for use in adults. Because the majority of VMMC clients in the 14 priority countries are adolescents under 18 years, research to establish the safety and efficacy of the device for males <18 years is required. Methods: One-arm, prospective study included 402 adolescents, aged 13–17 years, using PrePex device between August 2013 and January 2014 at a VMMC centre in Harare. Endpoints are number and grade of adverse events associated with device circumcision, time to complete wound healing, client satisfaction with the procedure, and outcome. Results: The rate of medical ineligibility among adolescent males was high; 237/402 (35.9%) of study participants had to be excluded based on medical reasons. The severe/moderate adverse event rate was low at 2/402 (0.5%). No device displacements/self-removals were observed. Time to complete wound healing was shorter than in adults; 367/398 (92.2%) adolescents had completed wound healing by day 35, whereas 90% of adults had completed wound healing by day 56 as demonstrated in previous studies. Overall, adolescents were highly satisfied with the results of their circumcision. Conclusions: The study demonstrates that the PrePex device can be safely used in adolescents aged 13–17 years. The significant proportion of males opting for surgical circumcision and the high medical ineligibility suggest that surgical circumcision needs to be provided alongside PrePex services in programs targeting young age groups. PMID:27331588

  5. Voluntary Medical Male Circumcision: A Framework Analysis of Policy and Program Implementation in Eastern and Southern Africa

    PubMed Central

    Dickson, Kim E.; Tran, Nhan T.; Samuelson, Julia L.; Njeuhmeli, Emmanuel; Cherutich, Peter; Dick, Bruce; Farley, Tim; Ryan, Caroline; Hankins, Catherine A.

    2011-01-01

    Background Following confirmation of the effectiveness of voluntary medical male circumcision (VMMC) for HIV prevention, the World Health Organization and the Joint United Nations Programme on HIV/AIDS issued recommendations in 2007. Less than 5 y later, priority countries are at different stages of program scale-up. This paper analyzes the progress towards the scale-up of VMMC programs. It analyzes the adoption of VMMC as an additional HIV prevention strategy and explores the factors may have expedited or hindered the adoption of policies and initial program implementation in priority countries to date. Methods and Findings VMMCs performed in priority countries between 2008 and 2010 were recorded and used to classify countries into five adopter categories according to the Diffusion of Innovations framework. The main predictors of VMMC program adoption were determined and factors influencing subsequent scale-up explored. By the end of 2010, over 550,000 VMMCs had been performed, representing approximately 3% of the target coverage level in priority countries. The “early adopter” countries developed national VMMC policies and initiated VMMC program implementation soon after the release of the WHO recommendations. However, based on modeling using the Decision Makers' Program Planning Tool (DMPPT), only Kenya appears to be on track towards achievement of the DMPPT-estimated 80% coverage goal by 2015, having already achieved 61.5% of the DMPPT target. None of the other countries appear to be on track to achieve their targets. Potential predicators of early adoption of male circumcision programs include having a VMMC focal person, establishing a national policy, having an operational strategy, and the establishment of a pilot program. Conclusions Early adoption of VMMC policies did not necessarily result in rapid program scale-up. A key lesson is the importance of not only being ready to adopt a new intervention but also ensuring that factors critical to supporting

  6. Single-arm evaluation of the AccuCirc device for early infant male circumcision in Botswana.

    PubMed

    Plank, Rebeca M; Wirth, Kathleen E; Ndubuka, Nnamdi O; Abdullahi, Rasak; Nkgau, Maggie; Lesetedi, Chiapo; Powis, Kathleen M; Mmalane, Mompati; Makhema, Joseph; Shapiro, Roger; Lockman, Shahin

    2014-05-01

    : Existing devices for early infant male circumcision (EIMC) have inherent limitations. We evaluated the newly developed AccuCirc device by circumcising 151 clinically well, full-term male infants with birth weight ≥2.5 kg within the first 10 days of life from a convenience sample in 2 hospitals in Botswana. No major adverse events were observed. There was 1 local infection, 5 cases of minor bleeding, and 1 case of moderate bleeding. In 3 cases, the device made only partial incisions that were completed immediately by the provider without complications. Parental satisfaction was high: >96% of mothers stated that they would circumcise a future son. The pre-assembled, sterile AccuCirc kit has the potential to overcome obstacles related to supply chain management and on-site instrument disinfection that can pose challenges in resource-limited settings. In our study, the AccuCirc was safe and it should be considered for programmatic EIMC in resource-limited settings.

  7. Single-arm evaluation of the AccuCirc device for early infant male circumcision in Botswana.

    PubMed

    Plank, Rebeca M; Wirth, Kathleen E; Ndubuka, Nnamdi O; Abdullahi, Rasak; Nkgau, Maggie; Lesetedi, Chiapo; Powis, Kathleen M; Mmalane, Mompati; Makhema, Joseph; Shapiro, Roger; Lockman, Shahin

    2014-05-01

    : Existing devices for early infant male circumcision (EIMC) have inherent limitations. We evaluated the newly developed AccuCirc device by circumcising 151 clinically well, full-term male infants with birth weight ≥2.5 kg within the first 10 days of life from a convenience sample in 2 hospitals in Botswana. No major adverse events were observed. There was 1 local infection, 5 cases of minor bleeding, and 1 case of moderate bleeding. In 3 cases, the device made only partial incisions that were completed immediately by the provider without complications. Parental satisfaction was high: >96% of mothers stated that they would circumcise a future son. The pre-assembled, sterile AccuCirc kit has the potential to overcome obstacles related to supply chain management and on-site instrument disinfection that can pose challenges in resource-limited settings. In our study, the AccuCirc was safe and it should be considered for programmatic EIMC in resource-limited settings. PMID:24594500

  8. Evidence-based identification of key beliefs explaining adult male circumcision motivation in Zimbabwe: targets for behavior change messaging.

    PubMed

    Montaño, Daniel E; Kasprzyk, Danuta; Hamilton, Deven T; Tshimanga, Mufuta; Gorn, Gerald

    2014-05-01

    Male circumcision (MC) reduces HIV acquisition among men, leading WHO/UNAIDS to recommend a goal to circumcise 80 % of men in high HIV prevalence countries. Significant investment to increase MC capacity in priority countries was made, yet only 5 % of the goal has been achieved in Zimbabwe. The integrated behavioral model (IBM) was used as a framework to investigate the factors affecting MC motivation among men in Zimbabwe. A survey instrument was designed based on elicitation study results, and administered to a representative household-based sample of 1,201 men aged 18-30 from two urban and two rural areas in Zimbabwe. Multiple regression analysis found all five IBM constructs significantly explained MC Intention. Nearly all beliefs underlying the IBM constructs were significantly correlated with MC Intention. Stepwise regression analysis of beliefs underlying each construct respectively found that 13 behavioral beliefs, 5 normative beliefs, 4 descriptive norm beliefs, 6 efficacy beliefs, and 10 control beliefs were significant in explaining MC Intention. A final stepwise regression of the five sets of significant IBM construct beliefs identified 14 key beliefs that best explain Intention. Similar analyses were carried out with subgroups of men by urban-rural and age. Different sets of behavioral, normative, efficacy, and control beliefs were significant for each sub-group, suggesting communication messages need to be targeted to be most effective for sub-groups. Implications for the design of effective MC demand creation messages are discussed. This study demonstrates the application of theory-driven research to identify evidence-based targets for intervention messages to increase men's motivation to get circumcised and thereby improve demand for male circumcision. PMID:24443147

  9. Evidence-based identification of key beliefs explaining adult male circumcision motivation in Zimbabwe: targets for behavior change messaging.

    PubMed

    Montaño, Daniel E; Kasprzyk, Danuta; Hamilton, Deven T; Tshimanga, Mufuta; Gorn, Gerald

    2014-05-01

    Male circumcision (MC) reduces HIV acquisition among men, leading WHO/UNAIDS to recommend a goal to circumcise 80 % of men in high HIV prevalence countries. Significant investment to increase MC capacity in priority countries was made, yet only 5 % of the goal has been achieved in Zimbabwe. The integrated behavioral model (IBM) was used as a framework to investigate the factors affecting MC motivation among men in Zimbabwe. A survey instrument was designed based on elicitation study results, and administered to a representative household-based sample of 1,201 men aged 18-30 from two urban and two rural areas in Zimbabwe. Multiple regression analysis found all five IBM constructs significantly explained MC Intention. Nearly all beliefs underlying the IBM constructs were significantly correlated with MC Intention. Stepwise regression analysis of beliefs underlying each construct respectively found that 13 behavioral beliefs, 5 normative beliefs, 4 descriptive norm beliefs, 6 efficacy beliefs, and 10 control beliefs were significant in explaining MC Intention. A final stepwise regression of the five sets of significant IBM construct beliefs identified 14 key beliefs that best explain Intention. Similar analyses were carried out with subgroups of men by urban-rural and age. Different sets of behavioral, normative, efficacy, and control beliefs were significant for each sub-group, suggesting communication messages need to be targeted to be most effective for sub-groups. Implications for the design of effective MC demand creation messages are discussed. This study demonstrates the application of theory-driven research to identify evidence-based targets for intervention messages to increase men's motivation to get circumcised and thereby improve demand for male circumcision.

  10. Male circumcision is associated with a lower prevalence of human papillomavirus-associated penile lesions among Kenyan men.

    PubMed

    Backes, Danielle M; Bleeker, Maaike C G; Meijer, Chris J L M; Hudgens, Michael G; Agot, Kawango; Bailey, Robert C; Ndinya-Achola, J O; Hayombe, Juma; Hogewoning, Cornelis J A; Moses, Stephen; Snijders, Peter J F; Smith, Jennifer S

    2012-04-15

    Human papillomavirus (HPV)-associated penile lesions in men may increase the risk of HPV transmission to their female partners. Risk factor data on HPV-associated penile lesions are needed from regions with a high burden of cervical cancer. Visual inspection of the penis was conducted using a colposcope at the 24-month visit among participants in a randomized controlled trial of male circumcision in Kenya, from May 2006 to October 2007. All photos were read independently by two observers for quality control. Penile exfoliated cells sampled from the glans/coronal sulcus and the shaft were tested for HPV DNA using GP5+/6+ PCR and for HPV16, 18 and 31 viral loads using a real time PCR assay. Of 275 men, 151 were circumcised and 124 uncircumcised. The median age was 22 years. Circumcised men had a lower prevalence of flat penile lesions (0.7%) versus uncircumcised (26.0%); adjusted odds ratio (OR) = 0.02; 95% confidence interval (CI) = 0.003-0.1. Compared to men who were HPV negative, men who were HPV DNA positive (OR = 6.5; 95% CI = 2.4-17.5) or who had high HPV16/18/31 viral load (OR = 5.2; 95% CI = 1.1-24.4) had higher odds of flat penile lesions. Among men with flat penile lesions, HPV56 (29.0%) and 16 (25.8%) were the most common types within single or multiple infections. Flat penile lesions are much more frequent in uncircumcised men and associated with higher prevalence of HPV and higher viral loads. This study suggests that circumcision reduces the prevalence of HPV-associated flat lesions and may ultimately reduce male-to-female HPV transmission. PMID:21618520

  11. Piloting PrePex for Adult and Adolescent Male Circumcision in South Africa – Pain Is an Issue

    PubMed Central

    Lebina, Limakatso; Taruberekera, Noah; Milovanovic, Minja; Hatzold, Karin; Mhazo, Miriam; Nhlapo, Cynthia; Tshabangu, Nkeko; Manentsa, Mmatsie; Kazangarare, Victoria; Makola, Millicent; Billy, Scott; Martinson, Neil

    2015-01-01

    Background The World Health Organisation and the Joint United Nations Programme on HIV/AIDS have recommended the scale-up of Medical Male Circumcision (MMC) in countries with high HIV and low MMC prevalence. PrePex device circumcision is proposed as an alternate method for scaling up MMC. Objective Evaluate safety and feasibility of PrePex in South Africa. Design A multisite prospective cohort PrePex study in adults and adolescents at three MMC clinics. Participants were followed-up 8 times, up to 56 days after PrePex placement. Results In total, 398 PrePex circumcisions were performed (315 adults and 83 adolescents) their median ages were 26 (IQR: 22–30) and 16 years (IQR: 15–17), respectively. The median time for device placement across both groups was 6 minutes (IQR: 5–9) with the leading PrePex sizes being B (30%) and C (35%) for adults (18–45 years), and A (31%) and B (38%) for adolescents (14–17 years). Additional sizes (size 12–20) were rarely used, even in the younger age group. Pain of device application was minimal but that of removal was severe. However, described pain abated rapidly and almost no pain was reported 1 hour after removal. The Adverse Events rate were experienced by 2.7% (11/398) of all participants, three of which were serious (2 displacements and 1 self-removal requiring prompt surgery). None of the Adverse Events required hospitalization. The majority of participants returned to work within a day of device placement. Conclusion Our study shows that PrePex is a safe MMC method, for males 14 years and above. PrePex circumcision had a similar adverse event rate to that reported for surgical MMC, but device removal caused high levels of pain, which subsided rapidly. PMID:26405786

  12. Adolescent Sexual and Reproductive Health Services and Implications for the Provision of Voluntary Medical Male Circumcision: Results of a Systematic Literature Review

    PubMed Central

    Van Lith, Lynn M.; Mallalieu, Elizabeth C.; Waxman, Aliza; Hatzhold, Karin; Marcell, Arik V.; Kasedde, Susan; Lija, Gissenge; Hasen, Nina; Ncube, Gertrude; Samuelson, Julia L.; Bonnecwe, Collen; Seifert-Ahanda, Kim; Njeuhmeli, Emmanuel; Tobian, Aaron A. R.

    2016-01-01

    Background Voluntary medical male circumcision (VMMC) is a critical HIV prevention tool. Since 2007, sub-Saharan African countries with the highest prevalence of HIV have been mobilizing resources to make VMMC available. While implementers initially targeted adult men, demand has been highest for boys under age 18. It is important to understand how male adolescents can best be served by quality VMMC services. Methods and Findings A systematic literature review was performed to synthesize the evidence on best practices in adolescent health service delivery specific to males in sub-Saharan Africa. PubMed, Scopus, and JSTOR databases were searched for literature published between January 1990 and March 2014. The review revealed a general absence of health services addressing the specific needs of male adolescents, resulting in knowledge gaps that could diminish the benefits of VMMC programming for this population. Articles focused specifically on VMMC contained little information on the adolescent subgroup. The review revealed barriers to and gaps in sexual and reproductive health and VMMC service provision to adolescents, including structural factors, imposed feelings of shame, endorsement of traditional gender roles, negative interactions with providers, violations of privacy, fear of pain associated with the VMMC procedure, and a desire for elements of traditional non-medical circumcision methods to be integrated into medical procedures. Factors linked to effective adolescent-focused services included the engagement of parents and the community, an adolescent-friendly service environment, and VMMC counseling messages sufficiently understood by young males. Conclusions VMMC presents an opportune time for early involvement of male adolescents in HIV prevention and sexual and reproductive health programming. However, more research is needed to determine how to align VMMC services with the unique needs of this population. PMID:26938639

  13. Reasons for the low uptake of adult male circumcision for the prevention of HIV transmission in Swaziland.

    PubMed

    Maibvise, Charles; Mavundla, Thandisizwe R

    2014-09-01

    Swaziland is currently experiencing the worst impact of HIV and AIDS of any country in the world. In an effort to curb further spread of the virus, the country adopted mass male circumcision (MC) as recommended by the World Health Organization in 2007. Despite intense campaigns to promote the procedure over the past three years, the uptake of circumcision remains very low for reasons that are not very clear. The purpose of this study was to explore the reasons for the low uptake of MC in Swaziland despite the massive national MC campaigns. A qualitative research design was used, in which all men who were targeted by the mass MC campaign were eligible. Participants were identified as they came for sexual and reproductive health services at the Family Life Association of Swaziland (FLAS) Clinic, Mbabane. In-depth, individual face-to-face unstructured interviews were conducted to elicit the reasons why men were not going for circumcision. A total of 17 men were interviewed. Results showed that these reasons include fear of the procedure and the possible outcome, perception of no significant benefit of the procedure, impatience about waiting for the procedure or the healing process, religious/cultural beliefs, and worries about the fate of the foreskin. These reasons were attributed to misconceptions and lack of accurate and specific information about some aspects of the circumcision strategy of HIV preventions. Physiological changes and economic activities associated with adulthood were also found to be hindrances to MC uptake. The study recommended that a comprehensive description of the procedure and more precise facts and scientific bases of the MC strategy be incorporated and emphasised in the MC campaigns. Involvement of religious leaders will also facilitate clarification of religious or cultural misunderstandings or misconceptions. A focus on neonatal MC would also help.

  14. Perceptions of HIV and Safe Male Circumcision in High HIV Prevalence Fishing Communities on Lake Victoria, Uganda

    PubMed Central

    Nevin, Paul E.; Pfeiffer, James; Kibira, Simon P. S.; Lubinga, Solomon J.; Mukose, Aggrey; Babigumira, Joseph B.

    2015-01-01

    Background In 2010, the Uganda Ministry of Health introduced its Safe Male Circumcision (SMC) strategy for HIV prevention with the goal of providing 4.2 million voluntary medical male circumcisions by 2015. Fishing communities, where HIV prevalence is approximately 3–5 times higher than the national average, have been identified as a key population needing targeted HIV prevention services by the National HIV Prevention Strategy. This study aimed to understand perceptions of HIV and identify potential barriers and facilitators to SMC in fishing communities along Lake Victoria. Methods We conducted 8 focus group discussions, stratified by sex and age, with 67 purposefully sampled participants in 4 communities in Kalangala District, Uganda. Results There was universal knowledge of the availability of SMC services, but males reported high uptake in the community while females indicated that it is low. Improved hygiene, disease prevention, and improved sexual performance and desirability were reported facilitators. Barriers included a perceived increase in SMC recipients’ physiological libido, post-surgical abstinence, lost income during convalescence, and lengthier recovery due to occupational hazards. Both males and females reported concerns about spousal fidelity during post-SMC abstinence. Reported misconceptions and community-held cultural beliefs include fear that foreskins are sold after their removal, the belief that a SMC recipient’s first sexual partner after the procedure should not be his spouse, and the belief that vaginal fluids aid circumcision wound healing. Conclusions Previous outreach efforts have effectively reached these remote communities, where availability and health benefits of SMC are widely understood. However, community-specific intervention strategies are needed to address the barriers identified in this study. We recommend the development of targeted counseling, outreach, and communication strategies to address barriers

  15. Sexually Transmitted Infections and Male Circumcision: A Systematic Review and Meta-Analysis

    PubMed Central

    Van Howe, Robert S.

    2013-01-01

    The claim that circumcision reduces the risk of sexually transmitted infections has been repeated so frequently that many believe it is true. A systematic review and meta-analyses were performed on studies of genital discharge syndrome versus genital ulcerative disease, genital discharge syndrome, nonspecific urethritis, gonorrhea, chlamydia, genital ulcerative disease, chancroid, syphilis, herpes simplex virus, human papillomavirus, and contracting a sexually transmitted infection of any type. Chlamydia, gonorrhea, genital herpes, and human papillomavirus are not significantly impacted by circumcision. Syphilis showed mixed results with studies of prevalence suggesting intact men were at great risk and studies of incidence suggesting the opposite. Intact men appear to be of greater risk for genital ulcerative disease while at lower risk for genital discharge syndrome, nonspecific urethritis, genital warts, and the overall risk of any sexually transmitted infection. In studies of general populations, there is no clear or consistent positive impact of circumcision on the risk of individual sexually transmitted infections. Consequently, the prevention of sexually transmitted infections cannot rationally be interpreted as a benefit of circumcision, and any policy of circumcision for the general population to prevent sexually transmitted infections is not supported by the evidence in the medical literature. PMID:23710368

  16. [Circumcision of new immigrants].

    PubMed

    Walfisch, S; Ben-Zion, Y Z; Gurman, G

    1994-02-01

    Recent immigration from eastern Europe to Israel (1990-1992) has brought to the Negev many uncircumcised newcomers. The rationale for circumcising healthy children has been a matter of controversy, not yet settled. Healthy adults are not usually circumcised except for ritual reasons. In the past 3 years we circumcised 2857 males 1-64 years old, mostly of Russian origin. All were operated on as outpatients on a 1-day, ambulatory service. 75% of the newcomers were operated on during the first 6 months after immigration. 86% of the circumcisions were done under general anesthesia and the rest under local. After stretching the prepuce backwards, the foreskin was excised. Hemostasis was achieved with the aid of electrocautery and the skin was approximated with in absorbable sutures. All patients were re examined 1 week later. There were complications in 50 (1.75%), consisting mostly of postoperative bleeding and wound infections. We conclude that ritual circumcision is a safe procedure in normal adults.

  17. Voluntary Medical Male Circumcision for HIV Prevention: New Mathematical Models for Strategic Demand Creation Prioritizing Subpopulations by Age and Geography

    PubMed Central

    Hankins, Catherine; Warren, Mitchell

    2016-01-01

    Over 11 million voluntary medical male circumcisions (VMMC) have been performed of the projected 20.3 million needed to reach 80% adult male circumcision prevalence in priority sub-Saharan African countries. Striking numbers of adolescent males, outside the 15-49-year-old age target, have been accessing VMMC services. What are the implications of overall progress in scale-up to date? Can mathematical modeling provide further insights on how to efficiently reach the male circumcision coverage levels needed to create and sustain further reductions in HIV incidence to make AIDS no longer a public health threat by 2030? Considering ease of implementation and cultural acceptability, decision makers may also value the estimates that mathematical models can generate of immediacy of impact, cost-effectiveness, and magnitude of impact resulting from different policy choices. This supplement presents the results of mathematical modeling using the Decision Makers’ Program Planning Tool Version 2.0 (DMPPT 2.0), the Actuarial Society of South Africa (ASSA2008) model, and the age structured mathematical (ASM) model. These models are helping countries examine the potential effects on program impact and cost-effectiveness of prioritizing specific subpopulations for VMMC services, for example, by client age, HIV-positive status, risk group, and geographical location. The modeling also examines long-term sustainability strategies, such as adolescent and/or early infant male circumcision, to preserve VMMC coverage gains achieved during rapid scale-up. The 2016–2021 UNAIDS strategy target for VMMC is an additional 27 million VMMC in high HIV-prevalence settings by 2020, as part of access to integrated sexual and reproductive health services for men. To achieve further scale-up, a combination of evidence, analysis, and impact estimates can usefully guide strategic planning and funding of VMMC services and related demand-creation strategies in priority countries. Mid

  18. Male circumcision and prevalence of genital human papillomavirus infection in men: a multinational study

    PubMed Central

    2013-01-01

    Background Accumulated evidence from epidemiological studies and more recently from randomized controlled trials suggests that male circumcision (MC) may substantially protect against genital HPV infection in men. The purpose of this study was to assess the association between MC and genital HPV infection in men in a large multinational study. Methods A total of 4072 healthy men ages 18–70 years were enrolled in a study conducted in Brazil, Mexico, and the United States. Enrollment samples combining exfoliated cells from the coronal sulcus, glans penis, shaft, and scrotum were analyzed for the presence and genotyping of HPV DNA by PCR and linear array methods. Prevalence ratios (PR) were used to estimate associations between MC and HPV detection adjusting for potential confounders. Results MC was not associated with overall prevalence of any HPV, oncogenic HPV types or unclassified HPV types. However, MC was negatively associated with non-oncogenic HPV infections (PR 0.85, 95% confident interval: 0.76-0.95), in particular for HPV types 11, 40, 61, 71, and 81. HPV 16, 51, 62, and 84 were the most frequently identified genotypes regardless of MC status. Conclusions This study shows no overall association between MC and genital HPV infections in men, except for certain non-oncogenic HPV types for which a weak association was found. However, the lack of association with MC might be due to the lack of anatomic site specific HPV data, for example the glans penis, the area expected to be most likely protected by MC. PMID:23327450

  19. Men's attitudes: A hindrance to the demand for voluntary medical male circumcision--a qualitative study in rural Mhondoro-Ngezi, Zimbabwe.

    PubMed

    Moyo, Stanzia; Mhloyi, Marvellous; Chevo, Tafadzwa; Rusinga, Oswell

    2015-01-01

    Male circumcision has witnessed a paradigm shift from being regarded as a religious and cultural practice to a global intervention strategy meant to curb transmission of HIV. This is particularly evident in sub-Saharan African countries where the HIV prevalence is greater than 15%. Zimbabwe adopted the voluntary medical male circumcision (VMMC) strategy in 2009; however, since then the uptake of the intervention has only 10% of the adult male population has reported having been circumcised. To better understand this limited uptake of VMMC, we conducted a qualitative study with uncircumcised men aged 15-79 years in Mhondoro-Ngezi, Zimbabwe. Through assessing men's attitudes towards VMMC in seven focus group discussions, conducted between July and August 2012, this article seeks to provide improved strategies for delivering this intervention in Zimbabwe. These data reveal that, in general, men have a negative attitude towards VMMC. Specific barriers to the uptake of VMMC included the perceived challenge to masculinity, post-circumcision stigma, lack of reliable and adequate information and perceptions about the appropriateness of VMMC. These results suggest that structural interventions aimed at reducing stigma related to circumcision, in addition to increased efforts to disseminate accurate information about VMMC, are required in order to dispel men's attitudes that hinder demand for VMMC.

  20. Transfer of the Kenyan Kikuyu Male Circumcision Ritual to Future Generations Living in the United States

    ERIC Educational Resources Information Center

    Mbito, Michael N.; Malia, Julia A.

    2009-01-01

    This phenomenological research report from analysis of interviews with 18 participants focuses on the theme of transferring an age-old initiation-into-manhood circumcision ritual to future generations of Kenyan Kikuyu who are living in the US. We identified three subthemes and found a strong indication that, while personally meaningful to the…

  1. Toward a Systematic Approach to Generating Demand for Voluntary Medical Male Circumcision: Insights and Results From Field Studies.

    PubMed

    Sgaier, Sema K; Baer, James; Rutz, Daniel C; Njeuhmeli, Emmanuel; Seifert-Ahanda, Kim; Basinga, Paulin; Parkyn, Rosie; Laube, Catharine

    2015-06-17

    By the end of 2014, an estimated 8.5 million men had undergone voluntary medical male circumcision (VMMC) for HIV prevention in 14 priority countries in eastern and southern Africa, representing more than 40% of the global target. However, demand, especially among men most at risk for HIV infection, remains a barrier to realizing the program's full scale and potential impact. We analyzed current demand generation interventions for VMMC by reviewing the available literature and reporting on field visits to programs in 7 priority countries. We present our findings and recommendations using a framework with 4 components: insight development; intervention design; implementation and coordination to achieve scale; and measurement, learning, and evaluation. Most program strategies lacked comprehensive insight development; formative research usually comprised general acceptability studies. Demand generation interventions varied across the countries, from advocacy with community leaders and community mobilization to use of interpersonal communication, mid- and mass media, and new technologies. Some shortcomings in intervention design included using general instead of tailored messaging, focusing solely on the HIV preventive benefits of VMMC, and rolling out individual interventions to address specific barriers rather than a holistic package. Interventions have often been scaled-up without first being evaluated for effectiveness and cost-effectiveness. We recommend national programs create coordinated demand generation interventions, based on insights from multiple disciplines, tailored to the needs and aspirations of defined subsets of the target population, rather than focused exclusively on HIV prevention goals. Programs should implement a comprehensive intervention package with multiple messages and channels, strengthened through continuous monitoring. These insights may be broadly applicable to other programs where voluntary behavior change is essential to achieving

  2. A Randomized Evaluation of a Demand Creation Lottery for Voluntary Medical Male Circumcision Among Adults in Tanzania

    PubMed Central

    Mahler, Hally; Machaku, Michael; Lemwayi, Ruth; Kulindwa, Yusuph; Gisenge Lija, Jackson; Mpora, Baraka; Ochola, Denice; Sarkar, Supriya; Williams, Emma; Plotkin, Marya; Juma, James

    2016-01-01

    Background: Uptake of voluntary medical male circumcision (VMMC) among adult men has fallen short of targets in Tanzania. We evaluated a smartphone raffle intervention designed to increase VMMC uptake in three regions. Methods: Among 7 matched pairs of health facilities, 1 in each pair was randomly assigned to the intervention, consisting of a weekly smartphone raffle for clients returning for follow-up and monthly raffle for peer promoters and providers. VMMC records of clients aged 20 and older were analyzed over three months, with the number performed compared with the same months in the previous year. In multivariable models, the intervention's effect on number of VMMCs was adjusted for client factors and clustering. Focus groups with clients and peer promoters explored preferences for VMMC incentives. Results: VMMCs increased 47% and 8% in the intervention and control groups, respectively; however, the changes were not significantly different from one another. In the Iringa region subanalysis, VMMCs in the intervention group increased 336% (exponentiated coefficient of 3.36, 95% CI: 1.14 to 9.90; P = 0.028), after controlling for facility pair, percentage of clients ≥ age 30, and percentage testing HIV positive; the control group had a more modest 63% increase (exponentiated coefficient 1.63, 95% CI: 1.18 to 2.26; P = 0.003). The changes were not significantly different. Focus group respondents expressed mixed opinions about smartphone raffles; some favored smaller cash incentive or transportation reimbursement. Implications: A smartphone raffle might increase VMMC uptake in some settings by helping late adopters move from intention to action; however, this study did not find strong evidence to support its implementation broadly. PMID:27404009

  3. Toward a Systematic Approach to Generating Demand for Voluntary Medical Male Circumcision: Insights and Results From Field Studies.

    PubMed

    Sgaier, Sema K; Baer, James; Rutz, Daniel C; Njeuhmeli, Emmanuel; Seifert-Ahanda, Kim; Basinga, Paulin; Parkyn, Rosie; Laube, Catharine

    2015-01-01

    By the end of 2014, an estimated 8.5 million men had undergone voluntary medical male circumcision (VMMC) for HIV prevention in 14 priority countries in eastern and southern Africa, representing more than 40% of the global target. However, demand, especially among men most at risk for HIV infection, remains a barrier to realizing the program's full scale and potential impact. We analyzed current demand generation interventions for VMMC by reviewing the available literature and reporting on field visits to programs in 7 priority countries. We present our findings and recommendations using a framework with 4 components: insight development; intervention design; implementation and coordination to achieve scale; and measurement, learning, and evaluation. Most program strategies lacked comprehensive insight development; formative research usually comprised general acceptability studies. Demand generation interventions varied across the countries, from advocacy with community leaders and community mobilization to use of interpersonal communication, mid- and mass media, and new technologies. Some shortcomings in intervention design included using general instead of tailored messaging, focusing solely on the HIV preventive benefits of VMMC, and rolling out individual interventions to address specific barriers rather than a holistic package. Interventions have often been scaled-up without first being evaluated for effectiveness and cost-effectiveness. We recommend national programs create coordinated demand generation interventions, based on insights from multiple disciplines, tailored to the needs and aspirations of defined subsets of the target population, rather than focused exclusively on HIV prevention goals. Programs should implement a comprehensive intervention package with multiple messages and channels, strengthened through continuous monitoring. These insights may be broadly applicable to other programs where voluntary behavior change is essential to achieving

  4. Toward a Systematic Approach to Generating Demand for Voluntary Medical Male Circumcision: Insights and Results From Field Studies

    PubMed Central

    Sgaier, Sema K; Baer, James; Rutz, Daniel C; Njeuhmeli, Emmanuel; Seifert-Ahanda, Kim; Basinga, Paulin; Parkyn, Rosie; Laube, Catharine

    2015-01-01

    By the end of 2014, an estimated 8.5 million men had undergone voluntary medical male circumcision (VMMC) for HIV prevention in 14 priority countries in eastern and southern Africa, representing more than 40% of the global target. However, demand, especially among men most at risk for HIV infection, remains a barrier to realizing the program's full scale and potential impact. We analyzed current demand generation interventions for VMMC by reviewing the available literature and reporting on field visits to programs in 7 priority countries. We present our findings and recommendations using a framework with 4 components: insight development; intervention design; implementation and coordination to achieve scale; and measurement, learning, and evaluation. Most program strategies lacked comprehensive insight development; formative research usually comprised general acceptability studies. Demand generation interventions varied across the countries, from advocacy with community leaders and community mobilization to use of interpersonal communication, mid- and mass media, and new technologies. Some shortcomings in intervention design included using general instead of tailored messaging, focusing solely on the HIV preventive benefits of VMMC, and rolling out individual interventions to address specific barriers rather than a holistic package. Interventions have often been scaled-up without first being evaluated for effectiveness and cost-effectiveness. We recommend national programs create coordinated demand generation interventions, based on insights from multiple disciplines, tailored to the needs and aspirations of defined subsets of the target population, rather than focused exclusively on HIV prevention goals. Programs should implement a comprehensive intervention package with multiple messages and channels, strengthened through continuous monitoring. These insights may be broadly applicable to other programs where voluntary behavior change is essential to achieving

  5. The role of sexually transmitted infections in male circumcision effectiveness against HIV – insights from clinical trial simulation

    PubMed Central

    Desai, Kamal; Boily, Marie-Claude; Garnett, Geoff P; Mâsse, Benoît R; Moses, Stephen; Bailey, Robert C

    2006-01-01

    Background A landmark randomised trial of male circumcision (MC) in Orange Farm, South Africa recently showed a large and significant reduction in risk of HIV infection, reporting MC effectiveness of 61% (95% CI: 34%–77%). Additionally, two further randomised trials of MC in Kisumu, Kenya and Rakai, Uganda were recently stopped early to report 53% and 48% effectiveness, respectively. Since MC may protect against both HIV and certain sexually transmitted infections (STI), which are themselves cofactors of HIV infection, an important question is the extent to which this estimated effectiveness against HIV is mediated by the protective effect of circumcision against STI. The answer lies in the trial data if the appropriate statistical analyses can be identified to estimate the separate efficacies against HIV and STI, which combine to determine overall effectiveness. Objectives and Methods Focusing on the MC trial in Kisumu, we used a stochastic prevention trial simulator (1) to determine whether statistical analyses can validly estimate efficacy, (2) to determine whether MC efficacy against STI alone can produce large effectiveness against HIV and (3) to estimate the fraction of all HIV infections prevented that are attributable to efficacy against STI when both efficacies combine. Results Valid estimation of separate efficacies against HIV and STI as well as MC effectiveness is feasible with available STI and HIV trial data, under Kisumu trial conditions. Under our parameter assumptions, high overall effectiveness of MC against HIV was observed only with a high MC efficacy against HIV and was not possible on the basis of MC efficacy against STI alone. The fraction of all HIV infections prevented which were attributable to MC efficacy against STI was small, except when efficacy of MC specifically against HIV was very low. In the three MC trials which reported between 48% and 61% effectiveness (combining STI and HIV efficacies), the fraction of HIV infections

  6. 'Secrets' that kill: crisis, custodianship and responsibility in ritual male circumcision in the Eastern Cape Province, South Africa.

    PubMed

    Kepe, Thembela

    2010-03-01

    This paper analyses a tension between traditional leaders and the post-apartheid government in South Africa, concerning the crisis in ritual male circumcision. Over the last two decades, following ritual male circumcision, thousands of youth have been admitted to hospitals, hundreds have undergone penile amputations and hundreds have died. Following the government's intervention through legislation and other health measures, traditional leaders allege that this is a violation of cultural rights enshrined in the Constitution. Drawing on newspaper and journal articles, books, policy documents, and legislation, as well as informal interviews with initiates and their parents and field observations in the Eastern Cape Province (2002-2009), this paper explores the validity of the traditional leaders' challenge, arguing that the crisis in the ritual should be seen in a broader context than the tension between traditional leaders and the state. Finally, the paper argues the tension between traditional leaders and government, and the sensational reporting of this by the media, unfortunately takes away focus from the health crisis in the ritual.

  7. Towards a gender perspective in qualitative research on voluntary medical male circumcision in east and southern Africa.

    PubMed

    Martínez Pérez, Guillermo; Triviño Durán, Laura; Gasch, Angel; Desmond, Nicole

    2015-01-01

    The World Health Organization endorsed voluntary medical male circumcision (VMMC) in 2007 as an effective method to provide partial protection against heterosexual female-to-male transmission of HIV in regions with high rates of such transmission, and where uptake of VMMC is low. Qualitative research conducted in east and southern Africa has focused on assessing acceptability, barriers to uptake of VMMC and the likelihood of VMMC increasing men's adoption of risky sexual behaviours. Less researched, however, have been the perceptions of women and sexual minorities towards VMMC, even though they are more vulnerable to HIV/AIDS transmission than are heterosexual men. The purpose of this paper is to identify core areas in which a gendered perspective in qualitative research might improve the understanding and framing of VMMC in east and southern Africa. Issues explored in this analysis are risk compensation, the post-circumcision appearance of the penis, inclusion of men who have sex with men as study respondents and the antagonistic relation between VMMC and female genital cutting. If biomedical and social science researchers explore these issues in future qualitative inquiry utilising a gendered perspective, a more thorough understanding of VMMC can be achieved, which could ultimately inform policy and implementation.

  8. Sutureless Adult Voluntary Male Circumcision with Topical Anesthetic: A Randomized Field Trial of Unicirc, a Single-Use Surgical Instrument

    PubMed Central

    2016-01-01

    Introduction The World Health Organization has solicited rapid and minimally invasive techniques to facilitate scale-up of voluntary medical male circumcision (VMMC). Study design Non-blinded randomized controlled field trial with 2:1 allocation ratio. Participants 75 adult male volunteers. Setting Outpatient primary care clinic. Intervention Open surgical circumcision under local anesthetic with suturing vs. Unicirc disposable instrument under topical anesthetic and wound sealing with cyanoacrylate tissue adhesive. Primary Outcome Intraoperative duration. Secondary Outcomes Intraoperative and postoperative pain; adverse events; time to healing; patient satisfaction; cosmetic result. Results The intraoperative time was less with the Unicirc technique (median 12 vs. 25 min, p < 0.001). Wound healing and cosmetic results were superior in the Unicirc group. Adverse events were similar in both groups. Conclusions VMMC with Unicirc under topical anesthetic and wound sealing with cyanoacrylate tissue adhesive is rapid, heals by primary intention with superior cosmetic results, and is potentially safer and more cost-effective than open surgical VMMC. Trial Registration Clinicaltrials.gov NCT02443792 PMID:27299735

  9. Erectile function in circumcised and uncircumcised men in Lusaka, Zambia: A cross-sectional study

    PubMed Central

    Chinkoyo, Evans

    2015-01-01

    Background Evidence from three randomised control trials in South Africa, Uganda and Kenya showing that male circumcision can reduce heterosexual transmission of human immunodeficiency virus (HIV) infection from infected females to their male partners by up to 60% has led to an increase in circumcisions in most African countries. This has created anxieties around possible deleterious effects of circumcision on erectile function (EF). Aim To compare EF in circumcised and uncircumcised men aged 18 years and older. Setting Four primary healthcare facilities in Lusaka, Zambia. Methods Using a cross-sectional survey 478 participants (242 circumcised and 236 uncircumcised) from four primary healthcare facilities in Lusaka, Zambia were asked to complete the IIEF-5 questionnaire. EF scores were calculated for the two groups, where normal EF constituted an IIEF-5 score ≥ 22 (out of 25). Results Circumcised men had higher average EF scores compared to their uncircumcised counterparts, (p < 0.001). The prevalence of erectile dysfunction was lower in circumcised men (56%) compared to uncircumcised men (68%) (p < 0.05). EF scores were similar in those circumcised in childhood and those who had the procedure in adulthood, (p = 0.59). The groups did not differ significantly in terms of age, relationship status, smoking, alcohol and medication use. A statistically significant difference was observed in education levels, with the circumcision group having higher levels of education (p < 0.005). Conclusion The higher EF scores in circumcised men show that circumcision does not confer adverse EF effects in men. These results suggest that circumcision can be considered safe in terms of EF. A definitive prospective study is needed to confirm these findings. PMID:26245613

  10. Modeling Impact and Cost-Effectiveness of Increased Efforts to Attract Voluntary Medical Male Circumcision Clients Ages 20–29 in Zimbabwe

    PubMed Central

    Kripke, Katharine; Hatzold, Karin; Mugurungi, Owen; Ncube, Gertrude; Xaba, Sinokuthemba; Gold, Elizabeth; Ahanda, Kim Seifert; Kruse-Levy, Natalie

    2016-01-01

    Background Zimbabwe aims to increase circumcision coverage to 80% among 13- to 29-year-olds. However, implementation data suggest that high coverage among men ages 20 and older may not be achievable without efforts specifically targeted to these men, incurring additional costs per circumcision. Scale-up scenarios were created based on trends in implementation data in Zimbabwe, and the cost-effectiveness of increasing efforts to recruit clients ages 20–29 was examined. Methods Zimbabwe voluntary medical male circumcision (VMMC) program data were used to project trends in male circumcision coverage by age into the future. The projection informed a base scenario in which, by 2018, the country achieves 80% circumcision coverage among males ages 10–19 and lower levels of coverage among men above age 20. The Zimbabwe DMPPT 2.0 model was used to project costs and impacts, assuming a US$109 VMMC unit cost in the base scenario and a 3% discount rate. Two other scenarios assumed that the program could increase coverage among clients ages 20–29 with a corresponding increase in unit cost for these age groups. Results When circumcision coverage among men ages 20–29 is increased compared with a base scenario reflecting current implementation trends, fewer VMMCs are required to avert one infection. If more than 50% additional effort (reflected as multiplying the unit cost by >1.5) is required to double the increase in coverage among this age group compared with the base scenario, the cost per HIV infection averted is higher than in the base scenario. Conclusions Although increased investment in recruiting VMMC clients ages 20–29 may lead to greater overall impact if recruitment efforts are successful, it may also lead to lower cost-effectiveness, depending on the cost of increasing recruitment. Programs should measure the relationship between increased effort and increased ability to attract this age group. PMID:27783637

  11. Improving the Quality of Voluntary Medical Male Circumcision through Use of the Continuous Quality Improvement Approach: A Pilot in 30 PEPFAR-Supported Sites in Uganda

    PubMed Central

    Opio, Alex; Calnan, Jacqueline; Njeuhmeli, Emmanuel

    2015-01-01

    Background Uganda adopted voluntary medical male circumcision (VMMC) (also called Safe Male Circumcision in Uganda), as part of its HIV prevention strategy in 2010. Since then, the Ministry of Health (MOH) has implemented VMMC mostly with support from the United States President’s Emergency Plan for AIDS Relief (PEPFAR) through its partners. In 2012, two PEPFAR-led external quality assessments evaluated compliance of service delivery sites with minimum quality standards. Quality gaps were identified, including lack of standardized forms or registers, lack of documentation of client consent, poor preparedness for emergencies and use of untrained service providers. In response, PEPFAR, through a USAID-supported technical assistance project, provided support in quality improvement to the MOH and implementing partners to improve quality and safety in VMMC services and build capacity of MOH staff to continuously improve VMMC service quality. Methods and Findings Sites were supported to identify barriers in achieving national standards, identify possible solutions to overcome the barriers and carry out improvement plans to test these changes, while collecting performance data to objectively measure whether they had bridged gaps. A 53-indicator quality assessment tool was used by teams as a management tool to measure progress; teams also measured client-level indicators through self-assessment of client records. At baseline (February-March 2013), less than 20 percent of sites scored in the “good” range (>80%) for supplies and equipment, patient counseling and surgical procedure; by November 2013, the proportion of sites scoring “good” rose to 67 percent, 93 percent and 90 percent, respectively. Significant improvement was noted in post-operative follow-up at 48 hours, sexually transmitted infection assessment, informed consent and use of local anesthesia but not rate of adverse events. Conclusion Public sector providers can be engaged to address the quality of

  12. Voluntary Medical Male Circumcision for HIV Prevention in Malawi: Modeling the Impact and Cost of Focusing the Program by Client Age and Geography

    PubMed Central

    Kripke, Katharine; Chimbwandira, Frank; Mwandi, Zebedee; Matchere, Faustin; Schnure, Melissa; Reed, Jason; Castor, Delivette; Sgaier, Sema

    2016-01-01

    Background In 2007, the World Health Organization (WHO) recommended scaling up voluntary medical male circumcision (VMMC) in priority countries with high HIV prevalence and low male circumcision (MC) prevalence. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), an estimated 5.8 million males had undergone VMMC by the end of 2013. Implementation experience has raised questions about the need to refocus VMMC programs on specific subpopulations for the greatest epidemiological impact and programmatic effectiveness. As Malawi prepared its national operational plan for VMMC, it sought to examine the impacts of focusing on specific subpopulations by age and region. Methods We used the Decision Makers’ Program Planning Toolkit, Version 2.0, to study the impact of scaling up VMMC to different target populations of Malawi. National MC prevalence by age group from the 2010 Demographic and Health Survey was scaled according to the MC prevalence for each district and then halved, to adjust for over-reporting of circumcision. In-country stakeholders advised a VMMC unit cost of $100, based on implementation experience. We derived a cost of $451 per patient-year for antiretroviral therapy from costs collected as part of a strategic planning exercise previously conducted in- country by UNAIDS. Results Over a fifteen-year period, circumcising males ages 10–29 would avert 75% of HIV infections, and circumcising males ages 10–34 would avert 88% of infections, compared to the current strategy of circumcising males ages 15–49. The Ministry of Health’s South West and South East health zones had the lowest cost per HIV infection averted. Moreover, VMMC met WHO’s definition of cost-effectiveness (that is, the cost per disability-adjusted life-year [DALY] saved was less than three times the per capita gross domestic product) in all health zones except Central East. Comparing urban versus rural areas in the country, we found that circumcising men in urban

  13. Male Circumcision and Sexual Risk Behaviors May Contribute to Considerable Ethnic Disparities in HIV Prevalence in Kenya: An Ecological Analysis

    PubMed Central

    Kenyon, Chris Richard; Vu, Lung; Menten, Joris; Maughan-Brown, Brendan

    2014-01-01

    Background HIV prevalence varies between 0.8 and 20.2% in Kenya’s various ethnic groups. The reasons underlying these variations have not been evaluated before. Methods We used data from seven national surveys spanning the period 1989 to 2008 to compare the prevalence of a range of risk factors in Kenya’s ethnic groups. Spearman’s and linear regression were used to assess the relationship between HIV prevalence and each variable by ethnic group. Results The ethnic groups exhibited significant differences in a number of HIV related risk factors. Although the highest HIV prevalence group (the Luo) had the highest rates of HIV testing (Men 2008 survey: 56.8%, 95% CI 51.0–62.5%) and condom usage at last sex (Men 2008∶28.6%, 95% CI 19.6–37.6%), they had the lowest prevalence of circumcision (20.9%, 95% CI 15.9–26.0) the highest prevalence of sex with a non-married, non-cohabiting partner (Men: 40.2%, 95% CI 33.2–47.1%) and pre-marital sex (Men 2008∶73.9%, 95% CI 67.5–80.3%) and the youngest mean age of debut for women (1989 Survey: 15.7 years old, 95% CI 15.2–16.2). At a provincial level there was an association between the prevalence of HIV and male concurrency (Spearman’s rho = 0.79, P = 0.04). Ethnic groups with higher HIV prevalence were more likely to report condom use (Men 2008 survey: R2 = 0.62, P = 0.01) and having been for HIV testing (Men 2008 survey: R2 = 0.47, P = 0.04). Conclusion In addition to differences in male circumcision prevalence, variation in sexual behavior may contribute to the large variations in HIV prevalence in Kenya’s ethnic groups. To complement the prevention benefits of the medical male circumcision roll-out in several parts of Kenya, interventions to reduce risky sexual behavior should continue to be promoted. PMID:25171060

  14. Voluntary Medical Male Circumcision Scale-Up in Nyanza, Kenya: Evaluating Technical Efficiency and Productivity of Service Delivery

    PubMed Central

    Omondi Aduda, Dickens S.; Ouma, Collins; Onyango, Rosebella; Onyango, Mathews; Bertrand, Jane

    2015-01-01

    Background Voluntary medical male circumcision (VMMC) service delivery is complex and resource-intensive. In Kenya’s context there is still paucity of information on resource use vis-à-vis outputs as programs scale up. Knowledge of technical efficiency, productivity and potential sources of constraints is desirable to improve decision-making. Objective To evaluate technical efficiency and productivity of VMMC service delivery in Nyanza in 2011/2012 using data envelopment analysis. Design Comparative process evaluation of facilities providing VMMC in Nyanza in 2011/2012 using output orientated data envelopment analysis. Results Twenty one facilities were evaluated. Only 1 of 7 variables considered (total elapsed operation time) significantly improved from 32.8 minutes (SD 8.8) in 2011 to 30 minutes (SD 6.6) in 2012 (95%CI = 0.0350–5.2488; p = 0.047). Mean scale technical efficiency significantly improved from 91% (SD 19.8) in 2011 to 99% (SD 4.0) in 2012 particularly among outreach compared to fixed service delivery facilities (CI -31.47959–4.698508; p = 0.005). Increase in mean VRS technical efficiency from 84% (SD 25.3) in 2011 and 89% (SD 25.1) in 2012 was not statistically significant. Benchmark facilities were #119 and #125 in 2011 and #103 in 2012. Malmquist Productivity Index (MPI) at fixed facilities declined by 2.5% but gained by 4.9% at outreach ones by 2012. Total factor productivity improved by 83% (p = 0.032) in 2012, largely due to progress in technological efficiency by 79% (p = 0.008). Conclusions Significant improvement in scale technical efficiency among outreach facilities in 2012 was attributable to accelerated activities. However, ongoing pure technical inefficiency requires concerted attention. Technological progress was the key driver of service productivity growth in Nyanza. Incorporating service-quality dimensions and using stepwise-multiple criteria in performance evaluation enhances comprehensiveness and validity. These findings

  15. A Sport-Based Intervention to Increase Uptake of Voluntary Medical Male Circumcision Among Adolescent Male Students: Results From the MCUTS 2 Cluster-Randomized Trial in Bulawayo, Zimbabwe

    PubMed Central

    DeCelles, Jeff; Bhauti, Kenneth; Hershow, Rebecca B.; Weiss, Helen A.; Chaibva, Cynthia; Moyo, Netsai; Mantula, Fennie; Hatzold, Karin; Ross, David A.

    2016-01-01

    Background: Mathematical models suggest that 570,000 HIV infections could be averted between 2011 and 2025 in Zimbabwe if the country reaches 80% voluntary medical male circumcision (VMMC) coverage among 15- to 49-year-old male subjects. Yet national coverage remains well below this target, and there is a need to evaluate interventions to increase the uptake. Methods: A cluster-randomized trial was conducted to assess the effectiveness of Make-The-Cut-Plus (MTC+), a single, 60-minute, sport-based intervention to increase VMMC uptake targeting secondary school boys (14–20 years). Twenty-six schools in Bulawayo, Zimbabwe, were randomized to either receive MTC+ at the start (intervention) or end (control) of a 4-month period (March to June 2014). VMMC uptake over these 4 months was measured via probabilistic matching of participants in the trial database (n = 1226 male participants; age, 14–20 years; median age, 16.2 years) and the registers in Bulawayo's 2 free VMMC clinics (n = 5713), using 8 identifying variables. Results: There was strong evidence that the MTC+ intervention increased the odds of VMMC uptake by approximately 2.5 fold (odds ratio = 2.53; 95% confidence interval, 1.21 to 5.30). Restricting to participants who did not report being already circumcised at baseline, MTC+ increased VMMC uptake by 7.6% (12.2% vs 4.6%, odds ratio = 2.65; 95% confidence interval, 1.19 to 5.86). Sensitivity analyses related to the probabilistic matching did not change these findings substantively. The number of participants who would need to be exposed to the demand creation intervention to yield one additional VMMC client was 22.7 (or 13.2 reporting not already being circumcised). This translated to approximately US dollars 49 per additional VMMC client. Conclusions: The MTC+ intervention was an effective and cost-effective strategy for increasing VMMC uptake among school-going adolescent male subjects in Bulawayo. PMID:27404011

  16. Voluntary Medical Male Circumcision (VMMC) in Tanzania and Zimbabwe: Service Delivery Intensity and Modality and Their Influence on the Age of Clients

    PubMed Central

    Ashengo, Tigistu Adamu; Hatzold, Karin; Mahler, Hally; Rock, Amelia; Kanagat, Natasha; Magalona, Sophia; Curran, Kelly; Christensen, Alice; Castor, Delivette; Mugurungi, Owen; Dhlamini, Roy; Xaba, Sinokuthemba; Njeuhmeli, Emmanuel

    2014-01-01

    Background Scaling up voluntary medical male circumcision (VMMC) to 80% of men aged 15–49 within five years could avert 3.4 million new HIV infections in Eastern and Southern Africa by 2025. Since 2009, Tanzania and Zimbabwe have rapidly expanded VMMC services through different delivery (fixed, outreach or mobile) and intensity (routine services, campaign) models. This review describes the modality and intensity of VMMC services and its influence on the number and age of clients. Methods and Findings Program reviews were conducted using data from implementing partners in Tanzania (MCHIP) and Zimbabwe (PSI). Key informant interviews (N = 13 Tanzania; N = 8 Zimbabwe) were conducted; transcripts were analyzed using Nvivo. Routine VMMC service data for May 2009–December 2012 were analyzed and presented in frequency tables. A descriptive analysis and association was performed using the z-ratio for the significance of the difference. Key informants in both Tanzania and Zimbabwe believe VMMC scale-up can be achieved by using a mix of service delivery modality and intensity approaches. In Tanzania, the majority of clients served during campaigns (59%) were aged 10–14 years while the majority during routine service delivery (64%) were above 15 (p<0.0001). In Zimbabwe, significantly more VMMCs were done during campaigns (64%) than during routine service delivery (36%) (p<0.00001); the difference in the age of clients accessing services in campaign versus non-campaign settings was significant for age groups 10–24 (p<0.05), but not for older groups. Conclusions In Tanzania and Zimbabwe, service delivery modalities and intensities affect client profiles in conjunction with other contextual factors such as implementing campaigns during school holidays in Zimbabwe and cultural preference for circumcision at a young age in Tanzania. Formative research needs to be an integral part of VMMC programs to guide the design of service delivery modalities in the face of, or

  17. Prevalence and associated factors of behavioral intention for risk compensation following voluntary medical male circumcision among male sexually transmitted diseases patients in China.

    PubMed

    Wang, Zixin; Feng, Tiejian; Lau, Joseph T F

    2016-10-01

    Risk compensation was an important concern of voluntary medical male circumcision (VMMC) promotion campaigns. No study investigated risk compensation following VMMC among male sexually transmitted diseases patients (MSTDP). A cross-sectional survey interviewed 308 uncircumcised MSTDP in Shenzhen, China. 26.9% of them intended to perform at least one of the five types of risk compensation behaviors following VMMC. In the summary stepwise model, provision of incorrect response to HIV/sexually transmitted diseases knowledge items (multivariate odds ratios (ORm) = 2.30), genital herpes infection (ORm = 3.19), Risk Reduction Score for Unprotected Sex, and Negative Condom Attitudes Scale (ORm = 1.13) were significantly associated with behavioral intention to perform at least one type of risk compensation behavior following VMMC. The results provided a framework for developing related interventions. Prevention of risk compensation should be an essential component of VMMC promotion for all MSTDP, irrespective of their intention for VMMC.

  18. Covering the Last Kilometer: Using GIS to Scale-Up Voluntary Medical Male Circumcision Services in Iringa and Njombe Regions, Tanzania

    PubMed Central

    Mahler, Hally; Plotkin, Marya; Kulindwa, Yusuph; Greenberg, Seth; Mlanga, Erick; Njeuhmeli, Emmanuel; Lija, Gissenje

    2015-01-01

    Background: Based on the established protective effect of voluntary medical male circumcision (VMMC) in reducing female-to-male HIV transmission, Tanzania's Ministry of Health and Social Welfare (MOHSW) embarked on the scale-up of VMMC services in 2009. The Maternal and Child Health Integrated Project (MCHIP) supported the MOHSW to roll out VMMC services in Iringa and Njombe, 2 regions of Tanzania with among the highest HIV and lowest circumcision prevalence. With ambitious targets of reaching 264,990 males aged 10–34 years with VMMC in 5 years, efficient and innovative program approaches were necessary. Program Description: Outreach campaigns, in which mobile teams set up temporary services in facilities or non-facility settings, are used to reach lesser-served areas with VMMC. In 2012, MCHIP began using geographic information systems (GIS) to strategically plan the location of outreach campaigns. MCHIP gathered geocoded data on variables such as roads, road conditions, catchment population, staffing, and infrastructure for every health facility in Iringa and Njombe. These data were uploaded to a central database and overlaid with various demographic and service delivery data in order to identify the VMMC needs of the 2 regions. Findings: MCHIP used the interactive digital maps as decision-making tools to extend mobile VMMC outreach to “the last kilometer.” As of September 2014, the MOHSW with MCHIP support provided VMMC to 267,917 men, 259,144 of whom were men were aged 10–34 years, an achievement of 98% of the target of eligible males in Iringa and Njombe. The project reached substantially more men through rural dispensaries and non-health care facilities each successive year after GIS was introduced in 2012, jumping from 48% of VMMCs performed in rural areas in fiscal year 2011 to 88% in fiscal year 2012 and to 93% by the end of the project in 2014. Conclusion: GIS was an effective tool for making strategic decisions about where to prioritize VMMC

  19. Circumcision - Multiple Languages: MedlinePlus

    MedlinePlus

    ... Male Circumcision (Arabic) العربية Bilingual PDF Health Information Translations Chinese - Simplified (简体中文) Male Circumcision 男性包皮环切术 - 简体中文 (Chinese - Simplified) Bilingual PDF Health Information Translations Chinese - Traditional (繁體中文) Male Circumcision 男性包皮環切術 - 繁體中文 (Chinese - ...

  20. ‘The body we leave behind’: a qualitative study of obstacles and opportunities for increasing uptake of male circumcision among Tanzanian Christians

    PubMed Central

    Downs, Jennifer A; Fuunay, Lucas D; Fuunay, Mary; Mbago, Mary; Mwakisole, Agrey; Peck, Robert N; Downs, David J

    2013-01-01

    Objectives Male circumcision (MC) reduces HIV infection by approximately 60% among heterosexual men and is recommended by the WHO for HIV prevention in sub-Saharan Africa. In northwest Tanzania, over 60% of Muslims but less than 25% of Christian men are circumcised. We hypothesised that the decision to circumcise may be heavily influenced by religious identity and that specific religious beliefs may offer both obstacles and opportunities to increasing MC uptake, and conducted focus group discussions to explore reasons for low rates of MC among Christian church attenders in the region. Design Qualitative study using focus group discussions and interpretative phenomenological analysis. Setting Discussions took place at churches in both rural and urban areas of the Mwanza region of northwest Tanzania. Participants We included 67 adult Christian churchgoers of both genders in a total of 10 single-gender focus groups. Results Christians frequently reported perceiving MC as a Muslim practice, as a practice for the sexually promiscuous, or as unnecessary since they are taught to focus on ‘circumcision of the heart’. Only one person had ever heard MC discussed at church, but nearly all Christian parishioners were eager for their churches to address MC and felt that MC could be consistent with their faith. Conclusions Christian religious beliefs among Tanzanian churchgoers provide both obstacles and opportunities for increasing uptake of MC. Since half of adults in sub-Saharan Africa identify themselves as Christians, addressing these issues is critical for MC efforts in this region. PMID:23793672

  1. [Circumcision: history, religion and law].

    PubMed

    Totaro, Angelo; Volpe, Andrea; Racioppi, Marco; Pinto, Francesco; Sacco, Emilio; Bassi, Pier Francesco

    2011-01-01

    The aim of this article is to describe the circumcision procedure during history, its therapeutic and preventive goals, with focus on bioethical, economic and law issues. The origins of this practice are lost in antiquity. It was performed since 3000 BC by the Egyptians for hygienic and religious reasons. Moreover, male circumcision is a religious commandment in Judaism and Islam, and it is customary in some Oriental Orthodox and other Christian churches of Africa. Nowadays, circumcision is performed as a routine procedure by the Jews and the Muslims for religious reasons. The world prevalence of men with circumcision is 12.5-33%, especially in USA, Canada, Islamic people and Africa; in Europe the prevalence rate is low (in Great Britain it is 1.5%). Currently, male circumcision is being highly debated because of ethical, law and scientific issues and the different roles of this procedure: therapeutic, prophylactic (but there is no universal consensus) and ritualistic role. Nowadays, in Italy there is a strong debate about the consensus for this practice and its indications. The Italian law does not allow performing ritualistic circumcision, as a free of charge procedure in public hospitals, at the government's expenses, because the Italian law must protect different religious cultures, in name of the laity of the State. Thus, national bioethical committee (CNB) has established that ritualistic circumcision may only be performed on a paying basis in public hospitals. As a protective practice, circumcision has decreased in the entire world because of the improvement of hygienical conditions and, above all, the lack of unanimous consent on the real usefulness of protective circumcision, even if several studies have recently demonstrated the protecting role of male circumcision against HIV infection. PMID:21452153

  2. Cohort study on circumcision of newborn boys and subsequent risk of urinary-tract infection.

    PubMed

    To, T; Agha, M; Dick, P T; Feldman, W

    1998-12-01

    A prospective population-based cohort study assessed the association between male circumcision and subsequent urinary tract infection (UTI) in children born in Ontario, Canada, in a 12-month period in 1993-94. Of the 69,100 eligible infants, 30,105 (43.6%) were circumcised in the first month of life. 29,217 uncircumcised boys were matched to circumcised boys by date of birth and followed for 24-36 months. Information on UTIs was extracted from the Canadian Institute for Health Information computerized database on hospital discharges. There were 83 UTI cases in the circumcised cohort (1.88/1000 person-years of observation) and 247 in the uncircumcised group (7.02/1000 person-years) (p 0.0001). The relative risk of UTI in uncircumcised compared to circumcised boys was 4.5 (95% CI, 2.4-8.4) in the first month of life and 3.7 (95% CI, 2.8-4.9) in the year after the procedure. Calculation of the attributable risk indicated 195 circumcisions would be necessary to prevent one admission for UTI in the first year of life. Previous studies have recorded UTI rates 10-20 times higher in uncircumcised than circumcised boys. These findings support the hypothesis that circumcision protects boys from UTI, but the magnitude of this effect may be less than previously estimated.

  3. Adverse Events Profile of PrePex a Non-Surgical Device for Adult Male Circumcision in a Ugandan Urban Setting

    PubMed Central

    Galukande, Moses; Duffy, Kevin; Bitega, Jean Paul; Rackara, Sam; Bbaale, Denis Sekavuga; Nakaggwa, Florence; Nagaddya, Teddy; Wooding, Nick; Dea, Monica; Coutinho, Alex

    2014-01-01

    Background Safe Male Circumcision is a proven approach for partial HIV prevention. Several sub Saharan African countries have plans to reach a prevalence of 80% of their adult males circumcised by 2015. These targets require out of ordinary organization, demand creation, timely execution and perhaps the use of SMC devices. Objective To profile Adverse Events rate and acceptance of PrePex, a non surgical device for adult male circumcision. Methods A prospective study, conducted at International Hospital Kampala, Uganda, between August and October 2012. Ethical approval was obtained from Uganda National Council of Science and Technology. Results Of 1,040 men received to undergo SMC, 678 opted for PrePex, 36 were excluded at an initial physical examination screening. 642 were enrolled and consented, and another 17 were excluded before device placement. 625 underwent the procedure. Average age was 24 years (±7). Twelve moderate AEs occurred among 10 participants 12/625, (1.9%). These were all reversible. Five had device displacement, one had an everted foreskin; five had bleeding after the device was removed and one had voiding difficulties. The majority (279 out of 300) of men interviewed complained of some pain within the week of placement. Mean pain score at device placement (using visual analogue scale) was 0.5, at device removal 4.5 and within 2 min of removal the pain score was 1.4. Over 70% of the devices were placed and removed by non-physician clinicians. Presented with a choice, 60% of men chose PrePex over surgical SMC. Close to 90% would recommend the device to their friends. Odour from the necrotic skin was a concern. Removals done 1–2 days earlier than day 7 were beneficial and conferred no extra risk. Conclusion AEs of a moderate or severe nature associated with PrePex were low and reversible. PrePex is feasible for mass safe male circumcision scaling up. PMID:24489754

  4. Sexual Satisfaction, Performance, and Partner Response Following Voluntary Medical Male Circumcision in Zambia: The Spear and Shield Project

    PubMed Central

    Zulu, Robert; Jones, Deborah; Chitalu, Ndashi; Cook, Ryan; Weiss, Stephen

    2015-01-01

    Background: Voluntary medical male circumcision (VMMC) is an important HIV prevention strategy, particularly in regions with high HIV incidence and low rates of male circumcision. However, 88% of the Zambian male population remain uncircumcised, and of these 80% of men surveyed expressed little interest in undergoing VMMC. Methods: The Spear and Shield study (consisting of 4 weekly, 90-minute sexual risk reduction/VMMC promotion sessions) recruited and enrolled men (N = 800) who self-identified as at risk of HIV by seeking HIV testing and counseling at community health centers. Eligible men tested HIV-negative, were uncircumcised, and expressed no interest in VMMC. Participants were encouraged (but not required) to invite their female partners (N = 668) to participate in the program in a gender-concordant intervention matched to their partners’. Men completed assessments at baseline, post-intervention (about 2 months after baseline), and 6 and 12 months post-intervention; women completed assessments at baseline and post-intervention. For those men who underwent VMMC and for their partners, an additional assessment was conducted 3 months following the VMMC. The ancillary analysis in this article compared the pre- and post-VMMC responses of the 257 Zambian men who underwent circumcision during or following study participation, using growth curve analyses, as well as of the 159 female partners. Results: Men were satisfied overall with the procedure (mean satisfaction score, 8.4 out of 10), and nearly all men (96%) and women (94%) stated they would recommend VMMC to others. Approximately half of the men reported an increase or no change in erections, orgasms, and time to achieve orgasms from pre-VMMC, while one-third indicated fewer erections and orgasms and decreased time to achieve orgasms post-VMMC. Nearly half (42%) of the men, and a greater proportion (63%) of the female partners, said their sexual pleasure increased while 22% of the men reported less

  5. Libertarianism and circumcision

    PubMed Central

    Testa, Patrick; Block, Walter E.

    2014-01-01

    Despite the millenniums-old tradition in Abrahamic circles of removing the foreskin of a penis at birth, the involuntary and aggressive practice of circumcision must not be made an exception to the natural, negative right to self-ownership—a birthright which should prevent a parent from physically harming a child from the moment of birth going forward. This paper will present a natural rights argument against the practice of male child circumcision, while also looking into some of the potential physical and psychological consequences of the practice. It will compare the practice with that of female circumcision, which is banned in developed nations but still practiced in the third world, as well as other forms of aggressive action, some once-prevalent, while disputing arguments made for parental ownership of the child, religious expression, cultural tradition, cleanliness, cosmetics, and conformity. PMID:24987720

  6. A Model for the Roll-Out of Comprehensive Adult Male Circumcision Services in African Low-Income Settings of High HIV Incidence: The ANRS 12126 Bophelo Pele Project

    PubMed Central

    Lissouba, Pascale; Taljaard, Dirk; Rech, Dino; Doyle, Sean; Shabangu, Daniel; Nhlapo, Cynthia; Otchere-Darko, Josephine; Mashigo, Thabo; Matson, Caitlin; Lewis, David; Billy, Scott; Auvert, Bertran

    2010-01-01

    Background World Health Organization (WHO)/Joint United Nations Programme on AIDS (UNAIDS) has recommended adult male circumcision (AMC) for the prevention of heterosexually acquired HIV infection in men from communities where HIV is hyperendemic and AMC prevalence is low. The objective of this study was to investigate the feasibility of the roll-out of medicalized AMC according to UNAIDS/WHO operational guidelines in a targeted African setting. Methods and Findings The ANRS 12126 “Bophelo Pele” project was implemented in 2008 in the township of Orange Farm (South Africa). It became functional in 5 mo once local and ethical authorizations were obtained. Project activities involved community mobilization and outreach, as well as communication approaches aimed at both men and women incorporating broader HIV prevention strategies and promoting sexual health. Free medicalized AMC was offered to male residents aged 15 y and over at the project's main center, which had been designed for low-income settings. Through the establishment of an innovative surgical organization, up to 150 AMCs under local anesthesia, with sterilized circumcision disposable kits and electrocautery, could be performed per day by three task-sharing teams of one medical circumciser and five nurses. Community support for the project was high. As of November 2009, 14,011 men had been circumcised, averaging 740 per month in the past 12 mo, and 27.5% of project participants agreed to be tested for HIV. The rate of adverse events, none of which resulted in permanent damage or death, was 1.8%. Most of the men surveyed (92%) rated the services provided positively. An estimated 39.1% of adult uncircumcised male residents have undergone surgery and uptake is steadily increasing. Conclusion This study demonstrates that a quality AMC roll-out adapted to African low-income settings is feasible and can be implemented quickly and safely according to international guidelines. The project can be a model for

  7. "Now we are in a different time; various bad diseases have come." understanding men's acceptability of male circumcision for HIV prevention in a moderate prevalence setting

    PubMed Central

    2012-01-01

    Background Adult male surgical circumcision (MC) has been shown to reduce HIV acquisition in men and is recommended by the WHO for inclusion in comprehensive national HIV prevention programs in high prevalence settings. Only limited research to date has been conducted in countries experiencing moderate burden epidemics, where the acceptability, operational feasibility and potential epidemiological impact of MC remain unclear. Methods A multi-method qualitative research study was conducted at four sites in Papua New Guinea (PNG), with 24 focus group discussions and 65 in-depth interviews carried out among 276 men. Results The majority of men were in favour of MC being introduced for HIV prevention in PNG and considered improved genital hygiene, enhanced sexual pleasure and culturally appropriateness key factors in the acceptability of a future intervention. A minority of men were against the introduction of MC, primarily due to concerns regarding sexual risk compensation and that the intervention went against prevailing cultural and religious beliefs. Conclusion This is one of the first community-based MC acceptability studies conducted in a moderate prevalence setting outside of Africa. Research findings from this study suggest that a future MC program for HIV prevention would be widely accepted by men in PNG. PMID:22264256

  8. Male circumcision for protection against HIV infection in sub-Saharan Africa: the evidence in favour justifies the implementation now in progress.

    PubMed

    Wamai, Richard G; Morris, Brian J; Bailey, Robert C; Klausner, Jeffrey D; Boedicker, Mackenzie N

    2015-01-01

    This article responds to a recent 'controversy study' in Global Public Health by de Camargo et al. directed at three randomised controlled trials (RCTs) of male circumcision (MC) for HIV prevention. These trials were conducted in three countries in sub-Saharan Africa (SSA) and published in 2005 and 2007. The RCTs confirmed observational data that had accumulated over the preceding two decades showing that MC reduces by 60% the risk of HIV infection in heterosexual men. Based on the RCT results, MC was adopted by global and national HIV policy-makers as an additional intervention for HIV prevention. Voluntary medical MC (VMMC) is now being implemented in 14 SSA countries. Thus referring to MC for HIV prevention as 'debate' and viewing MC through a lens of controversy seems mistaken. In their criticism, de Camargo et al. misrepresent and misinterpret current science supporting MC for HIV prevention, omit previous denunciations of arguments similar to theirs, and ignore evidence from ongoing scientific research. Here we point out the flaws in three areas de Camargo et al. find contentious. In doing so, we direct readers to growing evidence of MC as an efficacious, safe, acceptable, relatively low-cost one-off biomedical intervention for HIV prevention.

  9. Hybrid forum or network? The social and political construction of an international 'technical consultation': male circumcision and HIV prevention.

    PubMed

    Giami, Alain; Perrey, Christophe; Mendonça, André Luiz de Oliveira; de Camargo, Kenneth Rochel

    2015-01-01

    The technical consultation in Montreux, organised by World Health Organization and UNAIDS in 2007, recommended male circumcision as a method for preventing HIV transmission. This consultation came out of a long process of releasing reports and holding international and regional conferences, a process steered by an informal network. This network's relations with other parties is analysed along with its way of working and the exchanges during the technical consultation that led up to the formal adoption of a recommendation. Conducted in relation to the concepts of a 'hybrid forum' and 'network', this article shows that the decision was based on the formation and consolidation of a network of persons. They were active in all phases of this process, ranging from studies of the recommendation's efficacy, feasibility and acceptability to its adoption and implementation. In this sense, this consultation cannot be described as the constitution of a 'hybrid forum', which is characterised by its openness to a debate as well as a plurality of issues formulated by the actors and of resources used by them. On the contrary, little room was allowed for contradictory discussions, as if the decision had already been made before the Montreux consultation.

  10. Male circumcision: a globally relevant but under-utilized method for the prevention of HIV and other sexually transmitted infections.

    PubMed

    Tobian, Aaron A R; Kacker, Seema; Quinn, Thomas C

    2014-01-01

    Randomized trials have demonstrated that male circumcision (MC) reduces heterosexual acquisition of HIV, herpes simplex virus type 2, human papillomavirus (HPV), and genital ulcer disease among men, and it reduces HPV, genital ulcer disease, bacterial vaginosis, and trichomoniasis among female partners. The pathophysiology behind these effects is multifactorial, relying on anatomic and cellular changes. MC is cost effective and potentially cost saving in both the United States and Africa. The World Health Organization and Joint United Nations Program on HIV/AIDS proposed reaching 80% MC coverage in HIV endemic countries, but current rates fall far behind targets. Barriers to scale-up include supply-side and demand-side challenges. In the United States, neonatal MC rates are decreasing, but the American Academy of Pediatrics now recognizes the medical benefits of MC and supports insurance coverage. Although MC is a globally valuable tool to prevent HIV and other sexually transmitted infections, it is underutilized. Further research is needed to address barriers to MC uptake.

  11. Male Circumcision: A Globally Relevant but Under-Utilized Method for the Prevention of HIV and Other Sexually Transmitted Infections

    PubMed Central

    Tobian, Aaron A. R.; Kacker, Seema; Quinn, Thomas C

    2015-01-01

    Randomized trials have demonstrated that male circumcision (MC) reduces heterosexual acquisition of HIV, herpes simplex virus type-2, human papillomavirus (HPV), and genital ulcer disease (GUD) among men, and reduces HPV, GUD, bacterial vaginosis and trichomoniasis among female partners. The pathophysiology behind these effects is multifactorial, relying on anatomic and cellular changes. MC is cost-effective and potentially cost saving in both the US and Africa. The WHO and Joint United Nations Program on HIV/AIDS proposed reaching 80% MC coverage in HIV endemic countries, but current rates fall far behind targets. Barriers to scale-up include supply-side and demand-side challenges. In the US, neonatal MC rates are decreasing, but the American Academy of Pediatrics now recognizes the medical benefits of MC and supports insurance coverage. While MC is a globally valuable tool to prevent HIV and other sexually transmitted infections, it is under-utilized. Further research is needed to address barriers to MC uptake. PMID:24111891

  12. Factors associated with acceptability of circumcision among male drug users in western China: a cross-sectional study.

    PubMed

    Huang, J; Jiang, J; Abdullah, A S; Yang, X; Wei, B; Deng, W; Qin, B; Upur, H; Zhong, C; Wang, Q; Wang, Q; Ruan, Y; Zou, Y; Ye, L; Xie, P; Wei, F; Xu, N; Liang, H

    2013-07-01

    This study is aimed to investigate whether male circumcision (MC) is feasible among IDUs in China. 1304 drug users who attended methadone maintenance therapy clinics in Guangxi, Chongqing and Xinjiang were selected for participation by using convenience sampling, and completed a self-administered questionnaire. The factors associated with the acceptability of MC were examined via multiple logistic regression models. 45.2% (589/1304) of the participants reported an acceptance of MC. Many of the participants who were initially not willing to accept MC (715/1304) had changed their mind when they were informed that MC would reduce the risk of HIV and STDs (43.4%; 310/715), that MC is associated with few surgery-related complications (23.1%; 165/715), that the surgical procedure could be arranged free of charge (20.1%, 144/715). In the multivariate analysis, higher acceptability of MC was associated with knowledge of the hazards of phimosis (OR=2.22), the presence of phimosis (OR=14.87), and knowledge that MC can prevent AIDS and STDs (OR=1.49); while lower acceptability was associated with residing in Chongqing province (OR=0.41) and an educational level of junior (OR=0.64) and senior high (OR=0.63) school. The MC policy targeting IDUs in China should take into account these factors associated with MC acceptability. PMID:23970769

  13. Impact of male circumcision on the HIV epidemic in Papua New Guinea: a country with extensive foreskin cutting practices.

    PubMed

    Gray, Richard T; Vallely, Andrew; Wilson, David P; Kaldor, John; MacLaren, David; Kelly-Hanku, Angela; Siba, Peter; Murray, John M

    2014-01-01

    The degree to which adult medical male circumcision (MC) programs can reduce new HIV infections in a moderate HIV prevalence country like Papua New Guinea (PNG) are uncertain especially given the widespread prevalence of longitudinal foreskin cuts among adult males. We estimated the likely impact of a medical MC intervention in PNG using a mathematical model of HIV transmission. The model was age-structured and incorporated separate components for sex, rural/urban, men who have sex with men and female sex workers. Country-specific data of the prevalence of foreskin cuts, sexually transmitted infections, condom usage, and the acceptability of MC were obtained by our group through related studies. If longitudinal foreskin cutting has a protective efficacy of 20% compared to 60% for MC, then providing MC to 20% of uncut males from 2012 would require 376,000 procedures, avert 7,900 HIV infections by 2032, and require 143 MC per averted infection. Targeting uncut urban youths would achieve the most cost effective returns of 54 MC per HIV infection averted. These numbers of MC required to avert an HIV infection change little even with coverage up to 80% of men. The greater the protective efficacy of longitudinal foreskin cuts against HIV acquisition, the less impact MC interventions will have. Dependent on this efficacy, increasing condom use could have a much greater impact with a 10 percentage point increase averting 18,400 infections over this same period. MC programs could be effective in reducing HIV infections in PNG, particularly in high prevalence populations. However the overall impact is highly dependent on the protective efficacy of existing longitudinal foreskin cutting in preventing HIV.

  14. How Much Does It Cost to Improve Access to Voluntary Medical Male Circumcision among High-Risk, Low-Income Communities in Uganda?

    PubMed Central

    Larson, Bruce; Tindikahwa, Allan; Mwidu, George; Kibuuka, Hannah; Magala, Fred

    2015-01-01

    Background The Ugandan Ministry of Health has endorsed voluntary medical male circumcision as an HIV prevention strategy and has set ambitious goals (e.g., 4.2 million circumcisions by 2015). Innovative strategies to improve access for hard to reach, high risk, and poor populations are essential for reaching such goals. In 2009, the Makerere University Walter Reed Project began the first facility-based VMMC program in Uganda in a non-research setting. In addition, a mobile clinic began providing VMMC services to more remote, rural locations in 2011. The primary objective of this study was to estimate the average cost of performing VMMCs in the mobile clinic compared to those performed in health facilities (fixed sites). The difference between such costs is the cost of improving access to VMMC. Methods A micro-costing approach was used to estimate costs from the service provider’s perspective of a circumcision. Supply chain and higher-level program support costs are not included. Results The average cost (US$2012) of resources used per circumcision was $61 in the mobile program ($72 for more remote locations) compared to $34 at the fixed site. Costs for community mobilization, HIV testing, the initial medical exam, and staff for performing VMMC operations were similar for both programs. The cost of disposable surgical kits, the additional upfront cost for the mobile clinic, and additional costs for staff drive the differences in costs between the two programs. Cost estimates are relatively insensitive to patient flow over time. Conclusion The MUWRP VMMC program improves access for hard to reach, relatively poor, and high-risk rural populations for a cost of $27-$38 per VMMC. Costs to patients to access services are almost certainly less in the mobile program, by reducing out-of-pocket travel expenses and lost time and associated income, all of which have been shown to be barriers for accessing treatment. PMID:25774677

  15. [Ethics and ritual circumcision].

    PubMed

    Castagnola, C; Faix, A

    2014-12-01

    Circumcision dates back to ancient times, nowadays, this ritual is practiced mainly in the context of Jewish and Muslim religions. The purpose of this article is to give urologists elements of reflection on the act according to the ethical principles of autonomy, beneficence, non-maleficence and justice. According to a Kantian vision, priority should be given to the respect and wishes of the individuals. In contrast, for the utilitarian theory, circumcision can be justified by a contribution to the happiness of the majority of community members at the expense of a given few. In the event of a request for ritual circumcision, urologists find themselves in the middle, uncomfortable for some, questioning the ethics of its meaning. The main pitfall for the surgeon remains in respecting the child's autonomy. PMID:25199723

  16. [Ethics and ritual circumcision].

    PubMed

    Castagnola, C; Faix, A

    2014-12-01

    Circumcision dates back to ancient times, nowadays, this ritual is practiced mainly in the context of Jewish and Muslim religions. The purpose of this article is to give urologists elements of reflection on the act according to the ethical principles of autonomy, beneficence, non-maleficence and justice. According to a Kantian vision, priority should be given to the respect and wishes of the individuals. In contrast, for the utilitarian theory, circumcision can be justified by a contribution to the happiness of the majority of community members at the expense of a given few. In the event of a request for ritual circumcision, urologists find themselves in the middle, uncomfortable for some, questioning the ethics of its meaning. The main pitfall for the surgeon remains in respecting the child's autonomy.

  17. Scale-Up of Early Infant Male Circumcision Services for HIV Prevention in Lesotho: A Review of Facilitating Factors and Challenges

    PubMed Central

    Kikaya, Virgile; Kakaire, Rajab; Thompson, Elizabeth; Ramokhele, Mareitumetse; Adamu, Tigistu; Curran, Kelly; Njeuhmeli, Emmanuel

    2016-01-01

    ABSTRACT Background: The World Health Organization and the Joint United Nations Programme on HIV/AIDS recommend early infant male circumcision (EIMC) as a component of male circumcision programs in countries with high HIV prevalence and low circumcision rates. Lesotho began incorporating EIMC into routine maternal, newborn, and child health (MNCH) services in 2013 with funding from the United States Agency for International Development and United Nations Children’s Fund. This presented unique challenges: Lesotho had no previous experience with EIMC and cultural traditions link removal of the foreskin to rites of passage. This process evaluation provides an overview of EIMC implementation. Methodology: The Lesotho Ministry of Health and Jhpiego conducted a baseline assessment before service implementation. Baseline information from an initial assessment was used to develop and implement an EIMC program that had a pilot and a scale-up phase. Key program activities such as staff training, quality assurance, and demand creation were included at the program design phase. Facilitating factors and challenges were identified from a review of information collected during the baseline assessment as well as the pilot. Results: Between September 2013 and March 2015, 592 infants were circumcised at 9 sites: 165 (28%) between 1 day and 6 days after birth; 196 (33%) between 7 and 30 days, and 231 (39%) between 31 and 60 days. Facilitating factors included strong support from the Ministry of Health, collaboration with stakeholders, and donor funding. Providers were enthusiastic about the opportunity to offer new services and receive training. Challenges included gaining consent from family members other than mothers, and parents’ concern about pain and complications. The EIMC program also had to manage providers’ expectations of compensation because overtime was paid to providers who took part in adult circumcision programming but not for EIMC. Limited human resources

  18. Urinary tract infection following ritual Jewish circumcision.

    PubMed

    Goldman, M; Barr, J; Bistritzer, T; Aladjem, M

    1996-11-01

    Circumcision seems to reduce the overall incidence of urinary tract infections (UTI), although a few studies have suggested that ritual circumcision may be a predisposing factor for UTI within the first 2 weeks following the procedure. The aim of this study was to investigate a possible causal relationship between ritual circumcision and UTI. The study comprised 82 infants with UTI, 55 females and 27 males under the age of 1 year. All males were circumcised on the eighth day of life. The median age of infection was 0.75 and 7.0 months for males and females, respectively. Fifty-two percent (14/27) of UTI episodes were diagnosed within the 2 weeks following circumcision. A significantly lower incidence in Escherichia coli-induced UTI was observed in males compared to females, 67% and 93%, respectively. Similarly, the incidence of E. coli-induced UTI was also significantly lower in males presenting within 2 weeks following circumcision (57%) compared to infants presenting prior or more than 2 weeks following the procedure (92%). Positive blood cultures of an identical microorganism were observed in 6/27 males compared to 2/55 females. The incidence of urinary tract malformations and their severity were similar in both sexes. We conclude that the high incidence of UTI following a ritual Jewish circumcision, as well as the relatively high preponderance of bacteria other than E. coli, may suggest a causal relationship between circumcision and UTI.

  19. Acceptability of Male Circumcision among College Students in Medical Universities in Western China: A Cross-Sectional Study

    PubMed Central

    Yang, Xiaobo; Huang, Mingbo; Deng, Wei; Huang, Jiegang; Liang, Bingyu; Qin, Bo; Upur, Halmurat; Zhong, Chaohui; Wang, Qianqiu; Wang, Qian; Ruan, Yuhua; Ye, Li; Liang, Hao

    2015-01-01

    Background Male circumcision (MC) has been shown to reduce the risk of female to male transmission of HIV. The goal of this survey was to explore MC’s acceptability and the factors associated with MC among college students in medical universities in western China. Methods A cross-sectional study was carried out in three provinces in western China (Guangxi, Chongqing and Xinjiang) to assess the acceptability of MC as well as to discover factors associated with the acceptability among college students in medical universities. A total of 1,790 uncircumcised male students from three medical universities were enrolled in this study. In addition, 150 students who had undergone MC were also enrolled in the survey, and they participated in in-depth interviews. Results Of all the uncircumcised participants (n = 1,790), 55.2% (n = 988) were willing to accept MC. Among those who accepted MC, 67.3% thought that MC could improve their sexual partners’ hygiene, 46.3% believed that HIV and sexually transmitted diseases (STDs) could be partially prevented by MC. The multivariable logistic regression indicates that MC’s acceptability was associated with three factors: the redundant foreskin (OR = 10.171, 95% CI = 7.629–13.559), knowing the hazard of having a redundant foreskin (OR = 1.597, 95% CI = 1.097–2.323), and enhancing sexual pleasure (OR = 1.628, 95% CI = 1.312–2.021). The in-depth interviews for subjects who had undergone MC showed that the major reason for having MC was the redundant foreskin (87.3%), followed by the benefits and the fewer complications of having MC done. In addition, most of these participants (65.3%) said that the MC could enhance sexual satisfaction. Conclusions MC’s acceptance among college students in medical universities is higher than it is among other populations in western China. An implementation of an MC programme among this population is feasible in the future. PMID:26390212

  20. Implementation and Operational Research: A Randomized Noninferiority Trial of AccuCirc Device Versus Mogen Clamp for Early Infant Male Circumcision in Zimbabwe

    PubMed Central

    Larke, Natasha; Hatzold, Karin; Ncube, Getrude; Weiss, Helen A.; Mangenah, Collin; Mugurungi, Owen; Mufuka, Juliet; Samkange, Christopher A.; Sherman, Judith; Gwinji, Gerald; Cowan, Frances M.; Ticklay, Ismail

    2015-01-01

    Background: Early infant male circumcision (EIMC) is a potential key HIV prevention intervention, providing it can be safely and efficiently implemented in sub-Saharan Africa. Here, we present results of a randomized noninferiority trial of EIMC comparing the AccuCirc device with Mogen clamp in Zimbabwe. Methods: Between January and June 2013, eligible infants were randomized to EIMC through either AccuCirc or Mogen clamp conducted by a doctor, using a 2:1 allocation ratio. Participants were followed for 14 days post-EIMC. Primary outcomes for the trial were EIMC safety and acceptability. Results: One hundred fifty male infants were enrolled in the trial and circumcised between 6 and 54 days postpartum (n = 100 AccuCirc; n = 50 Mogen clamp). Twenty-six infants (17%) were born to HIV-infected mothers. We observed 2 moderate adverse events (AEs) [2%, 95% confidence interval (CI): 0.2 to 7.0] in the AccuCirc arm and none (95% CI: 0.0 to 7.1) in the Mogen clamp arm. The cumulative incident risk of AEs was 2.0% higher in the AccuCirc arm compared with the Mogen Clamp arm (95% CI: −0.7 to 4.7). As the 95% CI excludes the predefined noninferiority margin of 6%, the result provides evidence of noninferiority of AccuCirc compared with the Mogen clamp. Nearly all mothers (99.5%) reported great satisfaction with the outcome. All mothers, regardless of arm said they would recommend EIMC to other parents, and would circumcise their next son. Conclusions: This first randomized trial of AccuCirc versus Mogen clamp for EIMC demonstrated that EIMC using these devices is safe and acceptable to parents. There was no difference in the rate of AEs by device. PMID:26010029

  1. Assessing Odor Level when Using PrePex for HIV Prevention: A Prospective, Randomized, Open Label, Blinded Assessor Trial to Improve Uptake of Male Circumcision.

    PubMed

    Mutabazi, Vincent; Bitega, Jean Paul; Ngeruka, Leon Muyenzi; Karema, Corine; Binagwaho, Agnes

    2015-01-01

    The PrePex is a WHO--prequalified medical device for adult male circumcision for HIV prevention. The Government of Rwanda was the first country to implement the PrePex device and acts as the leading center of excellence providing training and formal guidelines. As part of the Government's efforts to improve PrePex implementation, it made efforts to improve the psychological acceptability of device by men, thus increasing uptake with VMMC in sub-Saharan Africa. Some men who underwent the PrePex procedure complained of foreskin odor while wearing the PrePex 3-7 days after it was placed. This complaint was identified as potential risk for uptake of the device. Researchers from Rwanda assumed there is a possible relation between the level of foreskin odor and patient foreskin hygiene technique. The Government of Rwanda decided to investigate those assumptions in a scientific way and conduct a trial to test different hygiene-cleaning methods in order to increase the acceptability of PrePex and mitigate the odor concern. The main objective of the trial was to compare odor levels between three arms, having identical personal hygiene but different foreskin hygiene techniques using either clear water with soap during a daily shower, soapy water using a syringe, or chlorhexidine using a syringe. One hundred and one subjects were enrolled to the trial and randomly allocated into three trial arms. Using chlorhexidine solution daily almost completely eliminated odor, and was statistically significant more effective that the other two arms. The trial results suggest that odor from the foreskin, while wearing the PrePex device, could be related to the growth of anaerobic bacteria, which can be prevented by a chlorhexidine cleaning method. This finding can be used to increase acceptability by men when considering PrePex as one of the leading methods for HIV prevention in VMMC programs.

  2. Assessing Odor Level when Using PrePex for HIV Prevention: A Prospective, Randomized, Open Label, Blinded Assessor Trial to Improve Uptake of Male Circumcision.

    PubMed

    Mutabazi, Vincent; Bitega, Jean Paul; Ngeruka, Leon Muyenzi; Karema, Corine; Binagwaho, Agnes

    2015-01-01

    The PrePex is a WHO--prequalified medical device for adult male circumcision for HIV prevention. The Government of Rwanda was the first country to implement the PrePex device and acts as the leading center of excellence providing training and formal guidelines. As part of the Government's efforts to improve PrePex implementation, it made efforts to improve the psychological acceptability of device by men, thus increasing uptake with VMMC in sub-Saharan Africa. Some men who underwent the PrePex procedure complained of foreskin odor while wearing the PrePex 3-7 days after it was placed. This complaint was identified as potential risk for uptake of the device. Researchers from Rwanda assumed there is a possible relation between the level of foreskin odor and patient foreskin hygiene technique. The Government of Rwanda decided to investigate those assumptions in a scientific way and conduct a trial to test different hygiene-cleaning methods in order to increase the acceptability of PrePex and mitigate the odor concern. The main objective of the trial was to compare odor levels between three arms, having identical personal hygiene but different foreskin hygiene techniques using either clear water with soap during a daily shower, soapy water using a syringe, or chlorhexidine using a syringe. One hundred and one subjects were enrolled to the trial and randomly allocated into three trial arms. Using chlorhexidine solution daily almost completely eliminated odor, and was statistically significant more effective that the other two arms. The trial results suggest that odor from the foreskin, while wearing the PrePex device, could be related to the growth of anaerobic bacteria, which can be prevented by a chlorhexidine cleaning method. This finding can be used to increase acceptability by men when considering PrePex as one of the leading methods for HIV prevention in VMMC programs. PMID:26023772

  3. Assessing Odor Level when Using PrePex for HIV Prevention: A Prospective, Randomized, Open Label, Blinded Assessor Trial to Improve Uptake of Male Circumcision

    PubMed Central

    Mutabazi, Vincent; Bitega, Jean Paul; Ngeruka, Leon Muyenzi; Karema, Corine; Binagwaho, Agnes

    2015-01-01

    The PrePex is a WHO–prequalified medical device for adult male circumcision for HIV prevention. The Government of Rwanda was the first country to implement the PrePex device and acts as the leading center of excellence providing training and formal guidelines. As part of the Government’s efforts to improve PrePex implementation, it made efforts to improve the psychological acceptability of device by men, thus increasing uptake with VMMC in sub-Saharan Africa. Some men who underwent the PrePex procedure complained of foreskin odor while wearing the PrePex 3–7 days after it was placed. This complaint was identified as potential risk for uptake of the device. Researchers from Rwanda assumed there is a possible relation between the level of foreskin odor and patient foreskin hygiene technique. The Government of Rwanda decided to investigate those assumptions in a scientific way and conduct a trial to test different hygiene-cleaning methods in order to increase the acceptability of PrePex and mitigate the odor concern. The main objective of the trial was to compare odor levels between three arms, having identical personal hygiene but different foreskin hygiene techniques using either clear water with soap during a daily shower, soapy water using a syringe, or chlorhexidine using a syringe. One hundred and one subjects were enrolled to the trial and randomly allocated into three trial arms. Using chlorhexidine solution daily almost completely eliminated odor, and was statistically significant more effective that the other two arms. The trial results suggest that odor from the foreskin, while wearing the PrePex device, could be related to the growth of anaerobic bacteria, which can be prevented by a chlorhexidine cleaning method. This finding can be used to increase acceptability by men when considering PrePex as one of the leading methods for HIV prevention in VMMC programs. Trial Registration Clinicaltrials.gov NCT02153658 PMID:26023772

  4. Assessing Progress, Impact, and Next Steps in Rolling Out Voluntary Medical Male Circumcision for HIV Prevention in 14 Priority Countries in Eastern and Southern Africa through 2014

    PubMed Central

    Kripke, Katharine; Samuelson, Julia; Schnure, Melissa; Dalal, Shona; Farley, Timothy; Hankins, Catherine; Thomas, Anne G.; Reed, Jason; Stegman, Peter; Bock, Naomi

    2016-01-01

    Background In 2007, the World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS) identified 14 priority countries across eastern and southern Africa for scaling up voluntary medical male circumcision (VMMC) services. Several years into this effort, we reflect on progress. Methods Using the Decision Makers’ Program Planning Tool (DMPPT) 2.1, we assessed age-specific impact, cost-effectiveness, and coverage attributable to circumcisions performed through 2014. We also compared impact of actual progress to that of achieving 80% coverage among men ages 15–49 in 12 VMMC priority countries and Nyanza Province, Kenya. We populated the models with age-disaggregated VMMC service statistics and with population, mortality, and HIV incidence and prevalence projections exported from country-specific Spectrum/Goals files. We assumed each country achieved UNAIDS’ 90-90-90 treatment targets. Results More than 9 million VMMCs were conducted through 2014: 43% of the estimated 20.9 million VMMCs required to reach 80% coverage by the end of 2015. The model assumed each country reaches the UNAIDS targets, and projected that VMMCs conducted through 2014 will avert 240,000 infections by the end of 2025, compared to 1.1 million if each country had reached 80% coverage by the end of 2015. The median estimated cost per HIV infection averted was $4,400. Nyanza Province in Kenya, the 11 priority regions in Tanzania, and Uganda have reached or are approaching MC coverage targets among males ages 15–24, while coverage in other age groups is lower. Across all countries modeled, more than half of the projected HIV infections averted were attributable to circumcising 10- to 19-year-olds. Conclusions The priority countries have made considerable progress in VMMC scale-up, and VMMC remains a cost-effective strategy for epidemic impact, even assuming near-universal HIV diagnosis, treatment coverage, and viral suppression. Examining circumcision coverage by five

  5. Foreskin cutting beliefs and practices and the acceptability of male circumcision for HIV prevention in Papua New Guinea

    PubMed Central

    2013-01-01

    Background Male circumcision (MC) reduces HIV acquisition and is a key public health intervention in settings with high HIV prevalence, heterosexual transmission and low MC rates. In Papua New Guinea (PNG), where HIV prevalence is 0.8%, there is no medical MC program for HIV prevention. There are however many different foreskin cutting practices across the country’s 800 language groups. The major form exposes the glans but does not remove the foreskin. This study aimed to describe and quantify foreskin cutting styles, practices and beliefs. It also aimed to assess the acceptability of MC for HIV prevention in PNG. Methods Cross-sectional multicentre study, at two university campuses (Madang Province and National Capital District) and at two ‘rural development’ sites (mining site Enga Province; palm-oil plantation in Oro Province). Structured questionnaires were completed by participants originating from all regions of PNG who were resident at each site for study or work. Results Questionnaires were completed by 861 men and 519 women. Of men, 47% reported a longitudinal foreskin cut (cut through the dorsal surface to expose the glans but foreskin not removed); 43% reported no foreskin cut; and 10% a circumferential foreskin cut (complete removal). Frequency and type of cut varied significantly by region of origin (p < .001). Most men (72-82%) were cut between the ages of 10 – 20 years. Longitudinal cuts were most often done in a village by a friend, with circumferential cuts most often done in a clinic by a health professional. Most uncut men (71%) and longitudinal cut men (84%) stated they would remove their foreskin if it reduced the risk of HIV infection. More than 95% of uncut men and 97% of longitudinal cut men would prefer the procedure in a clinic or hospital. Most men (90%) and women (74%) stated they would remove the foreskin of their son if it reduced the risk of HIV infection. Conclusion Although 57% of men reported some form of foreskin cut

  6. Adult male circumcision in Nyanza, Kenya at scale: the cost and efficiency of alternative service delivery modes

    PubMed Central

    2014-01-01

    Background Adult male circumcision (MC) services in Kenya are provided through both horizontal and vertical programs, and via facility-based, mobile and outreach service delivery. This study assesses the costs and composition of unit costs for each program approach and service delivery mode and assess the cost-effectiveness of each. Methods This study was conducted on the unit costs of adult MC delivery in 222 purposively-selected MC delivery sites in Nyanza Province, Kenya from November 2008 through April 2010 using program data from the AIDS, Population, and Health Integrated Assistance Project II (APHIA II) and from the Nyanza Reproductive Health Society (NRHS). The former program can be characterized as horizontal or integrated; the latter as ‘diagonal’; containing both horizontal and vertical elements. Expenditure and services data were collected from project financial and monitoring documents and via discussions with program officials. In addition, per-case, direct service delivery costs were calculated using time and motion observations of 246 adult MC procedures performed during May and June, 2010. We calculated the cost per HIV infections averted for each of the service delivery modalities. Results Unit cost per adult MC was $38.62 and $44.24 for APHIA II and NRHS respectively, ranging from $29.32 (APHIA II mobile) to $46.20 (NRHS outreach/mobile). Unit costs at base facilities was similar for the two approaches. Time and motion data revealed that the opportunity cost of the elapsed time between the arrival of the surgical team and the time the first MC procedure begins varies between $2.08 and $6.27 per case. The cost per HIV infection (HIA) averted ranged from $117.29 for mobile service via the horizontal APHIA-II program to $184.84 per HIA for the diagonal NRHS program. Conclusions This study provides evidence for the similar efficiency of a horizontal approach (APHIA II) and a combination of horizontal and vertical approaches (NRHS) to support

  7. “Man, what took you so long?” Social and individual factors affecting adult attendance at voluntary medical male circumcision services in Tanzania

    PubMed Central

    Plotkin, Marya; Castor, Delivette; Mziray, Hawa; Küver, Jan; Mpuya, Ezekiel; Luvanda, Paul James; Hellar, Augustino; Curran, Kelly; Lukobo-Durell, Mainza; Ashengo, Tigistu Adamu; Mahler, Hally

    2013-01-01

    ABSTRACT Background: In 2009, the Government of Tanzania embarked on scaling up voluntary medical male circumcision (VMMC) services for HIV prevention in 8 priority regions, with the aim of serving 2.8 million boys and men ages 10–34 years by 2013. By mid-2012, more than 110,000 boys and men in Iringa and Njombe regions had received VMMC. The majority (85%) of these VMMC clients were under 19 years old (average age, 16 years). This study aimed to identify potential barriers and facilitators to VMMC among older men. Methods: We conducted 16 focus group discussions, stratified by sex and age, with 142 purposefully selected participants in 3 districts of Iringa and Njombe regions. Results: Both men and women generally had positive attitudes toward VMMC. Social and personal barriers to obtaining VMMC among adult men included shame associated with seeking services co-located with younger boys and perceived inappropriateness of VMMC after puberty, particularly after marriage and after having children. Additional barriers included concerns about partner infidelity during the post-surgical abstinence period, loss of income, and fear of pain associated with post-surgical erections. Facilitators included awareness of the HIV-prevention benefit and perceptions of cleanliness and enhanced attractiveness to women. Conclusions: While men and women in Iringa and Njombe regions in Tanzania generally view VMMC as a desirable procedure, program implementers need to address barriers to VMMC services among adult men. Selected service delivery sites in the Iringa and Njombe regions will be segregated by age to provide services that are “friendly” to adult men. Services will be complemented with behavior change communication initiatives to address concerns of older men, encourage women’s support for circumcision and adherence to the post-surgical abstinence period, and change social norms that inhibit older men from seeking circumcision. PMID:25276521

  8. Safety and Efficacy of the PrePex Male Circumcision Device: Results From Pilot Implementation Studies in Mozambique, South Africa, and Zambia

    PubMed Central

    Feldblum, Paul; Martinson, Neil; Bvulani, Bruce; Taruberekera, Noah; Mahomed, Mehebub; Chintu, Namwinga; Milovanovic, Minja; Hart, Catherine; Billy, Scott; Necochea, Edgar; Samona, Alick; Mhazo, Miriam; Bossemeyer, Debora; Lai, Jaim Jou; Lebinai, Limakatso; Ashengo, Tigistu A.; Macaringue, Lucinda; Veena, Valentine

    2016-01-01

    Background: Fourteen countries in East and Southern Africa have engaged in national programs to accelerate the provision of voluntary medical male circumcision (VMMC) since 2007. Devices have the potential to accelerate VMMC programs by making the procedure easier, quicker, more efficient, and widely accessible. Methods: Pilot Implementation studies were conducted in Mozambique, South Africa, and Zambia. The primary objective of the studies was to assess the safety of PrePex device procedures when conducted by nurses and clinical officers in adults and adolescent males (13–17 years, South Africa only) with the following end points: number and grade of adverse events (AEs); pain-related AEs measured using visual analog score; device displacements/self-removals; time to complete wound healing; and procedure times for device placement and removal. Results: A total of 1401 participants (1318 adult and 83 adolescent males) were circumcised using the PrePex device across the 3 studies. Rates of moderate/severe AEs were low (1.0%; 2.0%; and 2.8%) in the studies in Mozambique, Zambia, and South Africa, respectively. Eight early self-removals of 1401 (0.6%) were observed, all required corrective surgery. High rates of moderate/severe pain-related AEs were recorded especially at device removal in South Africa (34.9%) and Mozambique (59.5%). Ninety percent of participants were healed at day 56 postplacement. Discussion: The study results from the 3 countries suggest that the implementation of the PrePex device using nonphysician health care workers is both safe and feasible, but better pain control at device removal needs to be put in place to increase the comfort of VMMC clients using the PrePex device. PMID:27331589

  9. Female Partner Acceptance as a Predictor of Men's Readiness to Undergo Voluntary Medical Male Circumcision in Zambia: The Spear and Shield Project

    PubMed Central

    Cook, Ryan; Jones, Deborah; Redding, Colleen A.; Zulu, Robert; Chitalu, Ndashi; Weiss, Stephen M.

    2015-01-01

    The World Health Organization has recommended the scale-up of voluntary medical male circumcision (VMMC) for HIV prevention in sub-Saharan Africa; however, men are often uninterested in undergoing VMMC. The Spear & Shield project enrolled 668 men and female partners from ten Zambian community health centers into parallel interventions promoting VMMC for HIV prevention or time-matched control conditions. A mediation model was utilized to examine the relationships between changes in women's acceptance of VMMC and men's readiness to undergo the procedure. Results demonstrated that, at 12 months post-intervention, a 5.9 % increase in the likelihood of undergoing VMMC among men in the experimental condition could be attributed to increased women's acceptance. From a public health perspective, involving women in VMMC promotion interventions such as the Spear & Shield project could significantly impact the demand for VMMC in Zambia. PMID:25931242

  10. Skills Training of Health Workers in the Use of a Non Surgical Device (PrePex) for Adult Safe Male Circumcision

    PubMed Central

    Galukande, Moses; Duffy, Kevin; Bitega, Jean Paul; Wooding, Nick

    2014-01-01

    Background Safe Male Circumcision (SMC) is a proven approach for partial protection of men from acquisition of HIV infection. Several sub-Saharan African countries have a target to circumcise 80% of males aged 15 to 49. The use of devices such as PrePex would aid scaling up of SMC. Since most health workers would have no prior experience with use of devices, skills training is needed. This paper explores a skills transfer model at an urban site in Uganda. Objective To assess the practicability and feasibility of rapid short duration training for safe PrePex device use. Methods A prospective study, conducted over 8 weeks (August–October 2012) at International Hospital Kampala, an urban Kampala hospital, examining the performance of various health worker cadres after training in the use of a non-surgical device (PrePex). The prospective study obtained approval from the Makerere School of Medicine Research and Ethics Committee and the Uganda National Council of Science and Technology. If eligible, and after the subject signed the informed consent form, they were enrolled into the study. Results Ten health workers were successfully trained in use of PrePex during a 3 day non-residential on-the-job training course. After the first three days of training, the trained health workers performed 561 placements and 529 device removals successfully. Over all adverse events (AE) rates were below ≤2%; however, there were some differences in AE rates across the cadres trained but not significant (p>0.25 for moderate AEs). Conclusion Rapid training for safe use of the PrePex device is feasible for the range of health workers available for SMC in resource limited settings, but among those with past SMC experience. PMID:25118716

  11. No difference in keratin thickness between inner and outer foreskins from elective male circumcisions in Rakai, Uganda.

    PubMed

    Dinh, Minh H; Hirbod, Taha; Kigozi, Godfrey; Okocha, Eneniziaogochukwu A; Cianci, Gianguido C; Kong, Xiangrong; Prodger, Jessica L; Broliden, Kristina; Kaul, Rupert; Serwadda, David; Wawer, Maria J; Gray, Ronald H; Hope, Thomas J

    2012-01-01

    It has been hypothesized that increased HIV acquisition in uncircumcised men may relate to a more thinly keratinized inner foreskin. However, published data are contradictory and potentially confounded by medical indications for circumcision. We tested the hypothesis that the inner foreskin was more thinly keratinized than the outer foreskin using tissues from 19 healthy, HIV-uninfected men undergoing routine prophylactic circumcision in Rakai, Uganda. Sections from 3 foreskin anatomic sites (inner, outer, and frenar band) were snap-frozen separately. Two independent laboratories each separately stained, imaged, and measured keratin thicknesses in a blinded fashion. There was no significant difference in keratin thickness between the inner (mean = 14.67±7.48 µm) and outer (mean = 13.30±8.49 µm) foreskin, or between the inner foreskin and the frenar band (mean = 16.91±12.42 µm). While the frenar band showed the greatest intra-individual heterogeneity in keratin thickness, there was substantial inter-individual variation seen in all regions. Measurements made by the two laboratories showed high correlation (r = 0.741, 95% CI, 0.533-0.864). We conclude that, despite inter- and intra-individual variability, keratin thickness was similar in the inner and outer foreskin of healthy Ugandan men, and that reduced keratin thickness is not likely to make the inner foreskin more susceptible to HIV acquisition. PMID:22815984

  12. Parental circumcision preferences and early outcome of plastibell circumcision in a Nigerian tertiary hospital

    PubMed Central

    Ekwunife, Okechukwu Hyginus; Ugwu, Jideofor Okechukwu; Okoli, Chinedu C.; Modekwe, Victor Ifeanyichukwu; Osuigwe, Andrew N.

    2015-01-01

    Background: Parents are central in decisions and choices concerning circumcision of their male children and plastibell circumcision is a widely practiced technique. This study determined parental preferences for male neonatal and infant circumcisions and evaluate the early outcomes of plastibell circumcisions in a tertiary centre. Patients and Methods: This is a prospective study on consecutive male neonates and infants who were brought for circumcisions at Nnamdi Azikiwe University Teaching Hospital Nnewi, South-East Nigeria and their respective parents between January 2012 and December 2012. Data on demography, parental choices and early outcome of plastibell circumcision were obtained and analysed. Results: A total of 337 requests for circumcisions were made for boys with age range of 2-140 days. Culture and religion were the most common reasons for circumcision requests in 200 (59.3%) and 122 (36.2%), respectively, other reasons were medical, cosmesis, to reduce promiscuity and just to follow the norm. Most parents, 249 (73.9%) preferred the procedure to be performed on the 8th day and 88.7% would like the doctors to perform the procedure while 84.6% preferred the plastibell method. Among those who had circumcision, 114 complied with follow-up schedules and there were complications in 22 (19.3%) patients. Parents assessed the early outcome as excellent, very good, good and poor in 30.7%, 45.6%, 18.4% and 5.3% of the patients, respectively. Conclusion: Parents request for male circumcision in our environment is largely for cultural and religious reasons; and prefer the procedure to be performed by a physician. Plastibell method is well known and preferred and its outcome is acceptable by most parents. PMID:26712290

  13. Randomized Controlled Trial of the ShangRing for Adult Medical Male Circumcision: Safety, Effectiveness, and Acceptability of Using 7 Versus 14 Device Sizes

    PubMed Central

    Zulu, Robert; Linyama, David; Long, Sarah; Nonde, Thikazi Jere; Lai, Jaim Jou; Kashitala, Joshua; Veena, Valentine; Kasonde, Prisca

    2016-01-01

    Objectives: To assess the safety, effectiveness, and acceptability of providing a reduced number of ShangRing sizes for adult voluntary medical male circumcision (VMMC) within routine service delivery in Lusaka, Zambia. Methods: We conducted a randomized controlled trial and enrolled 500 HIV-negative men aged 18–49 years at 3 clinics. Participants were randomized to 1 of 2 study arms (Standard Sizing arm vs Modified Sizing arm) in a 1:1 ratio. All 14 adult ShangRing sizes (40–26 mm inner diameter, each varying by 1 mm) were available in the Standard Sizing arm; the Modified Sizing arm used every other size (40, 38, 36, 34, 32, 30, 28 mm inner diameter). Each participant was scheduled for 2 follow-up visits: the removal visit (day 7 after placement) and the healing check visit (day 42 after placement), when they were evaluated for adverse events (AEs), pain, and healing. Results: Four hundred and ninety-six men comprised the analysis population, with 255 in the Standard Sizing arm and 241 in the Modified Sizing arm. Three men experienced a moderate or severe AEs (0.6%), including 2 in the Standard Sizing arm (0.8%) and 1 in the Modified Sizing arm (0.4%). 73.2% of participants were completely healed at the scheduled day 42 healing check visit, with similar percentages across study arms. Virtually all (99.6%) men, regardless of study arm, stated that they were very satisfied or satisfied with the appearance of their circumcised penis, and 98.6% stated that they would recommend ShangRing circumcision to family/friends. Conclusions: The moderate/severe AE rate was low and similar in the 2 study arms, suggesting that provision of one-half the number of adult device sizes is sufficient for safe service delivery. Effectiveness, time to healing, and acceptability were similar in the study arms. The simplicity of the ShangRing technique, and its relative speed, could facilitate VMMC program goals. In addition, sufficiency of fewer device sizes would simplify logistics

  14. A Clinical Trial to Introduce Voluntary Medical Male Circumcision for HIV Prevention in Areas of High Prevalence in the Dominican Republic

    PubMed Central

    Brito, Maximo O.; Lerebours, Leonel; Volquez, Claudio; Basora, Emmanuel; Khosla, Shaveta; Lantigua, Flavia; Flete, Roberto; Rosario, Riqui; Rodriguez, Luis A.; Fernandez, Mathius; Donastorg, Yeycy; Bailey, Robert C.

    2015-01-01

    Background Voluntary Medical Male Circumcision (VMMC) is an effective strategy to reduce the risk of HIV infection. Studies conducted in the Dominican Republic (DR) suggest that acceptability of VMMC among men may be as high as 67%. The goal of this clinical trial was to assess the acceptability, uptake and safety for VMMC services in two areas of high HIV prevalence in the country. Methods This was a single-arm, non-randomized, pragmatic clinical trial. Study personnel received background information about the risks and benefits of VMMC and practical training on the surgical technique. A native speaking research assistant administered a questionnaire of demographics, sexual practices and knowledge about VMMC. One week after the surgery, participants returned for wound inspection and to answer questions about their post-surgical experience. Results 539 men consented for the study. Fifty seven were excluded from participation for medical or anatomical reasons and 28 decided not to have the procedure after providing consent. A total of 454 men were circumcised using the Forceps Guided Method Under Local Anesthesia. The rate of adverse events (AE) was 4.4% (20% moderate, 80% mild). There were no serious AEs and all complications resolved promptly with treatment. Eighty eight percent of clients reported being “very satisfied” and 12% were “somewhat satisfied” with the outcome at the one-week postoperative visit. Conclusions Recruitment and uptake were satisfactory. Client satisfaction with VMMC was high and the rate of AEs was low. Roll out of VMMC in targeted areas of the DR is feasible and should be considered. Trial Registration ClinicalTrials.gov NCT02337179 PMID:26367187

  15. Employing Demand-Based Volumetric Forecasting to Identify Potential for and Roles of Devices in Scale-Up of Medical Male Circumcision in Zambia and Zimbabwe

    PubMed Central

    Fram, Francine; Church, Fred; Sundaram, Maaya; Sgaier, Sema K.; Ridzon, Renee; Eletskaya, Maria; Nanga, Alice; Gumede-Moyo, Sehlulekile; Tambatamba, Bushimbwa; Mugurungi, Owen; Ncube, Getrude; Xabayu, Sinokuthemba; Odawo, Patrick

    2016-01-01

    Introduction: Devices for male circumcision (MC) are becoming available in 14 priority countries where MC is being implemented for HIV prevention. Understanding potential impact on demand for services is one important programmatic consideration because countries determine whether to scale up devices within MC programs. Methods: A population-based survey measuring willingness to undergo MC, assuming availability of surgical MC and 3 devices, was conducted among 1250 uncircumcised men, ages 10–49 years in Zambia and 1000 uncircumcised men, ages 13–49 years in Zimbabwe. Simulated Test Market methodology was used to estimate incremental MC demand and the extent to which devices might be preferred over surgery, assuming availability of: surgical MC in both countries; the devices PrePex, ShangRing, and Unicirc in Zambia; and PrePex in Zimbabwe. Results: Modeled estimates indicate PrePex has the potential to provide an overall increase in MC demand ranging from an estimated 13%–50%, depending on country and WHO prequalification ages, replacing 11%–41% of surgical procedures. In Zambia, ShangRing could provide 8% overall increase, replacing 45% of surgical procedures, and Unicirc could provide 30% overall increase, replacing 85% of surgical procedures. Conclusions: In both countries, devices have potential to increase overall demand for MC, assuming wide scale awareness and availability of circumcision by the devices. With consideration for age and country, PrePex may provide the greatest potential increase in demand, followed by Unicirc (measured in Zambia only) and ShangRing (also Zambia only). These results inform one program dimension for decision making on potential device introduction strategies; however, they must be considered within the broader programmatic context. PMID:27331597

  16. Circumcision with “no-flip Shang Ring” and “Dorsal Slit” methods for adult males: a single-centered, prospective, clinical study

    PubMed Central

    Lei, Jun-Hao; Liu, Liang-Ren; Wei, Qiang; Xue, Wen-Ben; Song, Tu-Run; Yan, Shi-Bing; Yang, Lu; Han, Ping; Zhu, Yu-Chun

    2016-01-01

    This paper was aimed to compare the clinical effectiveness and safety of adult male circumcision using the Shang Ring™ (SR) with the no-flip technique compared with Dorsal Slit (DS) surgical method. A single-centered, prospective study was conducted at the West China Hospital, where patients were circumcised using the no-flip SR (n = 408) or the DS (n = 94) procedure. The adverse events (AEs) and satisfaction were recorded for both groups, and ring-removal time and percentage of delayed removals were recorded for the SR group. Finally, complete follow-up data were collected for 76.1% of patients (SR: n = 306; DS: n = 76). The average ring-removal time for the SR group was 17.62 ± 6.30 days. The operation time (P < 0.001), pain scores during the procedure (P < 0.001) and at 24 h postoperatively (P < 0.001), bleeding (P = 0.001), infection (P = 0.034), and satisfaction with penile appearance (P < 0.001) in the SR group were superior to those in the DS group. After two postoperative weeks, the percentage of patients with edema in the SR group (P = 0.029) was higher but no differences were found at 4 weeks (P = 0.185) between the two groups. In conclusions, the no-flip SR method was found to be superior to the DS method for its short operation time (<5 min), involving less pain, bleeding, infection, and resulting in a satisfactory appearance. However, the time for recovery from edema took longer, and patients may wear device for 2–3 weeks after the procedure. PMID:26585694

  17. Impact and Cost of Scaling Up Voluntary Medical Male Circumcision for HIV Prevention in the Context of the New 90-90-90 HIV Treatment Targets

    PubMed Central

    Kripke, Katharine; Reed, Jason; Hankins, Catherine; Smiley, Gregory; Laube, Catey

    2016-01-01

    Background The report of the Joint United Nations Programme on HIV/AIDS (UNAIDS) for World AIDS Day 2014 highlighted a Fast-Track Strategy that sets ambitious treatment and prevention targets to reduce global HIV incidence to manageable levels by 2020 and end the AIDS epidemic by 2030. The 90-90-90 treatment targets for 2020 call for 90% of people living with HIV to know their HIV status, 90% of people who know their status to receive treatment, and 90% of people on HIV treatment to be virally suppressed. This paper examines how scale-up of voluntary medical male circumcision (VMMC) services in four priority countries in sub-Saharan Africa could contribute to ending the AIDS epidemic by 2030 in the context of concerted efforts to close the treatment gap, and what the impact of VMMC scale-up would be if the 90-90-90 treatment targets were not completely met. Methods Using the Goals module of the Spectrum suite of models, this analysis modified ART (antiretroviral treatment) scale-up coverage from base scenarios to reflect the 90-90-90 treatment targets in four countries (Lesotho, Malawi, South Africa, and Uganda). In addition, a second scenario was created to reflect viral suppression levels of 75% instead of 90%, and a third scenario was created in which the 90-90-90 treatment targets are reached in women, with men reaching more moderate coverage levels. Regarding male circumcision (MC) coverage, the analysis examined both a scenario in which VMMCs were assumed to stop after 2015, and one in which MC coverage was scaled up to 90% by 2020 and maintained at 90% thereafter. Results Across all four countries, scaling up VMMC is projected to provide further HIV incidence reductions in addition to those achieved by reaching the 90-90-90 treatment targets. If viral suppression levels only reach 75%, scaling up VMMC leads to HIV incidence reduction to nearly the same levels as those achieved with 90-90-90 without VMMC scale-up. If only women reach the 90-90-90 targets

  18. Neonatal circumcision revisited. Fetus and Newborn Committee, Canadian Paediatric Society.

    PubMed Central

    1996-01-01

    OBJECTIVE: To assist physicians in providing guidance to parents regarding neonatal circumcision. OPTIONS: Whether to recommend the routine circumcision of newborn male infants. OUTCOMES: Costs and complications of neonatal circumcision, the incidence of urinary tract infections, sexually transmitted diseases and cancer of the penis in circumcised and uncircumcised males, and of cervical cancer in their partners, and the costs of treating these diseases. EVIDENCE: The literature on circumcision was reviewed by the Fetus and Newborn Committee of the Canadian Paediatric Society. During extensive discussion at meetings of the committee over a 24-month period, the strength of the evidence was carefully weighed and the perspective of the committee developed. VALUES: The literature was assessed to determine whether neonatal circumcision improves the health of boys and men and is a cost-effective approach to preventing penile problems and associated urinary tract conditions. Religious and personal values were not included in the assessment. BENEFITS, HARMS AND COSTS: The effect of neonatal circumcision on the incidence of urinary tract infection, sexually transmitted diseases, cancer of the penis, cervical cancer and penile problems; the complications of circumcision; and estimates of the costs of neonatal circumcision and of the treatment of later penile conditions, urinary tract infections and complications of circumcision. RECOMMENDATION: Circumcision of newborns should not be routinely performed. VALIDATION: This recommendation is in keeping with previous statements on neonatal circumcision by the Canadian Paediatric Society and the American Academy of Pediatrics. The statement was reviewed by the Infectious Disease Committee of the Canadian Paediatric Society. The Board of Directors of the Canadian Paediatric Society has reviewed its content and approved it for publication. SPONSOR: This is an official statement of the Canadian Paediatric Society. No external

  19. Circumcision: The Good, the Bad and American Values

    ERIC Educational Resources Information Center

    Buie, Mary E.

    2005-01-01

    National statistics estimate that 1.2 million newborn males are circumcised annually in the United States (70% to 80%). Such values as sanctity, equity, fraternity, paternity and liberty affect circumcision rates in America. The value of sanctity allows freedom of religious beliefs and traditions that often overcome medical impetus in…

  20. The Safety and Acceptance of the PrePex Device for Non-Surgical Adult Male Circumcision in Rakai, Uganda. A Non-Randomized Observational Study

    PubMed Central

    Kigozi, Godfrey; Musoke, Richard; Watya, Stephen; Kighoma, Nehemia; Nkale, James; Nakafeero, Mary; Namuguzi, Dan; Serwada, David; Nalugoda, Fred; Sewankambo, Nelson; Wawer, Maria Joan; Gray, Ronald Henry

    2014-01-01

    Objectives To assess the safety and acceptance of the PrePex device for medical male circumcision (MMC) in rural Uganda. Methods In an observational study, HIV-uninfected, uncircumcised men aged 18 and older who requested elective MMC were informed about the PrePex and dorsal slit methods and offered a free choice of their preferred procedure. 100 men received PrePex to assess preliminary safety (aim 1). An additional 329 men, 250 chose PrePex and 79 chose Dorsal slit, were enrolled following approval by the Safety Monitoring Committee (aim 2). Men were followed up at 7 days to assess adverse events (AEs) and to remove the PrePex device. Wound healing was assessed at 4 weeks, with subsequent weekly follow up until completed healing. Results The PrePex device was contraindicated in 5.7% of men due to a tight prepuce or phimosis/adhesions. Among 429 enrolled men 350 (82.0%) got the PrePex device and 79 (18.0%) the dorsal slit procedure. 250 of 329 men (76.0%) who were invited to choose between the 2 procedures chose Prepex. There were 9 AEs (2.6%) with the PrePex, of which 5 (1.4%) were severe complications, 4 due to patient self-removal of the device leading to edema and urinary obstruction requiring emergency surgical circumcision, and one due to wound dehiscence following device removal. 71.8% of men reported an unpleasant odor prior to PrePex removal. Cumulative rates of completed wound healing with the PrePex were 56.7% at week 4, 84.8% week 5, 97.6% week 6 and 98.6% week 7, compared to 98.7% at week 4 with dorsal slit (p<0.0001). Conclusion The PrePex device was well accepted, but healing was slower than with dorsal slit surgery. Severe complications, primarily following PrePex self-removal, required rapid access to emergency surgical facilities. The need to return for removal and delayed healing may increase Program cost and client burden. PMID:25144194

  1. Voluntary Medical Male Circumcision: Matching Demand and Supply with Quality and Efficiency in a High-Volume Campaign in Iringa Region, Tanzania

    PubMed Central

    Hellar, Augustino; Koshuma, Sifuni; Nyabenda, Simeon; Machaku, Michael; Lukobo-Durrell, Mainza; Castor, Delivette; Njeuhmeli, Emmanuel; Fimbo, Bennett

    2011-01-01

    The government of Tanzania has adopted voluntary medical male circumcision (VMMC) as an important component of its national HIV prevention strategy and is scaling up VMMC in eight regions nationwide, with the goal of reaching 2.8 million uncircumcised men by 2015. In a 2010 campaign lasting six weeks, five health facilities in Tanzania's Iringa Region performed 10,352 VMMCs, which exceeded the campaign's target by 72%, with an adverse event (AE) rate of 1%. HIV testing was almost universal during the campaign. Through the adoption of approaches designed to improve clinical efficiency—including the use of the forceps-guided surgical method, the use of multiple beds in an assembly line by surgical teams, and task shifting and task sharing—the campaign matched the supply of VMMC services with demand. Community mobilization and bringing client preparation tasks (such as counseling, testing, and client scheduling) out of the facility and into the community helped to generate demand. This case study suggests that a campaign approach can be used to provide high-volume quality VMMC services without compromising client safety, and provides a model for matching supply and demand for VMMC services in other settings. PMID:22140366

  2. Circumcision and STD in the United States: cross sectional and cohort analyses

    PubMed Central

    Diseker, R.; Peterman, T.; Kamb, M.; Kent, C.; Zenilman, J.; Douglas, J.; Rhodes, F.; Iatesta, M.

    2000-01-01

    Background: Male circumcision status has been shown to be associated with sexually transmitted disease (STD) acquisition in some, but not all, studies. Most studies have been cross sectional. Objectives: We examined the association between circumcision status and the prevalence and incidence of gonorrhoea, chlamydia, and syphilis. Methods: We analysed cross sectional and cohort study data from a multicentre controlled trial in the United States. Between July 1993 and September 1996, 2021 men visiting public inner city STD clinics in the United States were examined by a clinician at enrolment and 1456 were examined at follow up visits 6 and 12 months later. At each visit, men had laboratory tests for gonorrhoea, chlamydia, and syphilis and were examined for circumcision status. We used multiple logisitic regression to compare STD risk among circumcised and uncircumcised men adjusted for potentially confounding factors. Results: Uncircumcised men were significantly more likely than circumcised men to have gonorrhoea in the multivariate analyses, adjusted for age, race, and site, in both the cross sectional (odds ratio (OR), 1.3; 95% confidence interval (CI), 0.9 to 1.7) and in the cohort analysis (OR, 1.6; 95% CI, 1.0 to 2.6). There was no association between lack of circumcision and chlamydia in either the cross sectional (OR, 1.0; 95% CI 0.7-1.4) or the cohort analysis (OR, 0.9; 95% CI 0.5-1.5). The magnitude of association between lack of circumcision and syphilis was similar in the cross sectional (OR, 1.4; 95% CI 0.6 to 3.3) and cohort analysis (OR, 1.5; 95% CI 0.4 to 6.1). Conclusion: Uncircumcised men in the United States may be at increased risk for gonorrhoea and syphilis, but chlamydia risk appears similar in circumcised and uncircumcised men. Our results suggest that risk estimates from cross sectional studies would be similar to cohort findings. Key Words: circumcision; sexually transmitted diseases; United States PMID:11221132

  3. Estimating the Cost of Early Infant Male Circumcision in Zimbabwe: Results From a Randomized Noninferiority Trial of AccuCirc Device Versus Mogen Clamp

    PubMed Central

    Mavhu, Webster; Hatzold, Karin; Biddle, Andrea K.; Madidi, Ngonidzashe; Ncube, Getrude; Mugurungi, Owen; Ticklay, Ismail; Cowan, Frances M.; Thirumurthy, Harsha

    2015-01-01

    Background: Safe and cost-effective programs for implementing early infant male circumcision (EIMC) in Africa need to be piloted. We present results on a relative cost analysis within a randomized noninferiority trial of EIMC comparing the AccuCirc device with Mogen clamp in Zimbabwe. Methods: Between January and June 2013, male infants who met inclusion criteria were randomized to EIMC through either AccuCirc or Mogen clamp conducted by a doctor, using a 2:1 allocation ratio. We evaluated the overall unit cost plus the key cost drivers of EIMC using both AccuCirc and Mogen clamp. Direct costs included consumable and nonconsumable supplies, device, personnel, associated staff training, and environmental costs. Indirect costs comprised capital and support personnel costs. In 1-way sensitivity analyses, we assessed potential changes in unit costs due to variations in main parameters, one at a time, holding all other values constant. Results: The unit costs of EIMC using AccuCirc and Mogen clamp were $49.53 and $55.93, respectively. Key cost drivers were consumable supplies, capacity utilization, personnel costs, and device price. Unit prices are likely to be lowest at full capacity utilization and increase as capacity utilization decreases. Unit prices also fall with lower personnel salaries and increase with higher device prices. Conclusions: EIMC has a lower unit cost when using AccuCirc compared with Mogen clamp. To minimize unit costs, countries planning to scale-up EIMC using AccuCirc need to control costs of consumables and personnel. There is also need to negotiate a reasonable device price and maximize capacity utilization. PMID:26017658

  4. Is there an association between female circumcision and perinatal death?

    PubMed Central

    Essen, Birgitta; Bodker, Birgit; Sjoberg, N-O; Gudmundsson, Saemundur; Ostergren, P-O; Langhoff-Roos, Jens

    2002-01-01

    OBJECTIVE: In Sweden, a country with high standards of obstetric care, the high rate of perinatal mortality among children of immigrant women from the Horn of Africa raises the question of whether there is an association between female circumcision and perinatal death. METHOD: To investigate this, we examined a cohort of 63 perinatal deaths of infants born in Sweden over the period 1990-96 to circumcised women. FINDINGS: We found no evidence that female circumcision was related to perinatal death. Obstructed or prolonged labour, caused by scar tissue from circumcision, was not found to have any impact on the number of perinatal deaths. CONCLUSION: The results do not support previous conclusions that genital circumcision is related to perinatal death, regardless of other circumstances, and suggest that other, suboptimal factors contribute to perinatal death among circumcised migrant women. PMID:12219153

  5. Evaluating the cost of adult voluntary medical male circumcision in a mixed (surgical and PrePex) site compared to a hypothetical PrePex-only site in South Africa

    PubMed Central

    Kim, Hae-Young; Lebina, Limakatso; Milovanovic, Minja; Taruberekera, Noah; Dowdy, David W.; Martinson, Neil A.

    2015-01-01

    Background Several circumcision devices have been evaluated for a safe and simplified male circumcision among adults. The PrePex device was prequalified for voluntary male medical circumcision (VMMC) in May 2013 by the World Health Organization and is expected to simplify the procedure safely while reducing cost. South Africa is scaling up VMMC. Objective To evaluate the overall unit cost of VMMC at a mixed site vs. a hypothetical PrePex-only site in South Africa. Design We evaluated the overall unit cost of VMMC at a mixed site where PrePex VMMC procedure was added to routine forceps-guided scalpel-based VMMC in Soweto, South Africa. We abstracted costs and then modeled these costs for a hypothetical PrePex-only site, at which 9,600 PrePex circumcisions per year could be done. We examined cost drivers and modeled costs, varying the price of the PrePex device. The healthcare system perspective was used. Results In both sites, the main contributors of cost were personnel and consumables. If 10% of all VMMC were by PrePex at the mixed site, the overall costs of the surgical method and PrePex were similar – US$59.62 and $59.53, respectively. At the hypothetical PrePex-only site, the unit cost was US$51.10 with PrePex circumcisions having markedly lower personnel and biohazardous waste management costs. In sensitivity analysis with the cost of PrePex kit reduced to US$10 and $2, the cost of VMMC was further reduced. Conclusions Adding PrePex to an existing site did not necessarily reduce the overall costs of VMMC. However, starting a new PrePex-only site is feasible and may significantly reduce the overall cost by lowering both personnel and capital costs, thus being cost-effective in the long term. Achieving a lower cost for PrePex will be an important contributor to the scale-up of VMMC. PMID:26679407

  6. Sequential Cross-Sectional Surveys in Orange Farm, a Township of South Africa, Revealed a Constant Low Voluntary Medical Male Circumcision Uptake among Adults despite Demand Creation Campaigns and High Acceptability

    PubMed Central

    Marshall, Esaie; Rain-Taljaard, Reathe; Tsepe, Motlalepule; Monkwe, Cornelius; Hlatswayo, Florence; Tshabalala, Simphiwe; Khela, Simphiwe; Xulu, Lindo; Xaba, Dumazile; Molomo, Tebogo; Malinga, Thobile; Puren, Adrian; Auvert, Bertran

    2016-01-01

    Background WHO recommends a male circumcision (MC) prevalence rate higher than 80% to have a substantial impact on the HIV-AIDS epidemic in Eastern and Southern Africa. Orange Farm, a township in South Africa, has a free-for-service voluntary medical male circumcision (VMMC) clinic in operation since 2008. Following an intense campaign from 2008 to 2010, MC prevalence rate increased to 55.4% (ANRS-12126). Ongoing and past VMMC campaigns focused on youths, through school talks, and adults at a community level. The main objective of the study was to assess the change in MC prevalence rate among adults aged 18–19 and 18–49 years in the past 5 years. Methods A cross-sectional survey (ANRS-12285) was conducted among a random sample of 522 adult men in 2015. MC status and characteristics of participants were collected through a genital examination and a face-to-face questionnaire. Results MC prevalence rate among young adult men aged 18–19 years increased markedly from 61.2% (95%CI: 57.4% to 65.0%) in 2010 to 87.5% (76.0% to 94.6%) in 2015 (p<0.001). In the same period, among men aged 18–49 years, MC prevalence rate varied slightly from 55.4% (53.6% to 57.1%) to 56.7% (52.4% to 60.9%). In 2015, 84.9% (79.2% to 89.5%) of uncircumcised adult men reported that they were willing to be circumcised. However, we estimated that only 4.6% (11/237; 2.5% to 7.9%) of the uncircumcised men underwent circumcision in 2015, despite 117/185 (63.2%; 95%CI: 56.1% to 69.9%) who reported that they were definitely willing to become circumcised. Conclusions In Orange Farm, VMMC campaigns were successful among the youth and led to a sufficiently high MC prevalence rate to have a substantial impact in the future on the HIV-AIDS epidemic. However, despite high acceptability and a free VMMC service, VMMC campaigns since 2010 have failed to increase MC prevalence rate among adults to above 80%. These campaigns should be revisited. PMID:27427957

  7. Evaluating Opportunities for Achieving Cost Efficiencies Through the Introduction of PrePex Device Male Circumcision in Adult VMMC Programs in Zambia and Zimbabwe

    PubMed Central

    Chintu, Naminga; Yano, Nanako; Mugurungi, Owen; Tambatamba, Bushimbwa; Ncube, Gertrude; Xaba, Sinokuthemba; Mpasela, Felton; Muguza, Edward; Mangono, Tichakunda; Madidi, Ngonidzashe; Samona, Alick; Tagar, Elva; Hatzold, Karin

    2016-01-01

    Background: Results from recent costing studies have put into question potential Voluntary Medical Male Circumcision (VMMC) cost savings with the introduction of the PrePex device. Methods: We evaluated the cost drivers and the overall unit cost of VMMC for a variety of service delivery models providing either surgical VMMC or both PrePex and surgery using current program data in Zimbabwe and Zambia. In Zimbabwe, 3 hypothetical PrePex only models were also included. For all models, clients aged 18 years and older were assumed to be medically eligible for PrePex and uptake was based on current program data from sites providing both methods. Direct costs included costs for consumables, including surgical VMMC kits for the forceps-guided method, device (US $12), human resources, demand creation, supply chain, waste management, training, and transport. Results: Results for both countries suggest limited potential for PrePex to generate cost savings when adding the device to current surgical service delivery models. However, results for the hypothetical rural Integrated PrePex model in Zimbabwe suggest the potential for material unit cost savings (US $35 per VMMC vs. US $65–69 for existing surgical models). Conclusions: This analysis illustrates that models designed to leverage PrePex's advantages, namely the potential for integrating services in rural clinics and less stringent infrastructure requirements, may present opportunities for improved cost efficiency and service integration. Countries seeking to scale up VMMC in rural settings might consider integrating PrePex only MC services at the primary health care level to reduce costs while also increasing VMMC access and coverage. PMID:27331598

  8. Rapid Training and Implementation of the Pollock Technique, a Safe, Effective Newborn Circumcision Procedure, in a Low-Resource Setting.

    PubMed

    Kojima, Noah; Bristow, Claire C; Pollock, Neil; Crouse, Pierre; Theodore, Harry; Bonhomme, Jerry; Gaston, Claire F Stéphanie; Dévieux, Jessy G; Pape, Jean William; Klausner, Jeffrey D

    2015-01-01

    Male circumcision is highly protective against urinary tract infections, inflammatory conditions of the penis, sexually transmitted infections, and urogenital cancers. We aimed to reintroduce newborn male circumcision through the creation of a training program in Port-au-Prince, Haiti-an area with a considerable burden of preventable urogenital infections, sexually transmitted infections, and low circumcision rate-after an earlier study reported that a majority of Haitian medical providers were in need of and wanted newborn circumcision training. The program was conducted at the GHESKIO Health Centers, a large, non-governmental clinic offering comprehensive pediatric and adult health services. Two Haitian obstetricians and seven nurses learned circumcision procedures. On training completion, one of two obstetricians achieved surgical competence. Introduction of a newborn male circumcision training program was feasible, achieving an acceptable rate of procedural competency and high-quality services. Permanent resources now exist in Haiti to train additional providers to perform newborn male circumcisions. PMID:27335959

  9. Rapid Training and Implementation of the Pollock Technique, a Safe, Effective Newborn Circumcision Procedure, in a Low-Resource Setting

    PubMed Central

    Bristow, Claire C.; Pollock, Neil; Crouse, Pierre; Theodore, Harry; Bonhomme, Jerry; Gaston, Claire F. Stéphanie; Dévieux, Jessy G.; Pape, Jean William; Klausner, Jeffrey D.

    2015-01-01

    Male circumcision is highly protective against urinary tract infections, inflammatory conditions of the penis, sexually transmitted infections, and urogenital cancers. We aimed to reintroduce newborn male circumcision through the creation of a training program in Port-au-Prince, Haiti—an area with a considerable burden of preventable urogenital infections, sexually transmitted infections, and low circumcision rate—after an earlier study reported that a majority of Haitian medical providers were in need of and wanted newborn circumcision training. The program was conducted at the GHESKIO Health Centers, a large, non-governmental clinic offering comprehensive pediatric and adult health services. Two Haitian obstetricians and seven nurses learned circumcision procedures. On training completion, one of two obstetricians achieved surgical competence. Introduction of a newborn male circumcision training program was feasible, achieving an acceptable rate of procedural competency and high-quality services. Permanent resources now exist in Haiti to train additional providers to perform newborn male circumcisions. PMID:27335959

  10. [The effect of circumcision on the mental health of children: a review].

    PubMed

    Yavuz, Mesut; Demir, Türkay; Doğangün, Burak

    2012-01-01

    Circumcision is one of the oldest and most frequently performed surgical procedures in the world. It is thought that the beginning of the male circumcision dates back to the earliest times of history. Approximately 13.3 million boys and 2 million girls undergo circumcision each year. In western societies, circumcision is usually performed in infancy while in other parts of the world, it is performed at different developmental stages. Each year in Turkey, especially during the summer months, thousands of children undergo circumcision. The motivations for circumcision include medical-therapeutic, preventive-hygienic and cultural reasons. Numerous publications have suggested that circumcision has serious traumatic effects on children's mental health. Studies conducted in Turkey draw attention to the positive meanings attributed to the circumcision in the community and emphasize that social effects limit the negative effects of circumcision. Although there are many publications in foreign literature about the mental effects of the circumcision on children's mental health, there are only a few studies in Turkey about the mental effects of the one of the most frequently performed surgical procedures in our country. The aim of this study is to review this issue. The articles related to circumcision were searched by keywords in Pubmed, Medline, EBSCHOHost, PsycINFO, Turkish Medline, Cukurova Index Database and in Google Scholar and those appropriate for this review were used by authors. PMID:22374633

  11. Delivering PrePex Medical Male Circumcision Services Through a Mobile Clinic: The Experience From a Pilot Project in North West Province, South Africa.

    PubMed

    Kufa, Tendesayi; Chetty-Makkan, Candice; Maraisane, Mpho; Charalambous, Salome; Chihota, Violet; Toledo, Carlos

    2016-06-01

    We describe the implementation of a pilot project to demonstrate the safety and feasibility of providing PrePex circumcision from a mobile clinic. We analyzed available project diary entries and staff meeting minutes to identify challenges encountered. The main challenges identified were (1) daily time constraints because of setting up procedures, (2) transportation logistics for clients when the mobile clinic had moved to a different location, (3) integration and coordination of staff responsibilities, and (4) recruitment for PrePex services in the mobile clinic. The provision of PrePex device circumcision through a mobile clinic was feasible but careful planning and review of operational procedures were needed to resolve the implementation challenges. PMID:27331594

  12. Using the economics of certification to improve the safety and quality of male circumcision in developing countries: three models of implementation.

    PubMed

    Richards, Michael R

    2012-03-01

    Although male circumcision (MC) has been a widespread practice in some regions, while relatively new in others, it has recently ascended in popularity as a HIV-reduction intervention, particularly in areas with high rates of HIV but low rates of MC. However, the uptake and potential effectiveness of MC may be hampered by uneven levels of provider training and procedure skill within developing country settings. Indeed, this procedure that is otherwise considered simple and safe has witnessed complication rates as high as 25-35% in some areas, leaving some men with irreversible injuries. To improve the transparency of procedure quality for prospective patients, I borrow from a classic economics approach and advocate a new application in the form of provider certification. Building on some experience in the healthcare systems and economic rationale of high-income counties, I explore the potential for certifying providers of MC in low-income countries and compare and contrast three models of implementation: government agency, private certifiers and private MC device manufacturers. The hope is that increased transparency of provider quality through any or all three types of certifying programmes can better assist local men as they navigate this otherwise complex and unclear medical care market. As more resources are being devoted to MC scale up, I argue that certification should be considered for incorporation as a means of complementing both current and future efforts in order to enhance the effectiveness of MC campaigns. The two models based on privatized certification, as opposed to having the local government underwrite the intervention, may prove most useful when public or philanthropic funding is volatile or incomplete for a given location. The timing for MC campaign adoption and desired speed of scale up may vary across countries in ways that international assistance efforts cannot always immediately and flexibly adapt to. As such, the role of the diverse MC

  13. Using the economics of certification to improve the safety and quality of male circumcision in developing countries: three models of implementation.

    PubMed

    Richards, Michael R

    2012-03-01

    Although male circumcision (MC) has been a widespread practice in some regions, while relatively new in others, it has recently ascended in popularity as a HIV-reduction intervention, particularly in areas with high rates of HIV but low rates of MC. However, the uptake and potential effectiveness of MC may be hampered by uneven levels of provider training and procedure skill within developing country settings. Indeed, this procedure that is otherwise considered simple and safe has witnessed complication rates as high as 25-35% in some areas, leaving some men with irreversible injuries. To improve the transparency of procedure quality for prospective patients, I borrow from a classic economics approach and advocate a new application in the form of provider certification. Building on some experience in the healthcare systems and economic rationale of high-income counties, I explore the potential for certifying providers of MC in low-income countries and compare and contrast three models of implementation: government agency, private certifiers and private MC device manufacturers. The hope is that increased transparency of provider quality through any or all three types of certifying programmes can better assist local men as they navigate this otherwise complex and unclear medical care market. As more resources are being devoted to MC scale up, I argue that certification should be considered for incorporation as a means of complementing both current and future efforts in order to enhance the effectiveness of MC campaigns. The two models based on privatized certification, as opposed to having the local government underwrite the intervention, may prove most useful when public or philanthropic funding is volatile or incomplete for a given location. The timing for MC campaign adoption and desired speed of scale up may vary across countries in ways that international assistance efforts cannot always immediately and flexibly adapt to. As such, the role of the diverse MC

  14. “What do You Mean I’ve Got to Wait for Six Weeks?!” Understanding the Sexual Behaviour of Men and Their Female Partners after Voluntary Medical Male Circumcision in the Western Cape

    PubMed Central

    Toefy, Yoesrie; Skinner, Donald; Thomsen, Sarah C.

    2015-01-01

    Background Several studies have shown that voluntary male medical circumcision (VMMC) reduces the incidence of the Type-1 human immunodeficiency virus (HIV) in heterosexual men by up to 60%. However, there is an increased risk of transmission of STIs, including HIV, in the immediate post-operative period after receiving VMMC. This study is to understand sexual practices of couples in the post-operative period in a Coloured population in the Western Cape Province of South Africa. Methods Coloured Males who had undergone VMMC in the previous six months in the Cape Town area and their partners participated in eight single-gender focus group discussions. The groups explored why the men decided to undergo VMMC, what kind of counselling they received, and how they experienced the 6-week post-operative period, including sexually. Results The primary motivation to VMMC uptake included religious injunction and hygiene reasons and protection against sexually transmitted infections not necessarily HIV. There was some exploration of alternative sexual practices. During the period immediately post operation the respondents spoke of pain and fear of any sexual arousal, but towards the end of the six week period, sexual desire returned. Both men and women felt that sex was important to maintain the relationship. Gaps were identified in the pre- and post-MC procedure counselling. Conclusions There is a real risk that men in this population may begin sex before complete healing has occurred. VMMC counselling to encourage men to stay sexually safe in the wound-healing period, needs to take into account the real-life factors of the circumcised men. It is essential from a public health, and gender perspective that effective counselling strategies for the VMMC post-operative period, and the longer term, are developed and tested. PMID:26176946

  15. Circumcision and 'uncircumcision'.

    PubMed

    Schneider, T

    1976-03-27

    The origin of circumcision is shrouded in antiquity. Mummies, 6 000 years old, have been reported to show evidence of circumcision but the first definite account appears in Genesis, chapter 17. Many nations practise it as a rite, the time of its performance varying from soon after birth to early manhood. Antiochus Epiphanes prohibited it in Palestine and the introduction of Greek gymnasia where nudity was the practice, led to many seeking to become uncircumcised. Celsus has described such an operation which appears to have been successful. In Rome under Hadrian and in 16th century Spain a heavy funnel-shaped copper tube fitting was used as another method of restoring the prepuce. The debate concerning the value of circumcision has continued up until the present day. PMID:775659

  16. High Flow Priapism in a Pediatric Patient after Circumcision with Dorsal Penile Nerve Block.

    PubMed

    Granieri, Michael A; Fantony, Joseph J; Routh, Jonathan C

    2016-01-01

    We report the first documented case of high flow priapism after circumcision with dorsal penile nerve block. A 7-year-old male who had undergone circumcision three years before presented to our institution with a 3-year history of persistent nonpainful erections. Workup revealed a high flow priapism and, after discussion of the management options, the patient's family elected continued observation. PMID:27648333

  17. High Flow Priapism in a Pediatric Patient after Circumcision with Dorsal Penile Nerve Block

    PubMed Central

    Fantony, Joseph J.; Routh, Jonathan C.

    2016-01-01

    We report the first documented case of high flow priapism after circumcision with dorsal penile nerve block. A 7-year-old male who had undergone circumcision three years before presented to our institution with a 3-year history of persistent nonpainful erections. Workup revealed a high flow priapism and, after discussion of the management options, the patient's family elected continued observation. PMID:27648333

  18. High Flow Priapism in a Pediatric Patient after Circumcision with Dorsal Penile Nerve Block

    PubMed Central

    Fantony, Joseph J.; Routh, Jonathan C.

    2016-01-01

    We report the first documented case of high flow priapism after circumcision with dorsal penile nerve block. A 7-year-old male who had undergone circumcision three years before presented to our institution with a 3-year history of persistent nonpainful erections. Workup revealed a high flow priapism and, after discussion of the management options, the patient's family elected continued observation.

  19. Female circumcision and child mortality in urban Somalia.

    PubMed

    Mohamud, O A

    1991-01-01

    In Somalia, a demographer analyzed urban data obtained from the Family Health Survey to examine the effect female circumcision has on child mortality and the mechanism of that effect. Girls undergo female circumcision between 5-12 years old in Somalia. Since sunni circumcision (removal of the clitoral prepuce and tip of the clitoris) and clitoridectomy (removal of the entire clitoris) did not affect child mortality, he used them as the reference group. Infibulation (entire removal of the clitoris and of the labia minora and majora with the remains of the labia majora being sewn together allowing only a small opening for passage of urine) did affect child mortality. Female children who underwent infibulation and whose mothers most likely also underwent infibulation experienced higher mortality (13-72%) than those from other circumcised mothers. Female mortality exceeded male mortality indicating possible son preference. Mothers with clitoridectomy or infibulation had significantly higher infant mortality than those with sunni circumcision with the strongest effects during the neonatal period (95% and 42% higher mortality, respectively; p=.01). The effect of female circumcision on child mortality decreased with increased child's age. This higher than expected mortality among women with clitoridectomy may have been because women with infibulation had more stillbirths which were not counted as births. The exposed vagina of clitoridectomized women is more likely to be infected resulting in high risk of stillbirths and premature births than the closed vagina of infibulated women. The researcher suggested that the policies promoting education and consciousness raising may eventually eradicate female circumcision. This longterm campaign should use mass media, senior women of high status, and respected religious leaders. Legislation prohibiting this practice would only drive it underground under unsanitary conditions. Demographers should no longer ignore female circumcision

  20. Cultural circumcision in EU public hospitals--an ethical discussion.

    PubMed

    Brusa, Margherita; Barilan, Y Michael

    2009-10-01

    The paper explores the ethical aspects of introducing cultural circumcision of children into the EU public health system. We reject commonplace arguments against circumcision: considerations of good medical practice, justice, bodily integrity, autonomy and the analogy from female genital mutilation. From the unique structure of patient-medicine interaction, we argue that the incorporation of cultural circumcision into EU public health services is a kind of medicalization, which does not fit the ethos of universal healthcare. However, we support a utilitarian argument that finds hospital based circumcision safer than non-medicalized alternatives. The argument concerning medicalization and the utilitarian argument both rely on preliminary empirical data, which depend on future validation PMID:19076127

  1. The Cost of Medicaid Savings: The Potential Detrimental Public Health Impact of Neonatal Circumcision Defunding

    PubMed Central

    Andrews, Annie L.; Lazenby, Gweneth B.; Unal, Elizabeth Ramsey; Simpson, Kit N.

    2012-01-01

    Objective. To project the increased incidence of HIV and subsequent costs resulting from the expected decreased rate of circumcision due to Medicaid defunding in one southeastern state. Methods. Using 2009 South Carolina (SC) Medicaid birth cohort (n = 29, 316), we calculated expected heterosexually acquired HIV cases at current circumcision rates. To calculate age/race/gender specific HIV incidence rates, we used 2009 South Carolina Department of Health and Environmental Control reported gender and race specific HIV cases, CDC reported age distribution of HIV cases, and 2009 S.C. population data. Accounting for current circumcision rates, we calculated the change in incidence of heterosexually acquired HIV assuming circumcision provides 60% protection against HIV transmission to males and 46% protection against male to female transmission. Published lifetime cost of HIV was used to calculate the cost of additional HIV cases. Results. Assuming Medicaid circumcision rates decrease from current nationally reported levels to zero secondary to defunding, we project an additional 55 male cases of HIV and 47 female cases of HIV among this birth cohort. The total cost discounted to time of infection of these additional HIV cases is $20,924,400 for male cases and $17,711,400 for female cases. The cost to circumcise males in this birth cohort at currently reported rates is $4,856,000. Conclusions. For every year of decreased circumcision rates due to Medicaid defunding, we project over 100 additional HIV cases and $30,000,000 in net medical costs. PMID:23125519

  2. The culture of female circumcision.

    PubMed

    Morris, R

    1996-12-01

    The issue of female circumcision takes on special significance as more women migrate to the United States from countries where the practice has religious and traditional underpinnings. Female circumcision is a problem unfamiliar to most Western health care practitioners. This article describes an ethnographic study of the types of female circumcision, the reasons for and against the practice, the health implications of this practice, and cultural attitudes of circumcised women both in Western Africa and as migrant refugees living in the United States. Ethical dilemmas in dealing with this practice and implications for nurses and health care providers are discussed.

  3. Impact of Health Insurance Type on Trends in Newborn Circumcision, United States, 2000 to 2010

    PubMed Central

    Cox, Shanna; Whiteman, Maura; Jamieson, Denise J.; Macaluso, Maurizio; Bansil, Pooja; Kuklina, Elena; Kourtis, Athena P.; Posner, Samuel; Barfield, Wanda D.

    2015-01-01

    Objectives. We explored how changes in insurance coverage contributed to recent nationwide decreases in newborn circumcision. Methods. Hospital discharge data from the 2000–2010 Nationwide Inpatient Sample were analyzed to assess trends in circumcision incidence among male newborn birth hospitalizations covered by private insurance or Medicaid. We examined the impact of insurance coverage on circumcision incidence. Results. Overall, circumcision incidence decreased significantly from 61.3% in 2000 to 56.9% in 2010 in unadjusted analyses (P for trend = .008), but not in analyses adjusted for insurance status (P for trend = .46) and other predictors (P for trend = .55). Significant decreases were observed only in the South, where adjusted analyses revealed decreases in circumcision overall (P for trend = .007) and among hospitalizations with Medicaid (P for trend = .005) but not those with private insurance (P for trend = .13). Newborn male birth hospitalizations covered by Medicaid increased from 36.0% (2000) to 50.1% (2010; P for trend < .001), suggesting 390 000 additional circumcisions might have occurred nationwide had insurance coverage remained constant. Conclusions. Shifts in insurance coverage, particularly toward Medicaid, likely contributed to decreases in newborn circumcision nationwide and in the South. Barriers to the availability of circumcision should be revisited, particularly for families who desire but have less financial access to the procedure. PMID:26180994

  4. Circumcision for the prevention of significant bacteriuria in boys.

    PubMed

    Nayir, A

    2001-12-01

    The aim of this study was to determine whether circumcision affects significant bacteriuria in boys. During a 60-month prospective study, 100 boys with microbiologically confirmed symptomatic urinary tract infection (UTI) were evaluated. Twelve patients with abnormal ultrasonography findings were excluded from the study. Eighteen of the boys had not been circumcised due to parental choice. The remaining 70 boys with normal renal ultrasonography were randomly allocated into two groups. In the first group 35 boys ranging in age from 6 months to 10 years (mean 33.2+/-30.9 months) were observed for 6 months and urinary cultures were taken monthly. When they had a positive urine culture (with or without any symptoms), they received antibiotic treatment. After 6 months they were circumcised and then observed for another 6-month period. Group 2 comprised 35 boys aged from 3 months to 9 years (mean 29.1+/-36.7 months). They were circumcised immediately after the first UTI and were followed for 6 months. Urine samples were obtained by the bag technique in infants and by the mid-stream technique in older patients. In the uncircumcised group, the rate of significant bacteriuria per patient did not change in two 6-month follow-up periods (3.46+/-0.91 and 3.33+/-0.97 episodes). In group 1, the rate of positive urine cultures dropped from 3.57+/-1.11 to 0.14+/-0.35 episodes after circumcision (P<0.001). In the second group, the rate of significant bacteriuria was 0.17+/-0.38 episodes after circumcision. Among the uncircumcised patients, symptomatic UTI was observed in 6 cases (3 cases in the first period of group 1, 1 case in the first and 2 cases in the second period of the uncircumcised group), whereas after circumcision no patient had symptomatic UTI. The mean age at circumcision was 42.7+/-28.4 months. No complication due to circumcision occurred in any patient. UTI may also occur in boys after the 1st year of life. The present study indicated that circumcision in boys

  5. The International Student: Female Circumcision Issues.

    ERIC Educational Resources Information Center

    Bengston, Barbara; Baldwin, Cynthia

    1993-01-01

    Describes the process and practice of female circumcision, the impact it may have on circumcised female international college students, and some counseling strategies for the college counselor who works with this population. Explains variety of reasons for performing female circumcision, different types of female circumcisions, and psychological…

  6. Student Teachers' Perception on Integration of Traditional Circumcision Education into the School Curriculum

    ERIC Educational Resources Information Center

    Seloana, S. M.

    2011-01-01

    The purpose of this article is to report on the research findings of the views of student-teachers on the integration of some aspects of a traditional circumcision curriculum into higher education. The main question is: Could a traditional circumcision curriculum be integrated into the higher education curriculum? Seventy five participants were…

  7. Circumcision: is the risk of urinary tract infection really the pivotal issue?

    PubMed

    Chessare, J B

    1992-02-01

    Recent information regarding the increased risk of urinary tract infections in the first year of life for uncircumcised boys has created confusion regarding the appropriate guidance to be given to parents confronting the circumcision issue. A decision model was built that addressed the question of whether or not to circumcise a newborn male considering the probability of a non-circumcised boy having a UTI in the first year of life (0.041), the probability of a circumcised boy having a UTI in the first year of life (0.002), and the likelihood of renal scarring from a UTI (0.075). After considering the morbidity associated with the procedure, all possible outcomes were ranked from worst to best (circumcised-renal pathology to uncircumcised-no infection) and given a value on a 0 to 1 scale. For the set of values assigned to the outcomes, the choice of no circumcision yielded the highest expected utility. For the set of assigned utilities, sensitivity analysis showed that unless the probability of a UTI in the first year of life for an uncircumcised male was greater than or equal to 0.29, then non-circumcision was still the preferred choice. The decision was most sensitive to the degree of aversion to the morbidity associated with the procedure (pain, bleeding, inflammation).

  8. A 'snip' in time: what is the best age to circumcise?

    PubMed Central

    2012-01-01

    Background Circumcision is a common procedure, but regional and societal attitudes differ on whether there is a need for a male to be circumcised and, if so, at what age. This is an important issue for many parents, but also pediatricians, other doctors, policy makers, public health authorities, medical bodies, and males themselves. Discussion We show here that infancy is an optimal time for clinical circumcision because an infant's low mobility facilitates the use of local anesthesia, sutures are not required, healing is quick, cosmetic outcome is usually excellent, costs are minimal, and complications are uncommon. The benefits of infant circumcision include prevention of urinary tract infections (a cause of renal scarring), reduction in risk of inflammatory foreskin conditions such as balanoposthitis, foreskin injuries, phimosis and paraphimosis. When the boy later becomes sexually active he has substantial protection against risk of HIV and other viral sexually transmitted infections such as genital herpes and oncogenic human papillomavirus, as well as penile cancer. The risk of cervical cancer in his female partner(s) is also reduced. Circumcision in adolescence or adulthood may evoke a fear of pain, penile damage or reduced sexual pleasure, even though unfounded. Time off work or school will be needed, cost is much greater, as are risks of complications, healing is slower, and stitches or tissue glue must be used. Summary Infant circumcision is safe, simple, convenient and cost-effective. The available evidence strongly supports infancy as the optimal time for circumcision. PMID:22373281

  9. Circumcision Is Unethical and Unlawful.

    PubMed

    Svoboda, J Steven; Adler, Peter W; Van Howe, Robert S

    2016-06-01

    The foreskin is a complex structure that protects and moisturizes the head of the penis, and, being the most densely innervated and sensitive portion of the penis, is essential to providing the complete sexual response. Circumcision-the removal of this structure-is non-therapeutic, painful, irreversible surgery that also risks serious physical injury, psychological sequelae, and death. Men rarely volunteer for it, and increasingly circumcised men are expressing their resentment about it.Circumcision is usually performed for religious, cultural and personal reasons. Early claims about its medical benefits have been proven false. The American Academy of Pediatrics and the Centers for Disease Prevention and Control have made many scientifically untenable claims promoting circumcision that run counter to the consensus of Western medical organizations.Circumcision violates the cardinal principles of medical ethics, to respect autonomy (self-determination), to do good, to do no harm, and to be just. Without a clear medical indication, circumcision must be deferred until the child can provide his own fully informed consent.In 2012, a German court held that circumcision constitutes criminal assault. Under existing United States law and international human rights declarations as well, circumcision already violates boys› absolute rights to equal protection, bodily integrity, autonomy, and freedom to choose their own religion. A physician has a legal duty to protect children from unnecessary interventions. Physicians who obtain parental permission through spurious claims or omissions, or rely on the American Academy of Pediatrics' position, also risk liability for misleading parents about circumcision. PMID:27338602

  10. A Phase II Randomized Controlled Trial Comparing Safety, Procedure Time, and Cost of the PrePex™ Device to Forceps Guided Surgical Circumcision in Zimbabwe

    PubMed Central

    Tshimanga, Mufuta; Mangwiro, Tonderayi; Mugurungi, Owen; Xaba, Sinokuthemba; Murwira, Munyaradzi; Kasprzyk, Danuta; Montaño, Daniel E.; Nyamukapa, Daisy; Tambashe, Basile; Chatikobo, Pesanai; Gundidza, Patricia; Gwinji, Gerald

    2016-01-01

    Background The World Health Organization (WHO) and the Joint United Nations Program on HIV/AIDS promote MC (male circumcision) as a key HIV prevention strategy where HIV prevalence and incidence are high and MC prevalence is low. In Zimbabwe, to achieve the 1.26 million circumcisions needed to be performed by 2015 to achieve optimal MC coverage, a new approach was needed. The primary objective of the current trial was to assess the performance (safety, procedure time, and cost) of the PrePex device compared to forceps-guided surgical circumcision. Methods and Findings This Phase II, randomized, open-label trial in Zimbabwe involved healthy, non-circumcised adult male volunteers who were randomly assigned to the PrePex device (n = 160) or surgical arm (n = 80). Three doctors and 4 nurses, all certified on both circumcision methods, performed the procedures. The PrePex device procedure involves a plastic ring with a rubber O-ring that necrotizes the foreskin to facilitate easy and minimally invasive removal. Total procedure time was the primary endpoint. Adverse event (AE) data were also gathered for 90 days post-procedure. All 80 participants in the surgical arm and 158 participants in the PrePex arm achieved complete circumcision. The total procedure time for the PrePex device was approximately one-third of the total surgical procedure (4.8 minutes, Standard Deviation [SD]: 1.2 versus 14.6 minutes; SD: 4.2; p<0.00001). There were 2 AEs for 2 participants (rate of 1.3%, 95% Confidence Interval: 0.0025–4.53%), which were resolved with simple intervention. The AEs were device related, including 1 case of pain leading to device removal and 1 case of removal of the device. Conclusions The trial supports previous studies’ conclusions that the PrePex procedure is safe, quick, easy to apply, and effective in terms of procedure time as an alternative to traditional surgical circumcision. The PrePex device has great potential for use in overburdened health systems and in

  11. Sexual Risk Behaviours and Willingness to Be Circumcised among Uncircumcised Adult Men in Uganda

    PubMed Central

    Kibira, Simon P. S.; Makumbi, Fredrick; Daniel, Marguerite; Atuyambe, Lynn Muhimbuura; Sandøy, Ingvild Fossgard

    2015-01-01

    Background There has been substantial demand for safe male circumcision (SMC) in Uganda in the early programme scale-up phase. Research indicates that early adopters of new interventions often differ from later adopters in relation to a range of behaviours. However, there is limited knowledge about the risk profile of men who were willing to be circumcised at the time of launching the SMC programme, i.e., potential early adopters, compared to those who were reluctant. The aim of this study was to address this gap to provide indications on whether it is likely that potential early adopters of male circumcision were more in need of this new prevention measure than others. Methods Data were from the 2011 Uganda AIDS Indictor Survey (UAIS), with a nationally representative sample of men 15 to 59 years. The analysis was based on generalized linear models, obtaining prevalence risk ratios (PRR) with 95% confidence intervals (CI) as measures of association between willingness to be circumcised and multiple sexual partners, transactional sex, non-marital sex and non-use of condoms at last non-marital sex. Results Of the 5,776 men in the survey, 44% expressed willingness to be circumcised. Willingness to be circumcised was higher among the younger, urban and educated men. In the unadjusted analyses, all the sexual risk behaviours were associated with willingness to be circumcised, while in the adjusted analysis, non-marital sex (Adj PRR 1.27; CI: 1.16–1.40) and non-use of condoms at last such sex (Adj PRR 1.18; CI: 1.07–1.29) were associated with higher willingness to be circumcised. Conclusion Willingness to be circumcised was relatively high at the launch of the SMC programme and was more common among uncircumcised men reporting sexual risk behaviours. This indicates that the early adopters of SMC were likely to be in particular need of such additional HIV protective measures. PMID:26658740

  12. Circumcision: what should be done?

    PubMed

    Ben-Yami, Hanoch

    2013-07-01

    I explain why I think that considerations regarding the opposing rights involved in the practice of circumcision-rights of the individual to bodily integrity and rights of the community to practice its religion-would not help us decide on the desirable policy towards this controversial practice. I then suggest a few measures that are not in conflict with either religious or community rights but that can both reduce the harm that circumcision as currently practiced involves and bring about a change in attitude towards the practice, thus further reducing its frequency. These measures are the compulsory administration of anaesthetics; the banning of the metzitzah b'peh; and having an upper age limit of a few months on non-therapeutic circumcision of minors. I conclude with general considerations on why the steps taken towards the reform of circumcision should be moderate.

  13. What's wrong with female circumcision?

    PubMed

    Nelson, D

    1994-03-16

    Why should the multicultural society of Canada outlaw female genital mutilation (FGM) as proposed by federal Justice Minister Allan Rock or allow avoidance of the procedure to be a legitimate reason for gaining refugee status? Is this anti-FGM position simply an ethnocentric stance that would be called racism in other circumstances? Canadian objections to FGM can not arise from objections about mutilation of a child's sexual organs because male circumcision is legal in Canada, although it, too, is medically questionable. Perhaps Rock is being patriarchal in reserving his concern for females. In Somali culture, women determine the nature and extent of FGM, so Rock may simply be exhibiting his inability to understand other cultures. On the other hand, it is politically incorrect for Canadian government workers to criticize other cultures, and immigrants are assured that their values and beliefs will be accommodated in Canada. Thus, polygamy among Somali immigrants is ignored. The question is why should FGM be a major exception and invoke efforts at repression instead of a respect for diversity.

  14. Correlates of consistent condom use among recently initiated and traditionally circumcised men in the rural areas of the Eastern Cape Province, South Africa

    PubMed Central

    2014-01-01

    Background Consistent use of condoms is the most effective method of preventing STIs including HIV. However, recent evidence suggests that limited knowledge about HIV prevention benefits from male circumcision leads to inconsistent condom use among traditionally circumcised men. The aim of this paper is to report on the prevalence of consistent condom use and identify its psychosocial correlates to inform future HIV prevention strategies among traditionally circumcised men in rural areas of the Eastern Cape Province of South Africa. Methods A cross-sectional study using interviewer administered fully structured questionnaires was conducted among 1656 men who had undergone initiation and traditional male circumcision in rural areas of the Eastern Cape Province of South Africa. Logistic regression was used to evaluate univariate and multivariate relationships of psychosocial correlates with consistent condom use. Results The mean age of the participants was 21.4 years. About 45% belonged to the amaXhosa ethnic group, followed by 15.1% of the amaMpondo, 11.6% of the amaHlubi, and 27.9% from other ethnic groups. A total of 72.3% reported having a main sexual partner and of those 44.8% indicated having other sexual partners as well. About 49% reported consistent condom use and 80% used free government issued condoms, varies among ethnic groups. A total of 35.1% indicated having tested for HIV. Of those who tested for HIV, 46% reported inconsistent condom use when having sex with their sexual partners. Univariate and multivariate analyses showed a positive association between consistent condom use and the general knowledge of condom use, attitude towards condom use with main and casual sexual partners, subjective norm towards condom use with the main sexual partner, perceived self-efficacy towards condom use, positive self-esteem, beliefs about traditional male circumcision and STI protection, attitude towards gender based violence, and cultural alienation. Conclusions

  15. The ultrasonic harmonic scalpel for circumcision: experimental evaluation using dogs.

    PubMed

    Peng, Mou; Meng, Zhe; Yang, Zhong-Hua; Wang, Xing-Huan

    2013-01-01

    Male circumcision is one of the most commonly performed operations worldwide, and many novel techniques have been developed for better postoperative outcomes. The purpose of this study was to explore the feasibility of applying the ultracision harmonic scalpel (UHS) for circumcision by using dogs. Sixteen adult male dogs were divided into two groups: the UHS group and the control group. The dogs were circumcised with either the UHS or a conventional scalpel. The UHS circumcision procedure and the effects were imaged 1 week after surgery. The two groups were compared with respect to the operative time and volume of blood loss. Postoperative complications, including oedema, infection, bleeding of the incision and wound dehiscence, were recorded for both groups. The mean operative time for the UHS group was only 5.1 min compared with the 35.5 min of the conventional group. The mean blood loss was less than 2 ml for the UHS group and 15 ml for the conventional group. There was only one case of mild oedema in the UHS group, but the postoperative complications in the conventional group included two cases of mild oedema, one infection of the incision and one case of bleeding of the incision. In conclusion, circumcision using UHS is a novel technique to treat patients with phimosis and excessive foreskin, and this method has a short operative time, less blood loss and fewer complications than the conventional scalpel method. This small animal study provides a basis for embarking on a larger-scale clinical trial of the UHS. PMID:23042449

  16. Voluntary Medical Male Circumcision Programs Can Address Low HIV Testing and Counseling Usage and ART Enrollment among Young Men: Lessons from Lesotho

    PubMed Central

    Kikaya, Virgile; Skolnik, Laura; García, Macarena C.; Nkonyana, John; Curran, Kelly; Ashengo, Tigistu Adamu

    2014-01-01

    Background Early diagnosis of HIV and treatment initiation at higher CD4 counts improves outcomes and reduces transmission. However, Lesotho is not realizing the full benefits of ART because of the low proportion of men tested (40%). Public sector VMMC services, which were launched in district hospitals in February 2012 by the Lesotho MOH supported by USAID/MCHIP, include HIV testing with referral to care and treatment. The objective of this study was to better understand the contribution of VMMC services to HIV diagnosis and treatment. Methods VMMC clients diagnosed with HIV were traced after 6 months to ascertain whether they: (1) presented to the referral HIV center, (2) had a CD4 count done and (3) were enrolled on ART. Linkages between VMMC and HIV services were assessed by comparing the proportion of HIV-infected males referred from VMMC services with those from other hospital departments. Results Between March and September 2012, 72 men presenting for VMMC services tested positive for HIV, representing 65% of the total male tests at the hospital; 45 of these men (62.5%) received an immediate CD4 count and went to the HIV referral site; 40 (89%) were eligible for treatment and initiated ART. 27 clients did not have a CD4 count due to stock-out of reagents. Individuals who did not receive a CD4 count on the same day did not return to the HIV center. Conclusion All VMMC clients testing positive for HIV and receiving a CD4 count on the testing day began ART. Providing VMMC services in a district hospital offering the continuum of care could increase diagnoses and treatment uptake among men, but requires an investment in communication between VMMC and ART clinics. In high HIV prevalence settings, investing in PIMA CD4 devices at integrated VMMC clinics is likely to increase male ART enrolment. PMID:24801714

  17. Co-infection of human immunodeficiency virus and sexually transmitted infections in circumcised and uncircumcised cases in India

    PubMed Central

    Nayyar, Charu; Chander, Ram; Gupta, Poonam; Sherwal, B. L.

    2014-01-01

    Background: Acquired Immunodeficiency Syndrome (AIDS), is now one of the greatest challenges facing the world. Sexual transmission is the primary route of human immunodeficiency virus infection worldwide. Male circumcision is being considered as strategy to reduce the burden of HIV/AIDS. Material and Methods: The present study was conducted on 200 HIV positive clients. They were screened for bacterial causes of STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum and Gardnerella vaginalis). Results: There were 138 males and 62 females. The males were examined and the circumcision status was observed. In the females, circumcision status of their male partners was observed. The coinfection of HIV and STIs in circumcised and uncircumcised cases was found out. Diagnosis was made using standard tests. A total of 23% cases were diagnosed to have HIV –STI coinfection. Most common diagnosed diseases were Chlamydia (10%), Gonorrhoea (9%), Bacterial Vaginosis (4.8%) and Syphilis (2.5%). The coinfection rate in uncircumcised cases was found to be higher (29.2% in males and 39.2% in females) as compared to the circumcised cases (14.2% in males and 13.6% in females). Conclusion: The present study suggests that circumcision is a protective factor for acquisition of STIs in HIV positive clients but other factors like sexual behaviours, use of barrier contraceptives, drug abuse etc also play a role. PMID:26396445

  18. How do you circumcise a nation? The Rwandan case study.

    PubMed

    Mutabazi, Vincent; Forrest, Jamie I; Ford, Nathan; Mills, Edward J

    2014-01-01

    Voluntary medical male circumcision has been conclusively demonstrated to reduce the lifetime risk of male acquisition of HIV. The strategy has been adopted as a component of a comprehensive strategy towards achieving an AIDS-free generation. A number of countries in which prevalence of HIV is high and circumcision is low have been identified as a priority, where innovative approaches to scale-up are currently being explored. Rwanda, as one of the priority countries, has faced a number of challenges to successful scale-up. We discuss here how simplifications in the procedure, addressing a lack of healthcare infrastructure and mobilizing resources, and engaging communities of both men and women have permitted Rwanda to move forward with more optimism in its scale-up tactics. Examples from Rwanda are used to highlight how these barriers can and should be addressed. PMID:25604003

  19. Voice-Message–Based mHealth Intervention to Reduce Postoperative Penetrative Sex in Recipients of Voluntary Medical Male Circumcision in the Western Cape, South Africa: Protocol of a Randomized Controlled Trial

    PubMed Central

    Skinner, Donald; Toefy, Yoesrie; Esterhuizen, Tonya; McCaul, Michael; Petzold, Max; Diwan, Vinod

    2016-01-01

    Background There is an increased risk of transmission of sexually transmitted infections (STIs), including HIV, in the postoperative period after receiving voluntary medical male circumcision (VMMC). In South Africa, over 4 million men are being targeted with VMMC services but the health system is not able to offer quality counseling. More innovative strategies for communicating with and altering behavior in men and their partners in the postoperative period after VMMC are needed. Objective This paper presents a study protocol to test the effectiveness of an mHealth intervention designed to task-shift behavior change communication from health care personnel to an automated phone message system, encouraging self-care. Methods A single-blind, randomized controlled trial will be used. A total of 1188 participants will be recruited by nurses or clinicians at clinics in the study districts that have a high turnover of VMMC clients. The population will consist of men aged 18 years and older who indicate at the precounseling session that they possess a mobile phone and consent to participating in the study. Consenting participants will be randomized into either the control or intervention arm before undergoing VMMC. The control arm will receive the standard of care (pre- and postcounseling). The intervention arm will received standard of care and will be sent 38 messages over the 6-week recovery period. Patients will be followed up after 42 days. The primary outcome is self-reported sexual intercourse during the recovery period. Secondary outcomes include nonpenetrative sexual activity, STI symptoms, and perceived risk of acquiring HIV. Analysis will be by intention-to-treat. Results Enrollment is completed. Follow-up is ongoing. Loss to follow-up is under 10%. No interim analyses have been conducted. Conclusions The intervention has the potential of reducing risky sexual behavior after VMMC. The platform itself can be used for many other areas of health that require task

  20. Traumatic neuroma of the penis after circumcision--Case report.

    PubMed

    Cardoso, Thaís Abrão; dos Santos, Karen Regina; Franzotti, Aline Martinez; Avelar, Juliana Centofanti Dentello; Tebcherani, Antonio José; Pegas, José Roberto Pereira

    2015-01-01

    Traumatic neuromas are tumors resulting from hyperplasia of axons and nerve sheath cells after section or injury to the nervous tissue. We present a case of this tumor, confirmed by anatomopathological examination, in a male patient with history of circumcision. Knowledge of this entity is very important in achieving the differential diagnosis with other lesions that affect the genital area such as condyloma acuminata, bowenoid papulosis, lichen nitidus, sebaceous gland hyperplasia, achrochordon and pearly penile papules. PMID:26131873

  1. Traumatic neuroma of the penis after circumcision - Case report*

    PubMed Central

    Cardoso, Thaís Abrão; dos Santos, Karen Regina; Franzotti, Aline Martinez; Avelar, Juliana Centofanti Dentello; Tebcherani, Antonio José; Pegas, José Roberto Pereira

    2015-01-01

    Traumatic neuromas are tumors resulting from hyperplasia of axons and nerve sheath cells after section or injury to the nervous tissue1. We present a case of this tumor, confirmed by anatomopathological examination, in a male patient with history of circumcision. Knowledge of this entity is very important in achieving the differential diagnosis with other lesions that affect the genital area such as condyloma acuminata, bowenoid papulosis, lichen nitidus, sebaceous gland hyperplasia, achrochordon and pearly penile papules. PMID:26131873

  2. Circumcision and prostate cancer: a population-based case-control study in Montréal, Canada

    PubMed Central

    Spence, Andrea R; Rousseau, Marie-Claude; Karakiewicz, Pierre I; Parent, Marie-Élise

    2014-01-01

    Objectives To investigate the possible association between circumcision and prostate cancer risk, to examine whether age at circumcision influences prostate cancer risk, and to determine whether race modifies the circumcision–prostate cancer relationship. Subjects and Methods PROtEuS (Prostate Cancer and Environment Study), a population-based case-control study set amongst the mainly French-speaking population in Montréal, Canada, was used to address study objectives. The study included 1590 pathologically confirmed prostate cancer cases diagnosed in a Montréal French hospital between 2005 and 2009, and 1618 population controls ascertained from the French electoral list, frequency-matched to cases by age. In-person interviews elicited information on sociodemographic, lifestyle and environmental factors. Unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) between circumcision, age at circumcision and prostate cancer risk, adjusting for age, ancestry, family history of prostate cancer, prostate cancer screening history, education, and history of sexually transmitted infections. Results Circumcised men had a slightly lower risk, albeit not statistically significant, of developing prostate cancer than uncircumcised men (OR 0.89, 95% CI 0.76–1.04). Circumcision was found to be protective in men circumcised aged ≥36 years (OR 0.55, 95% CI 0.30–0.98). A weaker protective effect was seen among men circumcised within 1 year of birth (OR 0.86, 95% CI 0.72–1.04). The strongest protective effect of circumcision was recorded in Black men (OR 0.40, 95% CI 0.19–0.86, P-value for interaction 0.02) but no association was found with other ancestral groups. Conclusion Our findings provide novel evidence for a protective effect of circumcision against prostate cancer development, especially in those circumcised aged ≥36 years; although circumcision before the age of 1 year may also confer protection. Circumcision

  3. Can circumcision prevent recurrent urinary tract infections in hospitalized infants?

    PubMed

    Cason, D L; Carter, B S; Bhatia, J

    2000-12-01

    Urinary tract infection (UTI) is an uncommon but concerning condition for hospitalized premature infants. A retrospective chart review of all male infants admitted to the neonatal intensive care unit (NICU) from June 1996 through March 1999 was conducted at the Medical College of Georgia--a large academic medical center with a tertiary Level III NICU--to investigate the frequency and potential prevention of recurrent UTI in hospitalized infants. The effect of circumcision on recurrence of UTI was also investigated. There were 38 infants with 53 UTIs among 744 male infants admitted during the study period (5.1%). Infants were divided into two groups: A1 <37 weeks with a single UTI and A2 <37 weeks with more than one UTI. In groups A1 and A2, 57% of the first UTIs were due to Candida or E. coli, the remaining were due to other gram-negative organisms and Staphylococcus species. Mean gestational age (GA) in groups A1 and A2 were similar (29 +/- 2 weeks, and 29 +/- 4 weeks); however, mean GA of infants with Candida UTI was 27 +/- 2 weeks, and for bacterial UTI, 30 +/- 3 weeks (p<0.01). None of the premature infants in the study had a recurrent UTI once a circumcision was performed. Premature uncircumcised males had an increased risk for UTI (Odds Ratio=11.1, 95% CI, 3.3-28.9, p<0.001). Circumcision appears beneficial in reducing the risk for recurrent UTI in these infants.

  4. The effect of male teenage passengers on male teenage drivers: findings from a driving simulator study.

    PubMed

    Ouimet, Marie Claude; Pradhan, Anuj K; Simons-Morton, Bruce G; Divekar, Gautam; Mehranian, Hasmik; Fisher, Donald L

    2013-09-01

    Studies have shown that teenage drivers are less attentive, more frequently exhibit risky driving behavior, and have a higher fatal crash risk in the presence of peers. The effects of direct peer pressure and conversation on young drivers have been examined. Little is known about the impact on driving performance of the presence of a non-interacting passenger and subtle modes of peer influence, such as perceived social norms. The goal of this study was to examine if teenagers would engage in more risky driving practices and be less attentive in the presence of a passenger (vs. driving alone) as well as with a risk-accepting (vs. risk-averse) passenger. A confederate portrayed the passenger's characteristics mainly by his non-verbal attitude. The relationship between driver characteristics and driving behavior in the presence of a passenger was also examined. Thirty-six male participants aged 16-17 years old were randomly assigned to drive with a risk-accepting or risk-averse passenger. Main outcomes included speed, headway, gap acceptance, eye glances at hazards, and horizontal eye movement. Driver characteristics such as tolerance of deviance, susceptibility to peer pressure, and self-esteem were measured. Compared to solo driving, the presence of a passenger was associated with significantly fewer eye glances at hazards and a trend for fewer horizontal eye movements. Contrary to the hypothesis, however, Passenger Presence was associated with waiting for a greater number of vehicles to pass before initiating a left turn. Results also showed, contrary to the hypothesis, that participants with the risk-accepting passenger maintained significantly longer headway with the lead vehicle and engaged in more eye glances at hazards than participants with the risk-averse passenger. Finally, when driving with the passenger, earlier initiation of a left turn in a steady stream of oncoming vehicles was significantly associated with higher tolerance of deviance and

  5. Ischemia of the glans penis following circumcision: case report and revision of the literature.

    PubMed

    Pepe, Pietro; Pietropaolo, Francesco; Candiano, Giuseppe; Pennisi, Michele

    2015-03-01

    Ischemic complications of the glans penis are rare and commonly result from trauma, inadvertent administration of vasoconstrictive solutions, diabetes mellitus, circumcision and vasculitis; we refer about a young man with severe ischemia of the glans penis following circumcision. The patient had undergone circumcision 5 days before in a surgery department under local anesthesia (1% mepivacaine hydrochloride). The patient noticed a brownish color and edema of the glans penis at 24 h after he opened the wound dressing, but arrived to our hospital only 5 days after circumcision because these findings had progressed. Physical examination revealed the black color or necrotic appearance of the glans penis, and edema on the dorsal penile skin. The patient underwent antibiotic, antiplatatelet, corticosteroid and iperbaric therapy achieving a complete restitutio ad integrum.

  6. Reflections on female circumcision discourse in Hargeysa, Somaliland: purified or mutilated?

    PubMed

    Vestbøstad, Elin; Blystad, Astrid

    2014-06-01

    In communities where female circumcision is carried out, increasingly large segments of the population have been exposed to strong arguments against the practice. This study aimed to explore diverse discourses on female circumcision and the relationship between discourses and practice among informants who have been exposed both to local and global discourses on female circumcision. A qualitative study was carried out in 2009/10 in Hargeysa, Somaliland, employing interviews and informal discussion. The main categories of informants were nurses, nursing students, returned exile Somalis and development workers. The study findings suggest that substantial change has taken place about perceptions and practice related to female circumcision; the topic is today openly discussed, albeit more in the public than in the private arena. An important transformation moreover seems to be taking place primarily from the severe forms (pharaoni) to the less extensive forms (Sunna).

  7. Reflections on female circumcision discourse in Hargeysa, Somaliland: purified or mutilated?

    PubMed

    Vestbøstad, Elin; Blystad, Astrid

    2014-06-01

    In communities where female circumcision is carried out, increasingly large segments of the population have been exposed to strong arguments against the practice. This study aimed to explore diverse discourses on female circumcision and the relationship between discourses and practice among informants who have been exposed both to local and global discourses on female circumcision. A qualitative study was carried out in 2009/10 in Hargeysa, Somaliland, employing interviews and informal discussion. The main categories of informants were nurses, nursing students, returned exile Somalis and development workers. The study findings suggest that substantial change has taken place about perceptions and practice related to female circumcision; the topic is today openly discussed, albeit more in the public than in the private arena. An important transformation moreover seems to be taking place primarily from the severe forms (pharaoni) to the less extensive forms (Sunna). PMID:25022139

  8. Preliminary findings exploring the social determinants of Black males' lay health perspectives.

    PubMed

    Mount, David L; Johnson, Darin M; Rego, Maria Isabel; Schofield, Kandyce; Amponsah, Alethea; Graham, Louis F

    2012-01-01

    The unequal discussion of Black males' health is a pressing social problem. This study addressed Black males' lay perspectives regarding their health, illness, and mortality, with attention to the determinants of men's health, prevention, lifestyle, and opportunities for health promotion using an exploratory/qualitative research methodology. Participants were 68 Black males aged 15 to 68 years, with an average age of 44 years (SD = 14.5). The narratives represented a complex interplay of biopsychosocial factors, ranging from intrapersonal attitudes, interpersonal experiences to discussions about community and public policy injustices. Five prominent themes emerged: (a) lack of chronic disease awareness, (b) fatalism, (c) fear and anxiety of academic-medical settings, (d) hyperactive masculinity fatigue, and (e) the gay-straight divide. The term Tired Black Male Health syndrome was coined in the forum. Implications of these findings are discussed in the context of culturally relevant strategies for improving Black male community health engagement. PMID:22105065

  9. Urosepsis and postrenal acute renal failure in a neonate following circumcision with Plastibell device

    PubMed Central

    McQueen, Derrick; Sykes, Joseph; Phatak, Tej; Malik, Farhaan; Raghava, Preethi S.

    2015-01-01

    Plastibell is one of the three most common devices used for neonatal circumcision in the United States, with a complication rate as low as 1.8%. The Plastibell circumcision device is commonly used under local anesthesia for religious circumcision in male neonates, because of cosmetic reasons and ease of use. Occasionally, instead of falling off, the device may get buried under the skin along the shaft of the penis, thereby obstructing the normal flow of urine. Furthermore, the foreskin of neonates is highly vascularized, and hence, hemorrhage and infection are possible when the skin is cut. Necrosis of penile skin, followed by urethral obstruction and renal failure, is a serious surgical mishap requiring immediate corrective surgery and medical attention. We report a case of fulminant urosepsis, acute renal failure, and pyelonephritis in a 4-day-old male neonate secondary to impaction of a Plastibell circumcision device. Immediate medical management was initiated with fluid resuscitation and mechanical ventilation; thereby correcting life threatening complications. Pediatricians and Emergency Department physicians should be cognizant of the complications from Plastibell circumcision device in order to institute appropriate and timely management in neonates. PMID:25932038

  10. Clitoridectomy: female circumcision in Egypt.

    PubMed

    Hansen, H H

    Female circumcision, or clitoridectomy, has been mentioned in ancient writings from many parts of the world. There are 4 different degrees of total or partial clitoridectomy involving removal of different parts of the female genitalia. The most radical, Sudanese or Pharonic circumcision, is not now practiced in very many areas. The procedure is generally performed 1-2 years preceding puberty. Therefore, it cannot really be considered a rite of passage. Complications following the procedure are mentioned. The are 4 reasons for having the procedure performed: 1) religious; 2) aesthetic; 3) for prevention of undesirable sexual stimulation; and 4) tradition. In Egypt, the 4th most radical type of clitoridectomy is not practiced. The other 3 types are practiced by both Muslims and Christian Copts. During a stay in Egypt during 1966-67, the author had a chance to observe the incidence of the procedure among all classes of Egyptian women.

  11. Bullying Victimisation and Social Support of Adolescent Male Dance Students: An Analysis of Findings

    ERIC Educational Resources Information Center

    Risner, Doug

    2014-01-01

    This analysis (n?=?33), drawn from the findings of the author's larger mixed method research study, investigated bullying and harassment of adolescent male students (ages 13-18) pursuing dance study at the pre-professional level in the United States. Procedures for this analysis included review of primary and secondary sources from the…

  12. Neonatal herpes simplex virus infection following Jewish ritual circumcisions that included direct orogenital suction - New York City, 2000-2011.

    PubMed

    2012-06-01

    Herpes simplex virus (HSV) infection commonly causes "cold sores" (HSV type 1 [HSV-1]) and genital herpes (HSV-1 or HSV type 2 [HSV-2]); HSV infection in newborns can result in death or permanent disability. During November 2000-December 2011, a total of 11 newborn males had laboratory-confirmed HSV infection in the weeks following out-of-hospital Jewish ritual circumcision, investigators from the New York City Department of Health and Mental Hygiene (DOHMH) learned. Ten of the 11 newborns were hospitalized; two died. In six of the 11 cases, health-care providers confirmed parental reports that the ritual circumcision included an ultra-Orthodox Jewish practice known as metzitzah b'peh, in which the circumciser (mohel, plural: mohelim) places his mouth directly on the newly circumcised penis and sucks blood away from the circumcision wound (direct orogenital suction). In the remaining cases, other evidence suggested that genital infection was introduced by direct orogenital suction (probable direct orogenital suction). Based on cases reported to DOHMH during April 2006-December 2011, the risk for neonatal herpes caused by HSV-1 and untyped HSV following Jewish ritual circumcision with confirmed or probable direct orogenital suction in New York City was estimated at 1 in 4,098 or 3.4 times greater than the risk among male infants considered unlikely to have had direct orogenital suction. Oral contact with a newborn's open wound risks transmission of HSV and other pathogens. Circumcision is a surgical procedure that should be performed under sterile conditions. Health-care professionals advising parents and parents choosing Jewish ritual circumcision should inquire in advance whether direct orogenital suction will be performed, and orogenital suction should be avoided.

  13. Overuse of imaging the male breast-findings in 557 patients.

    PubMed

    Lapid, Oren; Siebenga, Pieter; Zonderland, Harmien M

    2015-01-01

    Gynecomastia is the most common abnormality of the male breast. However, breast cancer may occur, albeit with a significantly lower incidence than in females. Imaging is often used as part of the diagnosis. The aim of this study was to assess the utilization and outcome of imaging with mammography or ultrasound of the male breast in a university hospital's department of radiology. A retrospective study assessing the imaging of the male breast in 557 patients over a 10-year period. Referral was done mainly by general surgeons and general practitioners. The most common indication was enlargement of the breast, described as gynecomastia or swelling in 74% of patients, followed by pain in 24% and "lumps" in 10%. The modalities used were mammography in 65%, ultrasound in 51% and both in 26%. Most examinations, 519, were BI-RADS 1 or 2, and 38 were BI-RADS 3 or higher. Altogether 160 patients had additional fine-needle aspiration or biopsy. Malignancies were diagnosed in five patients (0.89%). Imaging had a sensitivity of 80% and a specificity of 99%. The positive predictive value was 44% and the negative predictive value 99.8%. Malignancies are rare in the male breast. The probability of finding cancer when performing imaging of clinically benign findings in the male breast is negligible. Imaging is not warranted unless there are suspicious abnormalities. Routine imaging of gynecomastia should be discouraged.

  14. Circumstances surrounding male sexual assault and rape: findings from the National Violence Against Women Survey.

    PubMed

    Light, David; Monk-Turner, Elizabeth

    2009-11-01

    Much work in the area of male sexual assault and rape relies on small clinical samples. From these samples, researchers reported that most male victims were physically injured during the attack and that penetration occurred. This work rests on a subsample of 219 men from the 1994-1996 Violence and Threats of Violence Against Women and Men in the United States Survey. Findings from the National Violence Against Women Survey (NVAW) show that the vast majority of male sexual assault victims reported that they were not physically injured during the assault, that a weapon was not used, that there was no substance use at the time of the assault, and that penetration did not occur. Only 29% of male respondents in the NVAW sought medical or psychological help after the assault. Prior work may have overrepresented men who reported being physically injured and/or penetrated. An analysis is presented of how those who presented for help in the NVAW differ from the whole sample. Results show that men who presented for help were more likely to have reported being physically injured during the assault and that penetration occurred. Thus, findings from prior work make sense; however, they may not be representative of male assault victims as a whole.

  15. Assessment of the impact of female circumcision on the gynecological, genitourinary and obstetrical health problems of women from Somalia: literature review and case series.

    PubMed

    Arbesman, M; Kahler, L; Buck, G M

    1993-01-01

    Approximately 80 million women worldwide have undergone surgery for circumcision. A variety of health risks resulting from the procedure have been reported in the literature including: bleeding, infection, shock, difficulties with menstruation and urination as well as painful intercourse. Prolonged labor and perinatal difficulties have also been noted. After an extensive literature review, a description of gynecological and obstetrical complications is provided. We had the opportunity to survey 12 Somali refugee women who were temporarily residing in a refugee center in Western New York about their personal experience with circumcision. We were interested in determining whether this convenient sample of women substantiated the clinical sequelae of circumcision reported in the literature. Structured interviews were conducted and included questions on sociodemographic, circumcision and health factors. Our findings, however limited, support the presence of heavy bleeding at the time of the surgery as a complication arising from circumcision. PMID:8266706

  16. Neonatal Herpes Simplex Virus Type 1 Infection and Jewish Ritual Circumcision With Oral Suction: A Systematic Review

    PubMed Central

    Leas, Brian F.; Umscheid, Craig A.

    2015-01-01

    Jewish ritual circumcision rarely but occasionally includes a procedure involving direct oral suction of the wound, which can expose an infant to infection with herpes simplex virus type 1 (HSV-1). This practice has provoked international controversy in recent years, but no systematic review of the clinical literature has previously been published. We designed this review to identify and synthesize all published studies examining the association between circumcision with direct oral suction and HSV-1 infection. Our search strategy identified 6 published case series or case reports, documenting 30 cases between 1988 and 2012. Clinical findings were consistent with transmission of infection during circumcision, although the evidence base is limited by the small number of infections and incomplete case data. Published evidence suggests that circumcision with direct oral suction has resulted in severe neonatal illness and death from HSV-1 transmission, but further research is necessary to clarify the risk of infection. PMID:26407411

  17. Female circumcision is curbed in Egypt.

    PubMed

    Wiens, J

    1996-08-01

    In the wake of the death of an 11-year-old girl the Egyptian government has banned any government-affiliated medical staff from performing female circumcision. Egyptian health policy has shifted from trying to control the practice by keeping it under government supervision towards condemnation. In October 1995 the health minister banned female circumcision from being carried out in state hospitals, a direct reversal of a 1994 decree that asked state hospitals to set aside one day a week for performing the procedure. The further restriction follows an incident in July 1996 when an 11-year-old girl bled to death in the rural area of Mansoora after being circumcised by a barber. Female genital mutilation in Egypt changed from an accepted custom to a political hot topic after the news network CNN in September 1994 featured the circumcision of a 9-year-old girl from Cairo. The footage embarrassed Egyptians and fueled an outcry by women's groups and nongovernmental organizations. Statistics compiled in 1994 by Egypt's former ministry of population estimated that between 70% and 90% of Egyptian women were circumcised. But a more recent survey puts the figure even higher, with 97% of women in both rural and urban areas having been circumcised. Circumcisions range from clitoridectomies to almost total removal of the outside genitalia. The practice seems to be rooted in both African tradition and Islamic beliefs, although many Islamic countries do not practice female circumcision. The main motivation seems to be in controlling women's sexual urges, and the belief that circumcision makes a woman more feminine. A university professor of gynecology teaches his medical students that circumcision is healthier for the woman. Most circumcisions in Egypt are performed by barbers or midwives, despite a sporadically enforced law forbidding the operation by anyone but a trained medical staff member. There is a high rate of complications, with some operations leading to infertility

  18. Economics of antiretroviral treatment vs. circumcision for HIV prevention.

    PubMed

    Bärnighausen, Till; Bloom, David E; Humair, Salal

    2012-12-26

    The HIV Prevention Trials Network (HPTN) 052 study, which showed the effectiveness of antiretroviral treatment in reducing HIV transmission, has been hailed as a "game changer" in the fight against HIV, prompting calls for scaling up treatment as prevention (TasP). However, it is unclear how TasP can be financed, given flat-lining support for global HIV programs. We assess whether TasP is indeed a game changer or if comparable benefits are obtainable at similar or lower cost by increasing coverage of medical male circumcision (MMC) and antiretroviral treatment (ART) at CD4 <350/μL. We develop a new mathematical model and apply it to South Africa, finding that high ART coverage combined with high MMC coverage provides approximately the same HIV incidence reduction as TasP, for $5 billion less over 2009-2020. MMC outperforms ART significantly in cost per infection averted ($1,096 vs. $6,790) and performs comparably in cost per death averted ($5,198 vs. $5,604). TasP is substantially less cost effective at $8,375 per infection and $7,739 per death averted. The prevention benefits of HIV treatment are largely reaped with high ART coverage. The most cost-effective HIV prevention strategy is to expand MMC coverage and then scale up ART, but the most cost-effective HIV-mortality reduction strategy is to scale up MMC and ART jointly. TasP is cost effective by commonly used absolute benchmarks but it is far less cost effective than MMC and ART. Given South Africa's current annual ART spending, the $5 billion in savings offered by MMC and ART over TasP in the next decade, for similar health benefits, challenges the widely hailed status of TasP as a game changer.

  19. Finding "Los Científicos" within: Latino Male Science Identity Development in the First College Semester

    ERIC Educational Resources Information Center

    Lu, Charles

    2015-01-01

    Latino males are the lowest male ethnic subgroup to attain a four-year STEM college degree. This phenomenological qualitative research study used two rounds of interviews with twelve Latino male students in Central Texas to examine their first semester science experiences using a science identity framework. Findings indicate that developing a…

  20. [Theme: circumcision. When culture harms health].

    PubMed

    Kjaergaard, G

    1994-05-01

    Millions of women are circumcised worldwide, and now Danish health personnel face this problem because of large numbers of immigrants and refugees entering the country. Circumcision is practiced among people from Somalia, where traditional infibulation, the most severe form, has been widespread. According to the World Health Organization there are about 80 million women who have been circumcised, some more extensively than others depending on the culture that they live in. This is mainly an African phenomenon that dates back to the time of the Pharaohs. In 1981 the Danish health authority issued an advisory to doctors not to perform circumcision. In contrast, in 1993 it left it up to the doctor to evaluate whether the procedure should be performed after childbirth. This poses a dilemma of interfering in the culture of other people which affects their identity and their concept of womanhood, no matter how brutal the practice. In Somalia a circumcised woman is regarded as unappealing and unesthetic. Three forms of circumcision are practiced: 1) sunna is the mildest form, 2) excision or cliterectomy, 3) infibulation or Pharaonic circumcision, the most mutilating operation which is repeated after each childbirth. Some Danish doctors favor, while others are against, performing infibulation after delivery. Infibulation poses the greatest risk to intercourse, pregnancy, and delivery. In Alborg nurses have tried to convince Somali women about changing their practice by means of education and instruction. Circumcision mostly occurs in connection with puberty rites in Sub-Saharan countries. In Egypt, Sudan, and Somalia girls undergo infibulation at 8-10 years of age. Complications often occur: difficulty in urination, bleeding, cysts or chronic inflammation that can result in infertility as well as psychological consequences.

  1. Cervical and lumbar MRI in asymptomatic older male lifelong athletes: Frequency of degenerative findings

    SciTech Connect

    Healy, J.F.; Healy, B.B.; Wong, W.H.M.; Olson, E.M.

    1996-01-01

    The athletic activity of the adult U.S. population has increased markedly in the last 20 years. To evaluate the possible long-term effects of such activity on the cervical and lumbar spine, we studied a group of asymptomatic currently very active lifelong male athletes over age 40 (41-69 years old, av. age 53). Nineteen active, lifelong male athletes were studied with MRI and the results compared with previous imaging studies of other populations. An athletic history and a spine history were also taken. Evidence of asymptomatic degenerative spine disease was similar to that seen in published series of other populations. Degenerative changes including disk protrusion and herniation, spondylosis, and spinal stenosis were present and increased in incidence with increasing patient age. In this group, all MRI findings proved to be asymptomatic and did not limit athletic activity. The incidence of lumbar degenerative changes in our study population of older male athletes was similar to those seen in other populations. 14 refs., 8 figs., 1 tab.

  2. Scaling Up Circumcision Programs in Southern Africa: The Potential Impact of Gender Disparities and Changes in Condom Use Behaviors on Heterosexual HIV Transmission

    PubMed Central

    Owens, Douglas K.; Paltiel, A. David

    2010-01-01

    Circumcision significantly reduces female-to-male transmission of HIV infection, but changes in behavior may influence the overall impact on transmission. We sought to explore these effects, particularly for societies where women have less power to negotiate safe sex. We developed a compartmental epidemic model to simulate the population-level impact of various circumcision programs on heterosexual HIV transmission in Soweto. We incorporated gender-specific negotiation of condom use in sexual partnerships and explored post-circumcision changes in condom use. A 5-year prevention program in which only an additional 10% of uncircumcised males undergo circumcision each year, for example, would prevent 13% of the expected new HIV infections over 20 years. Outcomes were sensitive to potential changes in behavior and differed by gender. For Southern Africa, even modest programs offering circumcision would result in significant benefits. Because decreases in male condom use could diminish these benefits, particularly for women, circumcision programs should emphasize risk-reduction counseling. PMID:20924783

  3. History of circumcision: a religious obligation or a medical necessity.

    PubMed

    Massry, Shaul G

    2011-01-01

    Circumcision is the oldest documented surgical procedure. Practiced for ritual religious and likely medical purposes, it seems to have emerged in Egypt and was adopted by the western Semitic tribes. In biblical times, circumcision became a religious doctrine described in the Covenant between God and Abraham in the book of Genesis. Although some claim that there are medical advantages to being circumcised, available data do not support a medical benefit for circumcision.

  4. Female circumcision: Limiting the harm

    PubMed Central

    Kandil, Mohamed

    2012-01-01

    Objective: To review the strength of evidence that links many health hazards to female genital cutting. Material and methods: Literature search in Medline/Pubmed and Google scholar. Results: Female genital cutting is still practiced secretly in both underdeveloped and developed countries due to prevailing strong traditional beliefs. There is insufficient evidence to support the claims that genital cutting is a harmful procedure if performed by experienced personnel in a suitable theatre with facilities for pain control and anesthesia. Cutting, however, is advised not to go beyond type I. Conclusion: Law makers around the globe are invited to review the legal situation in relation to female genital cutting. Proper counseling of parents about possible risks is a must in order to make informed decision about circumcising their daughters. The procedure should be offered to parents who insist on it; otherwise, they will do it illegally, exposing their daughters to possible complications. PMID:24627762

  5. Female circumcision as a public health issue.

    PubMed

    Toubia, N

    1994-09-15

    Female circumcision is practiced in 26 African countries, and it is estimated that at least 100 million women are circumcised. The mildest form is clitoridectomy and the more severe type is infibulation. Girls are commonly circumcised between the ages of 4 and 10 years. Since the operator is usually a nonprofessional without surgical experience, complications are common: hemorrhage and severe pain that can even result in shock and death. The most common long-term complication is the formation of dermoid cysts in the line of the scar. Childbirth adds other risks for infibulated women and vesicovaginal fistula is often the result. The attendant urinary incontinence leads to ostracism of these women. In sum, female circumcision is a major contributor to childhood and maternal mortality and morbidity in communities with poor health services. The physical complications add to the psychological trauma: many infibulated women have a syndrome of chronic anxiety and depression arising from their condition, intractable dysmenorrhea, and the fear of infertility. The psychological sequelae of immigrant women who live in societies where such practice is condemned is even worse and may need professional counseling to address their sexual identity and cultural identification. Tightly infibulated women require clinical intervention for deinfibulation in order to preclude serious maternal and fetal complications during childbirth. Reinfibulation is medically harmful and even though some women request it, health professionals who comply are ethically reprehensible. In Sweden a 1982 law makes all forms of female circumcision illegal, as does a law that was passed in the United Kingdom in 1985. In France several cases were brought against parents under child abuse laws for circumcising or attempting to circumcise their French-born daughters. In the United States a 1993 bill drafted by the Congressional Women's Caucus would make the practice illegal and fund a program to assist

  6. The effect of circumcision on the frequency of urinary tract infection, growth and nutrition status in infants with antenatal hydronephrosis.

    PubMed

    Kose, Engin; Yavascan, Onder; Turan, Ozlem; Kangin, Murat; Bal, Alkan; Alparslan, Caner; Sirin Kose, Seda; Kuyum, Pinar; Aksu, Nejat

    2013-01-01

    The objective of this study was to determine the effect of circumcision on the frequency of urinary tract infection (UTI), growth development, and the nutrition status in infants with antenatal hydronephrosis (AH). The data were collected prospectively between 1998 and 2010. Infants with a fetal pelvis diameter of >5 mm identified with antenatal ultrasound were followed-up. Body height and weight were expressed as HZ scores (observed height - median height/standard deviation) and WZ scores (observed weight - median weight/Standard deviation). The nutritional status was evaluated and the body weight was transformed to a weight-for-height index (WHI = weight/median weight for the height age × 100). The HZ and WZ scores or WHI were calculated for each patient at the first and last visits. The chi-square and Student's t tests were used for statistical analysis. A p value <0.05 was considered significant. The study included 178 (134 males, 44 females) patients. Of these, 29 were diagnosed by vesicoureteral reflux (VUR), 87 by obstructive uropathy, and 54 by normal. Of 134 males, 111 infants were circumcised. The mean monitoring time was 45±24.9 months and the mean age of circumcision was 14 ± 16.06 months. The pre-circumcision UTI frequency (2.97 ± 1.14/y) was significantly higher than post-circumcision period (0.25 ± 0.67/y) (p < 0.05). Also, pre-circumcision UTI frequency (2.97 ± 1.14/y) was significantly higher than the UTI frequency observed in female cases (0.85 ± 0.91/y) and in the overall study group (0.73 ± 0.79/y) (p < 0.05). In all patients, the HZ of the circumcised subjects (0.18 ± 1.01) was statistically higher than uncircumcised subjects (-0.26 ± 0.92) (p < 0.05). Although statistically insignificant, the HZ of the circumcised males (0.13 ± 1.24) with VUR was higher than the uncircumcised patients (0.03 ± 0.55) (p > 0.05). In obstructive uropathy groups, the HZ of the

  7. Circumcision

    MedlinePlus

    ... much more widespread in the United States, Canada, Africa, and the Middle East than in Asia, South ... About KidsHealth About Nemours Contact Us Partners Editorial Policy Privacy Policy & Terms of Use Visit the Nemours ...

  8. Is female circumcision evolving or dissolving in Norway? A qualitative study on attitudes toward the practice among young Somalis in the Oslo area

    PubMed Central

    Gele, Abdi A; Sagbakken, Mette; Kumar, Bernadette

    2015-01-01

    Female genital mutilation or female circumcision (FC) is increasingly visible on the global health and development agenda – both as a matter of social justice and equality for women and as a research priority. Norway is one of the global nations hosting a large number of immigrants from FC-practicing countries, the majority from Somalia. To help counteract this practice, Norway has adopted a multifaceted policy approach that employs one of the toughest measures against FC in the world. However, little is known about the impact of Norway’s approach on the attitudes toward the practice among traditional FC-practicing communities in Norway. Against this background, this qualitative study explores the attitudes toward FC among young Somalis between the ages of 16 to 22 living in the Oslo and Akershus regions of Norway. Findings indicate that young Somalis in the Oslo area have, to a large extent, changed their attitude toward the practice. This was shown by the participants’ support and sympathy toward criminalization of FC in Norway, which they believed was an important step toward saving young girls from the harmful consequences of FC. Most of the uncircumcised girls see their uncircumcised status as being normal, whereas they see circumcised girls as survivors of violence and injustice. Moreover, the fact that male participants prefer a marriage to uncircumcised girls is a strong condition for change, since if uncut girls are seen as marriageable then parents are unlikely to want to circumcise them. As newly arrived immigrants continue to have positive attitudes toward the practice, knowledge of FC should be integrated into introduction program classes that immigrants attend shortly after their residence permit is granted. This study adds to the knowledge of the process of the abandonment of FC among immigrants in Western countries. PMID:26648760

  9. Is female circumcision evolving or dissolving in Norway? A qualitative study on attitudes toward the practice among young Somalis in the Oslo area.

    PubMed

    Gele, Abdi A; Sagbakken, Mette; Kumar, Bernadette

    2015-01-01

    Female genital mutilation or female circumcision (FC) is increasingly visible on the global health and development agenda - both as a matter of social justice and equality for women and as a research priority. Norway is one of the global nations hosting a large number of immigrants from FC-practicing countries, the majority from Somalia. To help counteract this practice, Norway has adopted a multifaceted policy approach that employs one of the toughest measures against FC in the world. However, little is known about the impact of Norway's approach on the attitudes toward the practice among traditional FC-practicing communities in Norway. Against this background, this qualitative study explores the attitudes toward FC among young Somalis between the ages of 16 to 22 living in the Oslo and Akershus regions of Norway. Findings indicate that young Somalis in the Oslo area have, to a large extent, changed their attitude toward the practice. This was shown by the participants' support and sympathy toward criminalization of FC in Norway, which they believed was an important step toward saving young girls from the harmful consequences of FC. Most of the uncircumcised girls see their uncircumcised status as being normal, whereas they see circumcised girls as survivors of violence and injustice. Moreover, the fact that male participants prefer a marriage to uncircumcised girls is a strong condition for change, since if uncut girls are seen as marriageable then parents are unlikely to want to circumcise them. As newly arrived immigrants continue to have positive attitudes toward the practice, knowledge of FC should be integrated into introduction program classes that immigrants attend shortly after their residence permit is granted. This study adds to the knowledge of the process of the abandonment of FC among immigrants in Western countries. PMID:26648760

  10. Articulation Rate and Vowel Space Characteristics of Young Males with Fragile X Syndrome: Preliminary Acoustic Findings

    ERIC Educational Resources Information Center

    Zajac, David J.; Roberts, Joanne E.; Hennon, Elizabeth A.; Harris, Adrianne A.; Barnes, Elizabeth F.; Misenheimer, Jan

    2006-01-01

    Purpose: Increased speaking rate is a commonly reported perceptual characteristic among males with fragile X syndrome (FXS). The objective of this preliminary study was to determine articulation rate--one component of perceived speaking rate--and vowel space characteristics of young males with FXS. Method: Young males with FXS (n = 38), …

  11. Acceptability and Satisfaction Associated With the Introduction of the PrePex Circumcision Device in Maputo, Mozambique

    PubMed Central

    Necochea, Edgar; Ferreira, Thais; Soares, Benilde; Mahomed, Mehebub; Muquingue, Humberto; Nhambi, Leonel; Bossemeyer, Debora; Ashengo, Tigistu A.

    2016-01-01

    Background: Adult device circumcision may potentially reach more men in Sub-Saharan Africa, with fewer human resource and capacity needs than surgical procedures. Despite these advantages, little is known about device acceptability, including pain and maintaining the device in situ. Methods: Healthy, HIV-negative men, between 18 and 49 years, in a Maputo clinic, were consecutively asked to participate in a circumcision device study that included assessing acceptability. Clinical forms and self-administered surveys were used to collect data at various times during the circumcision process for consenting men. Data were entered into a central database and analyzed using statistical software. Results: Between May and July, 2013, 504 men received device circumcision. Placement was painless for 98.2% of the male population, but the pain was more common during removal with 38.3% reporting severe or unbearable and 21.5% moderate pain. Satisfaction was high at both time points with 88.8% and 92.6% of men being very or somewhat satisfied at placement and removal, respectively. Half of the male population (50.2%) was very or somewhat comfortable with the device in situ; whereas, 36.8% were somewhat or very uncomfortable. Common device difficulties experienced were painful erections (38.5%) and difficult urination (21.8%) and hygiene (21.4%). By the final clinic visit at day 49, 90.4% of them were very or somewhat satisfied with the procedure. Discussion: High levels of satisfaction were reported for device circumcision, despite the pain noted during removal and some challenges with the device in situ. Given the advantages and acceptability among Mozambican men in this study, device circumcision could be offered, when clinically appropriate, as an alternative to surgery. PMID:27331592

  12. Eavesdropping to Find Mates: The Function of Male Hearing for a Cicada-Hunting Parasitoid Fly, Emblemasoma erro (Diptera: Sarcophagidae)

    PubMed Central

    Stucky, Brian J.

    2016-01-01

    Females of several species of dipteran parasitoids use long-range hearing to locate hosts for their offspring by eavesdropping on the acoustic mating calls of other insects. Males of these acoustic eavesdropping parasitoids also have physiologically functional ears, but so far, no adaptive function for male hearing has been discovered. I investigated the function of male hearing for the sarcophagid fly Emblemasoma erro Aldrich, an acoustic parasitoid of cicadas, by testing the hypothesis that both male and female E. erro use hearing to locate potential mates. I found that both male and nongravid female E. erro perform phonotaxis to the sounds of calling cicadas, that male flies engage in short-range, mate-finding behavior once they arrive at a sound source, and that encounters between females and males at a sound source can lead to copulation. Thus, cicada calling songs appear to serve as a mate-finding cue for both sexes of E. erro. Emblemasoma erro’s mate-finding behavior is compared to that of other sarcophagid flies, other acoustic parasitoids, and nonacoustic eavesdropping parasitoids. PMID:27382133

  13. Eavesdropping to Find Mates: The Function of Male Hearing for a Cicada-Hunting Parasitoid Fly, Emblemasoma erro (Diptera: Sarcophagidae).

    PubMed

    Stucky, Brian J

    2016-01-01

    Females of several species of dipteran parasitoids use long-range hearing to locate hosts for their offspring by eavesdropping on the acoustic mating calls of other insects. Males of these acoustic eavesdropping parasitoids also have physiologically functional ears, but so far, no adaptive function for male hearing has been discovered. I investigated the function of male hearing for the sarcophagid fly Emblemasoma erro Aldrich, an acoustic parasitoid of cicadas, by testing the hypothesis that both male and female E. erro use hearing to locate potential mates. I found that both male and nongravid female E. erro perform phonotaxis to the sounds of calling cicadas, that male flies engage in short-range, mate-finding behavior once they arrive at a sound source, and that encounters between females and males at a sound source can lead to copulation. Thus, cicada calling songs appear to serve as a mate-finding cue for both sexes of E. erro Emblemasoma erro's mate-finding behavior is compared to that of other sarcophagid flies, other acoustic parasitoids, and nonacoustic eavesdropping parasitoids. PMID:27382133

  14. Circumcision status and time to first sex among never-married young men in Malawi: evidence from the demographic and health survey.

    PubMed

    Mkandawire, Paul; Luginaah, Isaac; Dixon, Jenna; Armah, Frederick; Arku, Godwin

    2013-07-01

    This study examines the association between circumcision status and the timing of first sexual intercourse among adolescents in Malawi. Results of survival models applied to nationally representative sample of never-married young men aged between 15 and 24 obtained from the Demographic and Health Survey data show that being circumcised is associated with earlier initiation of sexual activity in Malawi. Young men who reported being circumcised experienced their first sexual intercourse earlier in life than their uncircumcised counterparts. Although the introduction of theoretically relevant knowledge, socio-cultural, demographic, and socioeconomic variables in the multivariate models attenuated the association between circumcision and earlier sexual initiation, the relationship nonetheless remained robust. The study concludes by discussing the implications of these findings and suggests relevant policy recommendations. PMID:23474595

  15. Are Male Judokas with Visual Impairments Training Properly? Findings from an Observational Study

    ERIC Educational Resources Information Center

    Gutierrez-Santiago, Alfonso; Cancela, Jose M.; Zubiaur, Marta; Ayan, Carlos

    2012-01-01

    Introduction: One aim of the study was to describe the temporal structure of judo combat among male judokas with visual impairments. Another aim was to determine the possible differences between the judokas with visual impairments and sighted male judokas to determine whether judokas with visual impairments need specific training to achieve their…

  16. Circumstances Surrounding Male Sexual Assault and Rape: Findings from the National Violence against Women Survey

    ERIC Educational Resources Information Center

    Light, David; Monk-Turner, Elizabeth

    2009-01-01

    Much work in the area of male sexual assault and rape relies on small clinical samples. From these samples, researchers reported that most male victims were physically injured during the attack and that penetration occurred. This work rests on a subsample of 219 men from the 1994-1996 Violence and Threats of Violence Against Women and Men in the…

  17. Acquisition and Persistence of Human Papillomavirus 16 (HPV-16) and HPV-18 Among Men With High-HPV Viral Load Infections in a Circumcision Trial in Kisumu, Kenya

    PubMed Central

    Senkomago, Virginia; Backes, Danielle M.; Hudgens, Michael G.; Poole, Charles; Agot, Kawango; Moses, Stephen; Snijders, Peter J. F.; Meijer, Chris J. L. M.; Hesselink, Albertus T.; Schlecht, Nicolas F.; Bailey, Robert C.; Smith, Jennifer S.

    2015-01-01

    Background. Circumcision and lower human papillomavirus (HPV) viral loads in men are possibly associated with a reduced risk of HPV transmission to women. However, the association between male circumcision and HPV viral load remains unclear. Methods. Swab specimens from the glans and shaft of the penis were collected from men enrolled in a circumcision trial in Kisumu, Kenya. GP5+/6+ polymerase chain reaction (PCR) was used to identify HPV DNA types. HPV-16 and HPV-18 loads were measured with a LightCycler real-time PCR and classified as high (>250 copies/scrape) or low (≤250 copies/scrape). Results. A total of 1159 men were randomly assigned to undergo immediate circumcision, and 1140 men were randomly assigned to the control arm (these individuals were asked to remain uncircumcised until the study ended). The hazard of acquisition of high-viral load infections in the glans was lower in the circumcision arm, compared with the control arm, for HPV-16 (hazard ratio [HR], 0.32 [95% confidence interval {CI}, .20–.49]) and HPV-18 (HR, 0.34 [95% CI, .21–.54]). The 6-month risk of HPV persistence among men with high-viral load infections in the glans at baseline was lower in the circumcision arm, compared with the control arm, for HPV-16 (risk ratio [RR], 0.36 [95% CI, .18–.72]) and HPV-18 (RR 0.34 [95% CI, .13–.86]). Weaker and less precise results were obtained for shaft samples. Conclusions. Male circumcision could potentially reduce the risk of HPV transmission to women by reducing the hazard of acquisition, and the risk of persistence of high-HPV viral load infections in the glans in men. PMID:25261492

  18. Circumcising Circumcision: Renegotiating Beliefs and Practices among Somali Women in Johannesburg and Nairobi.

    PubMed

    Jinnah, Zaheera; Lowe, Lucy

    2015-01-01

    Female circumcision among Somalis is a deeply personal and subjective practice, framed within traditional norms and cultural practices, but negotiated within contemporary realities to produce a set of processes and practices that are nuanced, differentiated, and undergoing change. Based on ethnographic research among Somali women in Johannesburg and Nairobi, we argue that the context of forced migration provides women with opportunities to renegotiate and reinvent what female circumcision means to them. The complex, subjective, and diverse perceptions and experiences of circumcision as embedded processes, within the context of migration, we argue has been overlooked in the literature, which has tended to be framed within a normative discourse concerned with the medical effects of the practice, or in anthropological studies, counter to the normative discourse based on personal narratives. PMID:26076054

  19. Adult Female and Male Siblings of Persons with Disabilities: Findings from a National Survey

    ERIC Educational Resources Information Center

    Hodapp, Robert M.; Urbano, Richard C.; Burke, Meghan M.

    2010-01-01

    In this study, the authors used a national, Web-based survey to examine female and male siblings of individuals with disabilities. More than 1,160 adult siblings completed a 163-question survey about themselves, their siblings, and their sibling relationships. Most respondents reported fairly close contact with their siblings and positive sibling…

  20. Male Escorts' and Male Clients' Sexual Behavior During Their Last Commercial Sexual Encounter: Comparing and Contrasting Findings from Two Online Studies.

    PubMed

    Grov, Christian; Rodríguez-Díaz, Carlos E; Jovet-Toledo, Gerardo G

    2016-05-01

    Much of what is known about commercial sexual encounters between men is based on data gathered from escorts. With few exceptions, studies have not compared male clients' reports of behavior during commercial sexual encounters with male escorts'. The present study draws from two datasets, a 2012 survey of clients (n = 495) and a 2013 survey of escorts (n = 387)--both used virtually identical measures of sexual behavior during the most recent commercial sexual encounter. For clients and escorts, the majority eschewed having sex without a condom, and kissing and oral sex were among the most common behaviors reported. Using logistic regression, both samples were compared across 15 sexual behaviors, finding significant differences in six--the escort sample had greater odds of reporting their last commercial sexual encounter involved watching the client masturbate, viewing porn, role play (dad/son, dominant/submissive), and having prior sexual experience with their commercial partner. The escort sample had lower odds of reporting that the client watched the escort masturbate, and being told partner's HIV status. In multivariable modeling, both samples did not significantly differ in reports of condomless anal sex. Male-male commercial sexual encounters appear to be involved in a wide range of sexual behaviors, many of which convey low-to-no risk of HIV transmission. PMID:25953422

  1. Male Escorts' and Male Clients' Sexual Behavior During Their Last Commercial Sexual Encounter: Comparing and Contrasting Findings from Two Online Studies.

    PubMed

    Grov, Christian; Rodríguez-Díaz, Carlos E; Jovet-Toledo, Gerardo G

    2016-05-01

    Much of what is known about commercial sexual encounters between men is based on data gathered from escorts. With few exceptions, studies have not compared male clients' reports of behavior during commercial sexual encounters with male escorts'. The present study draws from two datasets, a 2012 survey of clients (n = 495) and a 2013 survey of escorts (n = 387)--both used virtually identical measures of sexual behavior during the most recent commercial sexual encounter. For clients and escorts, the majority eschewed having sex without a condom, and kissing and oral sex were among the most common behaviors reported. Using logistic regression, both samples were compared across 15 sexual behaviors, finding significant differences in six--the escort sample had greater odds of reporting their last commercial sexual encounter involved watching the client masturbate, viewing porn, role play (dad/son, dominant/submissive), and having prior sexual experience with their commercial partner. The escort sample had lower odds of reporting that the client watched the escort masturbate, and being told partner's HIV status. In multivariable modeling, both samples did not significantly differ in reports of condomless anal sex. Male-male commercial sexual encounters appear to be involved in a wide range of sexual behaviors, many of which convey low-to-no risk of HIV transmission.

  2. Psychosocial Results from a Phase I Trial of a Nonsurgical Circumcision Device for Adult Men in Zimbabwe.

    PubMed

    Kasprzyk, Danuta; Montaño, Daniel E; Hamilton, Deven T; Down, Kayla L; Marrett, Karl D; Tshimanga, Mufuta; Xaba, Sinokuthemba; Mugurungi, Owen

    2016-01-01

    Male circumcision (MC), an effective HIV prevention tool, has been added to Zimbabwe's Ministry of Health and Child Care HIV/AIDS Prevention Program. A Phase I safety trial of a nonsurgical male circumcision device was conducted and extensive psychosocial variables were assessed. Fifty-three men (18 and older) were recruited for the device procedure; 13 follow-up clinical visits were completed. Interviews conducted three times (before the procedure, at 2 weeks and 90 days post-procedure) assessed: Satisfaction; expectations; actual experience; activities of daily living; sexual behavior; and HIV risk perception. Using the Integrated Behavioral Model, attitudes towards MC, sex, and condoms, and sources of social influence and support were also assessed. Men (mean age 32.5, range 18-50; mean years of education = 13.6; 55% employed) were satisfied with device circumcision results. Men understand that MC is only partially protective against HIV acquisition. Most (94.7%) agreed that they will continue to use condoms to protect themselves from HIV. Pain ratings were surprisingly negative for a procedure billed as painless. Men talked to many social networks members about their MC experience; post-procedure (mean of 14 individuals). Minimal impact on activities of daily living and absenteeism indicate possible cost savings of device circumcisions. Spontaneous erections occurred frequently post-procedure. The results had important implications for changes in the pre-procedure clinical counseling protocol. Clear-cut counseling to manage pain and erection expectations should result in improved psychosocial outcomes in future roll-out of device circumcisions. Men's expectations must be managed through evidence-based counseling, as they share their experiences broadly among their social networks. PMID:26745142

  3. Circumcision of pacific boys: tradition at the cutting edge.

    PubMed

    Thomson, Robert; Finau, Sitaleki; Finau, Eseta; Ahokovi, Lavili; Tameifuna, Susi

    2006-09-01

    Circumcision of neonates and young boys, is a frequently performed elective surgical procedure, and is one of the oldest known surgical procedures. When properly performed circumcision prevents phimosis, paraphimosis, and balanoposthitis and has been shown to decrease the incidence of penile among men and cervical cancer among the women sexual partners of circumcised men. It may also result in a decreased incidence of urinary tract infection, sexually transmitted infections and HIV infection. Circumcision also has its own inherent risks. The risk are mainly associated with the procedure (pain, bleeding, inflammation) also included post operative infection, poor healing, excess foreskin removed leading to minor or major loss of sensation, accidental cutting of the glan penis, and cross infection if performed with un-sterile instruments especially during ritual circumcision. To make an informed choice, parents should be given accurate and unbiased information and be provided the opportunity to discuss this decision. PMID:18181400

  4. Spontaneous external auditory canal cholesteatoma in a young male: Imaging findings and differential diagnoses

    PubMed Central

    Aswani, Yashant; Varma, Ravi; Achuthan, Gayathri

    2016-01-01

    A cholesteatoma is a non-neoplastic lesion of the petrous temporal bone commonly described as “skin in the wrong place.” It typically arises within the middle ear cavity, may drain externally via tympanic membrane (mural type), or may originate in the external auditory canal (EAC). The latter type is rarely encountered and typically affects the elderly. EAC cholesteatoma poses diagnostic challenges because it has numerous differential diagnoses. The present case describes a 19-year-old male who presented with gradually progressive diminution of hearing in a previously naïve right ear since 8 months. A soft tissue attenuation lesion confined to the right EAC with erosion of the canal on computed tomography prompted magnetic resonance imaging (MRI). The lesion showed restricted diffusion on MRI. Thus, a diagnosis of spontaneous EAC cholesteatoma was established. The case elucidates the rarity of spontaneous EAC cholesteatoma in a young male. In addition, it describes the role of imaging to detect, delineate the extent, and characterize lesions of petrous temporal bone. The case also discusses common differential diagnoses of EAC cholesteatoma, as well as the importance of diffusion weighted imaging in EAC cholesteatoma similar to its middle ear counterpart. PMID:27413272

  5. Findings

    MedlinePlus

    ... Issue All Issues Explore Findings by Topic Cell Biology Cellular Structures, Functions, Processes, Imaging, Stress Response Chemistry ... Glycobiology, Synthesis, Natural Products, Chemical Reactions Computers in Biology Bioinformatics, Modeling, Systems Biology, Data Visualization Diseases Cancer, ...

  6. Ritual circumcision and risk of autism spectrum disorder in 0- to 9-year-old boys: national cohort study in Denmark

    PubMed Central

    Simonsen, Jacob

    2015-01-01

    Objective Based on converging observations in animal, clinical and ecological studies, we hypothesised a possible impact of ritual circumcision on the subsequent risk of autism spectrum disorder (ASD) in young boys. Design National, register-based cohort study. Setting Denmark. Participants A total of 342,877 boys born between 1994 and 2003 and followed in the age span 0–9 years between 1994 and 2013. Main outcome measures Information about cohort members’ ritual circumcisions, confounders and ASD outcomes, as well as two supplementary outcomes, hyperkinetic disorder and asthma, was obtained from national registers. Hazard ratios (HRs) with 95% confidence intervals (CIs) associated with foreskin status were obtained using Cox proportional hazards regression analyses. Results With a total of 4986 ASD cases, our study showed that regardless of cultural background circumcised boys were more likely than intact boys to develop ASD before age 10 years (HR = 1.46; 95% CI: 1.11–1.93). Risk was particularly high for infantile autism before age five years (HR = 2.06; 95% CI: 1.36–3.13). Circumcised boys in non-Muslim families were also more likely to develop hyperkinetic disorder (HR = 1.81; 95% CI: 1.11–2.96). Associations with asthma were consistently inconspicuous (HR = 0.96; 95% CI: 0.84–1.10). Conclusions We confirmed our hypothesis that boys who undergo ritual circumcision may run a greater risk of developing ASD. This finding, and the unexpected observation of an increased risk of hyperactivity disorder among circumcised boys in non-Muslim families, need attention, particularly because data limitations most likely rendered our HR estimates conservative. Considering the widespread practice of non-therapeutic circumcision in infancy and childhood around the world, confirmatory studies should be given priority. PMID:25573114

  7. Socioeconomic factors and incidence of erectile dysfunction: findings of the longitudinal Massachussetts Male Aging Study.

    PubMed

    Aytaç, I A; Araujo, A B; Johannes, C B; Kleinman, K P; McKinlay, J B

    2000-09-01

    Despite the well-documented relationship of socioeconomic factors (SEF) to various health problems, the relationship of SEF to erectile dysfunction (ED) is not well understood. As such, the goals of this paper are: (1) to determine whether incident ED is more likely to occur among men with low SEF; and (2) to determine whether incident ED varies by SEF after taking into consideration other well-established ED risk factors that are also associated with SEF such as smoking, diabetes, and high blood pressure. We used data from 797 participants in the longitudinal population-based Massachusetts Male Aging Study (baseline 1987-1989, follow-up 1995-1997) who were free of ED at baseline and had complete data on ED and all risk factors. ED was determined by a self-administered questionnaire and its relationship to SEF was assessed using logistic regression. We first analyzed the age-adjusted relationship of education, income, and occupation to incidence of ED. The results show that men with low education (O.R. = 1.46, 95% C.I. = 1.02-2.08) or men in blue-collar occupations (O.R. = 1.68, 95% C.I. = 1.16-2.43) are significantly more likely to develop ED. For the multivariate model, due to multicollinearity among education, income, and occupation, we ran three separate models. After taking into consideration all the other risk factors--age, lifestyle and medical conditions--the effect of occupation remained significant. Men who worked in blue-collar occupations were one and a half times more likely to develop ED compared to men in white-collar occupations (O.R. = 1.55, 95% C.I. = 1.06-2.28).

  8. Ancient rites and new laws: how should we regulate religious circumcision of minors?

    PubMed

    Davis, Dena S

    2013-07-01

    The ancient practice of metzitzah b'peh, direct oral suction, is still practiced by ultra-Orthodox Jews as part of the religious rite of male newborn circumcision. Between 2000 and 2011, 11 children have died in New York and New Jersey, following infection by herpes simplex virus, presumably from infected practitioners. The City responded by requiring signed parental consent before oral suction, with parents being warned of the dangers of the practice. This essay argues that informed consent is not an appropriate response to this problem. An outright ban would a better response to a practice that is dangerous to children, but might prove unconstitutional under New York State law.

  9. Latina adolescents' perceptions of their male partners' influences on childbearing: findings from a qualitative study in California.

    PubMed

    Schwartz, Sarah L; Brindis, Claire D; Ralph, Lauren J; Biggs, M Antonia

    2011-09-01

    Teenage births among Latina women living in the USA remain higher than any other racial/ethnic group. This study explored the role that male partners play in the occurrence of pregnancy and their influence on teenage mothers' future plans in a sample of women pregnant with their first child. Qualitative analysis revealed that partners played a significant role in the use of contraception, timing and desire for pregnancy and young women's post-pregnancy plans for education, work and childrearing. Men's older age, concerns about contraceptive use and fertility, reluctance to use condoms, and readiness for parenthood put their partners at increased risk for pregnancy. More acculturated men were supportive of young women's educational goals in many cases, whereas less acculturated males subscribed to more rigid gender roles which required that their partners remain at home after the birth of their child. These findings have important implications for programmes that seek to reduce teenage pregnancy in the US Latino population.

  10. Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Findings of Post Traumatic Lymphangioma in a Young Adult Male

    PubMed Central

    Kwon, Sang Don; Chun, Kyung Ah; Kong, Eun Jung; Cho, Ihn Ho

    2016-01-01

    The authors report the case of a 34-year-old male, who underwent a fluorine-18 fluoro deoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) scan 7 years after trauma for the evaluation of multifocal masses in the right iliac and right inguinal areas. CT findings showed multifocal low density masses and 18F-FDG PET revealed slightly increased uptake (maximum standardized uptake value [SUVmax] 3.1). These findings did not exclude the possibility of a benign or malignant lesion. To achieve differential diagnosis, partial surgical excision was performed and a pathologic examination subsequently revealed lymphangioma. Here, the authors describe the 18F-FDG PET/CT findings of a rare case of lymphangioma resulting from trauma. PMID:27699163

  11. Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Findings of Post Traumatic Lymphangioma in a Young Adult Male

    PubMed Central

    Kwon, Sang Don; Chun, Kyung Ah; Kong, Eun Jung; Cho, Ihn Ho

    2016-01-01

    The authors report the case of a 34-year-old male, who underwent a fluorine-18 fluoro deoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) scan 7 years after trauma for the evaluation of multifocal masses in the right iliac and right inguinal areas. CT findings showed multifocal low density masses and 18F-FDG PET revealed slightly increased uptake (maximum standardized uptake value [SUVmax] 3.1). These findings did not exclude the possibility of a benign or malignant lesion. To achieve differential diagnosis, partial surgical excision was performed and a pathologic examination subsequently revealed lymphangioma. Here, the authors describe the 18F-FDG PET/CT findings of a rare case of lymphangioma resulting from trauma.

  12. Phimosis in male dromedary camels: Clinical findings and changes in the hemogram, nitric oxide metabolites, and testosterone concentrations.

    PubMed

    Ali, Ahmed; Derar, Derar; Al-Sobyil, Fahd A; Zeitoun, Moustafa M; Hassanein, Khaled M A; Al-Howas, Abdella

    2016-06-01

    The objectives of this study were to elucidate the clinical findings in male dromedary camels with phimosis (PHI, n = 43) and to investigate the association of this syndrome with the hemogram, nitric oxide metabolites (NOMs), and testosterone concentrations. History and signalment were obtained, and a breeding soundness examination was performed. The penis was exteriorized after administration of a pudendal nerve block. Abnormal masses obtained from the prepuce and penis were prepared for histopathology. Blood samples for hemogram assessment were taken from the diseased animals and from 10 healthy control males. Total nitrates/nitrites were determined in sera using the Griess assay. Testosterone was estimated in sera using ELISA. Phimosis associated with detectable pathologic lesions, mainly including ulcerative posthitis and lacerated glans penis, was present in 34 (79.1%) of the 43 cases (PHI-P), whereas the remaining nine (20.9%) of the 43 cases had no noticeable lesions (PHI-N). The PHI-P group showed higher leukocyte counts (P = 0.001), especially neutrophils (P = 0.0001), and greater NOM concentrations (P = 0.002) than the PHI-N and control groups. However, testosterone concentrations did not differ among groups. In conclusion, PHI in the male dromedary camels was mainly associated with ulcerative posthitis and laceration of the glans penis. The presence of pathologic lesions in cases with PHI was associated with leukocytosis, neutrophilia, and high NOM concentrations. PMID:26879996

  13. Rarely seen complications of circumcision, and their management

    PubMed Central

    İnce, Bilsev; Dadacı, Mehmet; Altuntaş, Zeynep; Bilgen, Fatma

    2016-01-01

    Objective Circumcision, performed for religious or medical reasons is the procedure of surgical excision of the skin covering the glans penis, preputium in a certain shape and dimension so as to expose the tip of the glans penis. Short- and long- term complication rates of up to 50% have been reported, varying due to the recording system of different countries in which the procedure has been accepted as a widely performed simple surgical procedure. In this study, treatment procedures in patients presented to our clinic with complications after circumcision are described and methods to decrease the rate of the complications are reviewed. Material and metods Cases that presented to our clinic between 2010 and 2013 with early complications of circumcision were retrospectively reviewed. Cases with acceptedly major complications as excess skin excision, skin necrosis and total amputation of the glans were included in the study, while cases with minor complications such as bleeding, hematoma and infection were excluded from the study. Results Repair with full- thickness skin grafts was performed in patients with excess skin excision. In cases with skin necrosis, following the debridement of the necrotic skin, primary repair or repair with full- thickness graft was performed in cases where full- thickness skin defects developed and other cases with partial skin loss were left to secondary healing. Repair with an inguinal flap was performed in the case with glans amputation. Conclusion Circumcisions performed by untrained individuals are to be blamed for the complications of circumcision reported in this country. The rate of complications increases during the “circumcision feasts” where multiple circumcisions were performed. This also predisposes to transmission of various diseases, primarily hepatitis B/C and AIDS. Circumcision is a surgical procedure that should be performed by specialists under appropriate sterile circumstances in which the rate of complications

  14. Influence of circumcision technique on frequency of urinary tract infections in neonates.

    PubMed

    Harel, Liora; Straussbergr, Rachel; Jackson, Shlomo; Amir, Jacob; Tiqwa, Petah

    2002-09-01

    An increase in urinary tract infection (UTI) during the first weeks after traditional Jewish circumcision has been reported. Circumcision can be performed by a nonmedical person (mohel) or by a physician, with the main difference being in hemostasis techniques. We assessed the effect of circumcision procedure on development of UTI in neonates. Circumcision performed by a mohel was associated with higher incidence of UTI compared with that by physicians. Hemostasis technique and shaft wrapping are postulated risk factors.

  15. The Effect of Health Education Program for Caregivers on Circumcision Outcome in Neonates and Infants

    ERIC Educational Resources Information Center

    Gafer, Youser abd Elsalam; Nafee, Houda Mohammed; Pal, Kamlish

    2015-01-01

    Circumcision is a surgical excision of the foreskin to the level of the coronal sulcus which may perform in the neonatal period or in later life. Circumcision has many medical benefits such as minimizing urinary tract infection, reduces the incidence of balanitis and enhances of penile hygiene, prevents of penile cancer. However, Circumcision may…

  16. [Circumcision in the newborn child and risk of urinary tract infection during the first year of life. A meta-analysis].

    PubMed

    Amato, D; Garduño-Espinosa, J

    1992-10-01

    To assess if neonatal circumcision may decrease the incidence of urinary tract infection (UTI), published papers on these topics were reviewed, to address their methodological shortcomings, and to analyze them in individual and grouped form. A systematic search of the papers on circumcision and UTI was conducted in Index Medicus (1975-1991) and MEDLINE (1988-1991). Six papers were included in the meta-analysis because all of them presented original data obtained from groups of patients. All of the elected articles were considered in individual and grouped form to calculate odds ratio (OR) and confidence interval at 95% (CI 95%). The number of patients included in each paper ranged from 112 to 219,775. Clustering of the articles enabled us to obtain a global sample number of 221,799 patients. In each individual article there was a higher risk of UTI in uncircumcised patients (OR from 10.82 to 156.42). Global risk obtained from the six clustered papers was of 13.05 with a CI 95% from 10.86 to 15.70. Uncircumcised males have low risk of UTI during their first year of life, but the risk may decrease even more with circumcision. This conclusion may not be considered as definitive because of the methodological shortcomings of the papers reviewed. Recommendation of routinely circumcision to all newborns in not justified with these data.

  17. Self-efficacy, male rape myth acceptance, and devaluation of emotions in sexual trauma sequelae: Findings from a sample of male veterans.

    PubMed

    Voller, Emily; Polusny, Melissa A; Noorbaloochi, Siamak; Street, Amy; Grill, Joseph; Murdoch, Maureen

    2015-11-01

    Sexual trauma is an understudied but regrettably significant problem among male Veterans. As in women, sexual trauma often results in serious mental health consequences for men. Therefore, to guide potential future interventions in this important group, we investigated associations among self-efficacy, male rape myth acceptance, devaluation of emotions, and psychiatric symptom severity after male sexual victimization. We collected data from 1,872 Gulf War era Veterans who applied for posttraumatic stress disorder (PTSD) disability benefits using standard mailed survey methods. The survey asked about history of childhood sexual abuse, sexual assault during the time of Gulf War I, and past-year sexual assault as well as Veterans' perceived self-efficacy, male rape myth acceptance, devaluation of emotions, PTSD, and depression symptoms. Structural equation modeling revealed that self-efficacy partially mediated the association between participants' sexual trauma history and psychiatric symptoms. Greater male rape myth acceptance and greater devaluation of emotions were directly associated with lower self-efficacy, but these beliefs did not moderate associations between sexual trauma and self-efficacy. In this population, sexual trauma, male rape myth acceptance, and devaluation of emotions were associated with lowered self-efficacy, which in turn was associated with more severe psychiatric symptoms. Implications for specific, trauma-focused treatment are discussed.

  18. Aerobic Fitness Linked to Cortical Brain Development in Adolescent Males: Preliminary Findings Suggest a Possible Role of BDNF Genotype.

    PubMed

    Herting, Megan M; Keenan, Madison F; Nagel, Bonnie J

    2016-01-01

    Aerobic exercise has been shown to impact brain structure and cognition in children and adults. Exercise-induced activation of a growth protein known as brain derived neurotrophic factor (BDNF) is thought to contribute to such relationships. To date, however, no study has examined how aerobic fitness relates to cortical brain structure during development and if BDNF genotype moderates these relationships. Using structural magnetic resonance imaging (MRI) and FreeSurfer, the current study examined how aerobic fitness relates to volume, thickness, and surface area in 34 male adolescents, 15 to 18 years old. Moreover, we examined if the val66met BDNF genotype moderated these relationships. We hypothesized that aerobic fitness would relate to greater thickness and volumes in frontal, parietal, and motor regions, and that these relationships would be less robust in individuals carrying a Met allele, since this genotype leads to lower BDNF expression. We found that aerobic fitness positively related to right rostral middle frontal cortical volume in all adolescents. However, results also showed BDNF genotype moderated the relationship between aerobic fitness and bilateral medial precuneus surface area, with a positive relationship seen in individuals with the Val/Val allele, but no relationship detected in those adolescents carrying a Met allele. Lastly, using self-reported levels of aerobic activity, we found that higher-fit adolescents showed larger right medial pericalcarine, right cuneus and left precuneus surface areas as compared to their low-fit peers. Our findings suggest that aerobic fitness is linked to cortical brain development in male adolescents, and that more research is warranted to determine how an individual's genes may influence these relationships. PMID:27445764

  19. Aerobic Fitness Linked to Cortical Brain Development in Adolescent Males: Preliminary Findings Suggest a Possible Role of BDNF Genotype

    PubMed Central

    Herting, Megan M.; Keenan, Madison F.; Nagel, Bonnie J.

    2016-01-01

    Aerobic exercise has been shown to impact brain structure and cognition in children and adults. Exercise-induced activation of a growth protein known as brain derived neurotrophic factor (BDNF) is thought to contribute to such relationships. To date, however, no study has examined how aerobic fitness relates to cortical brain structure during development and if BDNF genotype moderates these relationships. Using structural magnetic resonance imaging (MRI) and FreeSurfer, the current study examined how aerobic fitness relates to volume, thickness, and surface area in 34 male adolescents, 15 to 18 years old. Moreover, we examined if the val66met BDNF genotype moderated these relationships. We hypothesized that aerobic fitness would relate to greater thickness and volumes in frontal, parietal, and motor regions, and that these relationships would be less robust in individuals carrying a Met allele, since this genotype leads to lower BDNF expression. We found that aerobic fitness positively related to right rostral middle frontal cortical volume in all adolescents. However, results also showed BDNF genotype moderated the relationship between aerobic fitness and bilateral medial precuneus surface area, with a positive relationship seen in individuals with the Val/Val allele, but no relationship detected in those adolescents carrying a Met allele. Lastly, using self-reported levels of aerobic activity, we found that higher-fit adolescents showed larger right medial pericalcarine, right cuneus and left precuneus surface areas as compared to their low-fit peers. Our findings suggest that aerobic fitness is linked to cortical brain development in male adolescents, and that more research is warranted to determine how an individual’s genes may influence these relationships. PMID:27445764

  20. Infant circumcision: the last stand for the dead dogma of parental (sovereignal) rights.

    PubMed

    Van Howe, Robert S

    2013-07-01

    J S Mill used the term 'dead dogma' to describe a belief that has gone unquestioned for so long and to such a degree that people have little idea why they accept it or why they continue to believe it. When wives and children were considered chattel, it made sense for the head of a household to have a 'sovereignal right' to do as he wished with his property. Now that women and children are considered to have the full complement of human rights and slavery has been abolished, it is no longer acceptable for someone to have a 'right' to completely control the life of another human being. Revealingly, parental rights tend to be invoked only when parents want to do something that is arguably not in their child's best interest. Infant male circumcision is a case in point. Instead of parental rights, I claim that parents have an obligation to protect their children's rights as well as to preserve the future options of those children so far as possible. In this essay, it is argued that the notion that parents have a right to make decisions concerning their children's bodies and minds-irrespective of the child's best interests-is a dead dogma. The ramifications of this argument for the circumcision debate are then spelled out and discussed. PMID:23698886

  1. Rationalising circumcision: from tradition to fashion, from public health to individual freedom--critical notes on cultural persistence of the practice of genital mutilation.

    PubMed

    Hellsten, S K

    2004-06-01

    Despite global and local attempts to end genital mutilation, in their various forms, whether of males or females, the practice has persisted throughout human history in most parts of the world. Various medical, scientific, hygienic, aesthetic, religious, and cultural reasons have been used to justify it. In this symposium on circumcision, against the background of the other articles by Hutson, Short, and Viens, the practice is set by the author within a wider, global context by discussing a range of rationalisations used to support different types of genital mutilation throughout time and across the globe. It is argued that in most cases the rationalisations invented to provide support for continuing the practice of genital mutilation--whether male or female--within various cultural and religious settings have very little to do with finding a critical and reflective moral justification for these practices. In order to question the ethical acceptability of the practice in its non-therapeutic forms, we need to focus on child rights protection.

  2. Popular perceptions of circumcision among Colombian men who have sex with men

    PubMed Central

    Gonzales, Felisa A.; Zea, Maria Cecilia; Reisen, Carol A.; Bianchi, Fernanda T.; Rodríguez, Carlos Fabian Betancourt; Pardo, Marcela Aguilar; Poppen, Paul J.

    2012-01-01

    Circumcision has received increased attention for its potential to reduce sexual transmission of HIV. Research on the acceptability of circumcision as a means of HIV prevention among MSM is virtually non-existent. Men who have sex with men (MSM) in Bogotá, Colombia either participated in a focus group in which they shared information regarding their perceptions of circumcision, or completed a survey which assessed circumcision experiences, attitudes, beliefs, and willingness. Few participants reported they were circumcised, yet most participants reported knowing something about the procedure. Overall, attitudes towards circumcision were mixed: although circumcision was viewed as safe, it was also viewed as unnatural and cruel to babies. Beliefs that circumcision could improve sexual functioning and protect against STIs and HIV were not widely endorsed by survey participants, although focus group participants discussed the potential impacts of circumcision on the availability of sexual partners and sexual performance. Some focus group participants and many survey participants reported a hypothetical willingness to get circumcised if strong evidence of its effectiveness could be provided, barriers removed, and recovery time minimised. PMID:22917475

  3. [CIRCUMCISION AND EXCISION: TOWARDS A NON-LAW OF BIOETHICS?].

    PubMed

    Delage, Pierre-Jérôme

    2015-07-01

    This article defines the practices of circumcision and excision, and studies their foundations. Then, it considers some of the conflicts (of rights, laws and cultures) inherent to these practices. Finally, it suggests that the solution to these conflicts may not lie in the law, but in a non-law of bioethics. PMID:27356346

  4. Is V-Y plasty necessary for penile lengthening? Girth enhancement and increased length solely through circumcision: description of a novel technique.

    PubMed

    Mertziotis, Nikos; Kozyrakis, Diomidis; Bogris, Elias

    2013-11-01

    Our objective is to describe a novel ligamentolysis approach using a subcoronal incision technique and to determine its safety and efficacy. During the last 7 years, 82 consecutive patients had penile augmentation surgery. Ligamentolysis, through a lower abdominal incision (V-Y plasty) in the first 35 males, was performed (Group A), followed by circumcision ligamentolysis in the next 47 males (Group B). The operation time, complications, and the preoperative and postoperative values of penile length and girth along with the self-esteem and relations questionnaire score as well as satisfaction score was calculated before and after the surgery, and a comparison was conducted between the groups. The mean age at presentation was 32 years (range: 18-56 years). Seventy-nine patients suffered from penile dysmorphophobia, and three patients had micropenises (length <7.5 cm). The mean surgical times were 150.7 and 125.2 min for Groups A and B, respectively (P=0.005). Postoperatively, four Group A patients and three Group B patients (11% versus 6%, respectively) experienced penile retraction (P=0.453). Hypertrophic scars were observed in 18 men (51%) in the former [corrected] group. In the circumcision group, no major wound complications were recorded. The length and girth improvements between the groups were similar. In terms of satisfaction and SEAR improvement, the resulting difference for both variables favored the circumcision group (P=0.007 and <0.001, respectively). With strict selection criteria, the circumcision ligamentolysis procedure compared to the V-Y plasty demonstrated improved results in terms of safety, operation time, retraction rate and cosmetic appearance without any compromise in the gained penile size. PMID:23792340

  5. Correlates of disordered eating attitudes among male and female young talented dancers: findings from the UK centres for advanced training.

    PubMed

    Nordin-Bates, Sanna M; Walker, Imogen J; Redding, Emma

    2011-01-01

    Correlates of disordered eating attitudes were examined with a mixed-sex sample of 347 young talented dancers aged 10-18 years from all UK Centres for Advanced Training. Equal proportions of females (7.3%) and males (7.6%) were symptomatic for disordered eating but correlates differed: for females, self-evaluative perfectionism, waking up > twice/night and hours of non-dance physical activity were predictive while for males, only the combination of self-evaluative and conscientious perfectionism was significant. Differences between menstrual status groups were evident, with young dancers (pre-menarcheal/within first year of menarche) reporting the least disordered eating attitudes and those with dysfunctional menses reporting the most.

  6. The Structure of Male Adolescent Peer Networks and Risk for Intimate Partner Violence Perpetration: Findings from a National Sample

    PubMed Central

    Casey, Erin A.; Beadnell, Blair

    2015-01-01

    Although peer networks have been implicated as influential in a range of adolescent behaviors, little is known about relationships between peer network structures and risk for intimate partner violence (IPV) among youth. This study is a descriptive analysis of how peer network “types” may be related to subsequent risk for IPV perpetration among adolescents using data from 3,030 male respondents to the National Longitudinal Study of Adolescent Health. Sampled youth were a mean of 16 years of age when surveyed about the nature of their peer networks, and 21.9 when asked to report about IPV perpetration in their adolescent and early adulthood relationships. A latent class analysis of the size, structure, gender composition and delinquency level of friendship groups identified four unique profiles of peer network structures. Men in the group type characterized by small, dense, mostly male peer networks with higher levels of delinquent behavior reported higher rates of subsequent IPV perpetration than men whose adolescent network type was characterized by large, loosely connected groups of less delinquent male and female friends. Other factors known to be antecedents and correlates of IPV perpetration varied in their distribution across the peer group types, suggesting that different configurations of risk for relationship aggression can be found across peer networks. Implications for prevention programming and future research are addressed. PMID:20422351

  7. How boys become dogs: stigmatization and marginalization of uninitiated xhosa males in East London, South Africa.

    PubMed

    Mavundla, Thandisizwe R; Netswera, Fulufhelo G; Toth, Ferenc; Bottoman, Brian; Tenge, Stembele

    2010-07-01

    Male circumcision is practiced in South Africa among the Xhosa people as a rite of passage from boyhood to manhood. The manhood status achieved after the ritual accords men power and authority in the community over women and uncircumcised men. Therefore, uninitiated men experience great pressures to get circumcised. We describe the experience of newly initiated Xhosa men in East London, South Africa. Interpretive phenomenology was used as the inquiry of choice. Data were collected through focus group discussions in which 14 men participated. The theme of marginalization of uninitiated Xhosa males emerged with two categories: (a) rejection, and (b) lack of respect. The participants revealed that uninitiated men are rejected by the community, their own families, friends, and women. We frame the discussion around the concept of stigma. Acknowledging that uninitiated males are stigmatized can help mitigate stigma, and in turn, the incidence of medical complications from botched circumcisions. PMID:20363954

  8. Coping with Aversive Stimulation in the Neonatal Period: Quiet Sleep and Plasma Cortisol Levels during Recovery from Circumcision.

    ERIC Educational Resources Information Center

    Gunnar, Megan R.; And Others

    1985-01-01

    Determines the time course of circulating cortisol following circumcision in 80 healthy newborns and investigates whether changes in behavioral state following circumcision in anyway paralleled the adrenocortical time course. Adrenocortical and behavioral data indicated that subjects were able to cope with circumcision trauma. Cortisol levels…

  9. Shared Decision Making for Routine Infant Circumcision: A Pilot Study

    PubMed Central

    Mitchell, Teri M.; Beal, Claudia

    2015-01-01

    ABSTRACT It is important that expectant parents receive accurate information about the benefits and risks of circumcision as well as the benefits and risks of having an intact foreskin when making a decision about routine infant circumcision (RIC). A pilot study was conducted using the shared decision making (SDM) conceptual model to guide expectant parents through a 3-phase decision-making program about RIC as part of their childbirth education class. The participants showed a high level of preparedness following each of the 3 phases. Preparedness score were highest for those who decided to keep their expected sons’ penises natural. This SDM program was an effective way of guiding expectant parents through the decision-making process for RIC. PMID:26834440

  10. Circumcision using CO2 laser: report of 860 cases

    NASA Astrophysics Data System (ADS)

    Chen, Wen B.; Chen, Zi-Fu; Zhan, Tian-qi; Gao, Xiang-Xun; Huang, Chao

    1993-03-01

    Eight-hundred-sixty cases of circumcision using CO2 laser are reported. The age of patients ranged from 9 - 65 years, with a mean age of 23.8 years. The technique was simple and can be quickly accomplished by a single operator. After local anesthesia the glans penis was protected by a protector. Then, circumcision was performed with a CO2 laser -- HeNe laser combined machine. There was an HeNe laser aiming system in this machine thus the surgeon had a three-dimensional visible indicator of the incision. The focusing CO2 laser beam was used for cutting the prepuce during the operation. There was almost no operative bleeding. All the patients needed no antibiotic postoperatively. Complications were minimal and satisfactory results were achieved.

  11. Disposable circumcision suture device: clinical effect and patient satisfaction.

    PubMed

    Lv, Bo-Dong; Zhang, Shi-Geng; Zhu, Xuan-Wen; Zhang, Jie; Chen, Gang; Chen, Min-Fu; Shen, Hong-Liang; Pei, Zai-Jun; Chen, Zhao-Dian

    2014-01-01

    In our experience patients undergoing circumcision are mostly concerned about pain and penile appearances. We conducted a prospective randomized trial to assess the benefits of a new disposable circumcision suture device (DCSD). A total of 942 patients were equally divided into three groups (conventional circumcision, Shang ring and disposable suture device group). Patients in the DCSD group were anesthetized with compound 5% lidocaine cream, the others with a 2% lidocaine penile block. Operation time, intra-operative blood loss, incision healing time, intra-operative and post-operative pain, the penile appearance and overall satisfaction degree were measured. Operation time and intra-operative blood loss were significantly lower in the Shang ring and suture device groups compared to the conventional group (P < 0.001). Intra-operative pain was less in the suture device group compared with the other two groups (P < 0.001); whereas post-operative pain was higher in the conventional group compared to the other two groups (P < 0.001). Patients in the suture device (80.57%) and Shang ring (73.57%) groups were more satisfied with penile appearances compared with the conventional circumcision group (20.06%, P < 0.05). Patients in suture device group also healed markedly faster than the conventional group (P < 0.01). The overall satisfaction rate was better in the suture device group (78.66%) compared with the conventional (47.13%) and Shang ring (50.00%) groups (P < 0.05). The combination of DCSD and lidocaine cream resulted in shorter operation and incision healing times, reduced intra-operative and post-operative pain and improved patient satisfaction with the cosmetic appearances. PMID:24759586

  12. A salvage operation for total penis amputation due to circumcision.

    PubMed

    Ince, Bilsev; Gundeslioglu, Ayse Ozlem

    2013-05-01

    Circumcision is one of the most common rituals in Jewish and Islamic cultures. It may also be performed for phimosis correction or the treatment of recurrent balanitis. Although circumcision is considered to be a technically easy and safe surgical procedure with no significant risk, it may lead to severe complications such as necrotizing fasciitis or total penis amputation. In this report, we present a case of penis amputation at two levels occurring with third-degree burns due to electrocautery during circumcision. Although penile replantation was attempted, it was unsuccessful due to burn damage to the veins. After restoration of the functional structures, the penis was buried in the inguinal area by reepithelization to maintain blood circulation. The recovery of the penis was successful. This case is presented as a novel example of groin flap surgery to achieve a functionally and aesthetically acceptable outcome in a salvage operation for a penis with significant traumatic injury, which has not been previously reported in the literature. PMID:23730602

  13. German law on circumcision and its debate: how an ethical and legal issue turned political.

    PubMed

    Aurenque, Diana; Wiesing, Urban

    2015-03-01

    The article aims to illuminate the recent debate in Germany about the legitimacy of circumcision for religious reasons. The aim is both to evaluate the new German law allowing religious circumcision, and to outline the resulting conflict between the surrounding ethical and legal issues. We first elucidate the diversity of legal and medical views on religious circumcision in Germany. Next we examine to what extent invasive and irreversible physical interventions on infant boys unable to given their consent should be carried out for non-medical reasons. To this end, the potential benefits and harms of circumcision for non-medical reasons are compared. We argue that circumcision does not provide any benefits for the 'child as a child' and poses only risks to boys. We then set out to clarify and analyse political (rather than ethical) justifications of the new circumcision law. We demonstrate through this analysis how the circumcision debate in Germany has been transformed from a legal and ethical problem into a political issue, due at least in part to Germany's unique historical context. Although such a particular political sensibility is entirely comprehensible, it raises particular problems when it comes to framing and responding to medical ethical issues - as in the case of religious circumcision.

  14. German law on circumcision and its debate: how an ethical and legal issue turned political.

    PubMed

    Aurenque, Diana; Wiesing, Urban

    2015-03-01

    The article aims to illuminate the recent debate in Germany about the legitimacy of circumcision for religious reasons. The aim is both to evaluate the new German law allowing religious circumcision, and to outline the resulting conflict between the surrounding ethical and legal issues. We first elucidate the diversity of legal and medical views on religious circumcision in Germany. Next we examine to what extent invasive and irreversible physical interventions on infant boys unable to given their consent should be carried out for non-medical reasons. To this end, the potential benefits and harms of circumcision for non-medical reasons are compared. We argue that circumcision does not provide any benefits for the 'child as a child' and poses only risks to boys. We then set out to clarify and analyse political (rather than ethical) justifications of the new circumcision law. We demonstrate through this analysis how the circumcision debate in Germany has been transformed from a legal and ethical problem into a political issue, due at least in part to Germany's unique historical context. Although such a particular political sensibility is entirely comprehensible, it raises particular problems when it comes to framing and responding to medical ethical issues - as in the case of religious circumcision. PMID:24372097

  15. Circumcision with Glubran® 2 in children: experience of Italian Center

    PubMed Central

    Cerchia, Elisa; Molinaro, Francesco; Bulotta, Anna Lavinia; Ferrara, Francesco; Bindi, Edoardo; Messina, Mario

    2016-01-01

    Background Circumcision is one of the most common surgical procedures in the world. Despite it is known its wide prevalence for religious and medical reasons in children, it remains a controversial practice in paediatric age. To date, there is no described the gold standard technique to circumcise paediatric patients. We started to use glue for circumcision about 2 years ago. We designed this prospective study with the aim to compare two surgical techniques, which were used in our hospital to perform circumcision in children. The implication for practice was the understanding if there were differences between these approaches related to patient’s and parents benefits to manage this condition and benefits for surgeon and hospital in term of saving money and time. Methods This is a randomized, single-blind one-center study. It was conducted at the Department of Paediatric Surgery of Siena. Data were collected between March 2011 and December 2012. Study’s population involved all patients who required circumcision. Two randomizes groups: group one which involved patients who underwent circumcision using sutures and group two, which involved patients who underwent circumcision using surgical glue (Glubran® 2). Two exclusion criteria were used: the redo-circumcision and the allergy or hyper-sensibility to cyanoacrylate (main component of glue). Results We report 99 patients who underwent circumcision with Glubran® 2 in comparison with a group of children circumcised with sutures (vycril rapide). We measured three outcomes (operating time, postoperative pain and assessment of cosmetic), which, even if not all statistically significant, allowed us to draw any conclusions about the use of glue in circumcision. Conclusions Traditional circumcision is performed using a standard sleeve technique with sutures for the approximation of the skin edges. However, since some years a tissue adhesive as N-butyl-2-cyanoacrylate (NBCA) (Glubran® 2) is used in many centers to

  16. Perceptions of the PrePex Device Among Men Who Received or Refused PrePex Circumcision and People Accompanying Them

    PubMed Central

    Taruberekera, Noah; Martinson, Neil; Lebina, Limakatso

    2016-01-01

    Background: The PrePex medical male circumcision (MMC) device has been approved for MMC scale-up. However, the WHO has recommended that a country-specific situation analysis should be carried out before MMC device rollout. Method: A cross-sectional survey was conducted over 12 months in 3 MMC clinics, by trained nurses and researchers, to ascertain attitudes toward PrePex MMC in 3 groups: men consenting for PrePex MMC (PrePex recipients), people accompanying men, and adolescents coming for either PrePex or surgical circumcision (MMC escorts) and men refusing the PrePex device MMC (PrePex rejecters). All participants received information on surgical and the PrePex device MMC methods. Results: A total of 312 PrePex recipients, 117 MMC escorts, and 21 PrePex rejecters were recruited into the study. Ninety-nine percent of PrePex recipients thought that their expectations (safe, convenient, minimal pain) were met, and they were pleased with cosmetic outcome. Fifty-nine percent of PrePex rejecters opted for surgical circumcision because they perceived PrePex to be novel and risky. All 3 groups of participants were concerned about odor, dead skin, discomfort, healing time, and wound care. Ninety-eight percent of MMC escorts, 99% of PrePex recipient, and 81% of PrePex rejecters perceived PrePex circumcision as an acceptable option for South African MMC programmes. Conclusions: This acceptability study suggests that PrePex MMC is considered safe and convenient and could be incorporated into existing MMC programmes. Concerns about odor, pain, wound care, and healing time suggest that the need for more research to further optimize methods and that MMC clients should be counseled on available methods to enable them to choose among options based on their preferences. PMID:27331596

  17. Men's Understanding of and Experiences During the Postcircumcision Abstinence Period: Results From a Field Study of ShangRing Circumcision During Routine Clinical Services in Kenya and Zambia

    PubMed Central

    Li, Philip S.; Zulu, Robert; Awori, Quentin D.; Agot, Kawango; Combes, Stephanie; Simba, Raymond O.; Lee, Richard K.; Hart, Catherine; Lai, Jaim Jou; Zyambo, Zude; Goldstein, Marc; Feldblum, Paul J.; Sokal, David C.

    2016-01-01

    Background: Men's understanding of counseling messages after voluntary medical male circumcision (VMMC) plays an important role in whether they follow them. Data on triggers for early resumption of sex may be useful as scale-up of VMMC for HIV prevention continues in sub-Saharan Africa. Methods: Data on understanding of post-VMMC abstinence recommendations, resumption of sex, condom use, and triggers for resuming sex were collected from participants during a follow-up interview 35–42 days after ShangRing circumcision in Kenya and Zambia. Results: Of 1149 men who had ShangRing circumcision, 1096 (95.4%) completed follow-up. Nearly all (99.2%) reported being counseled to abstain from sex post-VMMC; among those, most (92.2%) recalled the recommended abstinence period was 6 weeks. Most men (94.1%) reported that the counselor gave reasons for post-VMMC abstinence and recalled appropriate reasons. Few (13.4%) men reported resuming sex at 35–42 days' follow-up. Among those, 54.8% reported never using a condom post-VMMC. Younger participants (odds ratio 0.3, 95% confidence interval: 0.2 to 0.5, P < 0.0001) and those reporting at least some condom use at baseline (odds ratio 0.5, 95% confidence interval: 0.3 to 0.7, P = 0.0003) were less likely to report resuming sex. Among men who reported some condom use, most (71.5%) said condoms were much easier or easier to use after circumcision. Men reported various reasons for early resumption of sex, primarily strong sexual desire (76.4%). Conclusions: Most men reported awareness of and adherence to the counseling recommendations for post-VMMC abstinence. A minority reported early resumption of sex, and, among those, condom use was low. Results could be used to improve post-VMMC counseling. PMID:27331585

  18. Occupational segregation, gender essentialism and male primacy as major barriers to equity in HIV/AIDS caregiving: Findings from Lesotho

    PubMed Central

    2011-01-01

    Background Gender segregation of occupations, which typically assigns caring/nurturing jobs to women and technical/managerial jobs to men, has been recognized as a major source of inequality worldwide with implications for the development of robust health workforces. In sub-Saharan Africa, gender inequalities are particularly acute in HIV/AIDS caregiving (90% of which is provided in the home), where women and girls make up the informal (and mostly unpaid) workforce. Men's and boy's entry into HIV/AIDS caregiving in greater numbers would both increase the equity and sustainability of national and community-level HIV/AIDS caregiving and mitigate health workforce shortages, but notions of gender essentialism and male primacy make this far from inevitable. In 2008 the Capacity Project partnered with the Lesotho Ministry of Health and Social Welfare in a study of the gender dynamics of HIV/AIDS caregiving in three districts of Lesotho to account for men's absence in HIV/AIDS caregiving and investigate ways in which they might be recruited into the community and home-based care (CHBC) workforce. Methods The study used qualitative methods, including 25 key informant interviews with village chiefs, nurse clinicians, and hospital administrators and 31 focus group discussions with community health workers, community members, ex-miners, and HIV-positive men and women. Results Study participants uniformly perceived a need to increase the number of CHBC providers to deal with the heavy workload from increasing numbers of patients and insufficient new entries. HIV/AIDS caregiving is a gender-segregated job, at the core of which lie stereotypes and beliefs about the appropriate work of men and women. This results in an inequitable, unsustainable burden on women and girls. Strategies are analyzed for their potential effectiveness in increasing equity in caregiving. Conclusions HIV/AIDS and human resources stakeholders must address occupational segregation and the underlying gender

  19. Involvement in Specific HIV Risk Practices among Men Who Use the Internet to Find Male Partners for Unprotected Sex

    PubMed Central

    2013-01-01

    Purpose. Men who have sex with other men (MSM) account for more than one-half of all new HIV infections in the USA. This study reports on the prevalence of a variety of HIV risk behaviors in one specific subpopulation of risk-seeking MSM. Methods. The study was based on a national sample of 332 MSM who use the Internet to find partners for unprotected sex. Data collection was conducted via telephone interviews between January 2008 and May 2009. Results. Unprotected oral and anal sex was commonplace among study participants. Men engaged in a large number of other risky behaviors as well, including having had multiple recent sex partners (mean number = 11), simultaneous double-penile penetration of the anus (16%), eating semen out of another man's anus (17%), engaging in multiple-partner sexual encounters (47%), engaging in anonymous sex (51%), and having sex while “under the influence” (52%). Conclusions. HIV intervention and prevention programs need to address numerous behaviors that place MSM at risk for contracting/transmitting HIV. Merely focusing on unprotected anal sex does a disservice to members of this community, who typically engage in many types of behavioral risks, each of which requires addressing if HIV transmission rates are to be reduced. PMID:24826369

  20. Attitudes toward Female Circumcision among Men and Women in Two Districts in Somalia: Is It Time to Rethink Our Eradication Strategy in Somalia?

    PubMed Central

    Gele, Abdi A.; Bø, Bente P.; Sundby, Johanne

    2013-01-01

    Somalia has the highest global prevalence (98%) of female circumcision (FC), and, despite a long history of abandonment efforts, it is not clear as to whether or not these programmes have changed people's positive attitudes toward the practice. Against this background, this paper explores the attitudes of Somalis living in Hargeisa and Galkayo districts to the practice of FC. Methods. A purposive sampling of 24 Somalis, including activists and practitioners, men and women, was conducted in Somalia. Unstructured interviews were employed to explore the participants' knowledge of FC, their attitudes toward the continuation/discontinuation of the practice, and the type they want to continue or not to continue. Result. The findings of this qualitative study indicate that there is a strong resistance towards the abandonment of the practice in Somalia. The support for the continuation of Sunna circumcision is widespread, while there is a quite large rejection of Pharaonic circumcision. Conclusion. Therefore, since the “zero tolerance policy” has failed to change people's support for the continuation of the practice in Somalia, programmes that promote the pinch of the clitoral skin and verbal alteration of status, with the goal of leading to total abandonment of FC, should be considered for the Somali context. PMID:23710186

  1. Attitudes toward Female Circumcision among Men and Women in Two Districts in Somalia: Is It Time to Rethink Our Eradication Strategy in Somalia?

    PubMed

    Gele, Abdi A; Bø, Bente P; Sundby, Johanne

    2013-01-01

    Somalia has the highest global prevalence (98%) of female circumcision (FC), and, despite a long history of abandonment efforts, it is not clear as to whether or not these programmes have changed people's positive attitudes toward the practice. Against this background, this paper explores the attitudes of Somalis living in Hargeisa and Galkayo districts to the practice of FC. Methods. A purposive sampling of 24 Somalis, including activists and practitioners, men and women, was conducted in Somalia. Unstructured interviews were employed to explore the participants' knowledge of FC, their attitudes toward the continuation/discontinuation of the practice, and the type they want to continue or not to continue. Result. The findings of this qualitative study indicate that there is a strong resistance towards the abandonment of the practice in Somalia. The support for the continuation of Sunna circumcision is widespread, while there is a quite large rejection of Pharaonic circumcision. Conclusion. Therefore, since the "zero tolerance policy" has failed to change people's support for the continuation of the practice in Somalia, programmes that promote the pinch of the clitoral skin and verbal alteration of status, with the goal of leading to total abandonment of FC, should be considered for the Somali context.

  2. Attitudes toward and perceived psychosocial impact of female circumcision as practiced among the Bedouin-Arabs of the Negev.

    PubMed

    al-Krenawi, A; Wiesel-Lev, R

    1999-01-01

    The present pilot study examines attitudes toward and the perceived psychosocial impact of circumcision as practiced among the Bedouin-Arabs of the Negev, Israel. A convenience sample of 24 women participated in the study: 12 who had experienced the ritual, and 12 who had not, but who had witnessed or been told about the practice of the ritual on women in their extended families. Two research instruments were used: a structured questionnaire, and a semi-structured open-ended interview. Data showed differences in subject responses depending on the research tools. The structured questionnaire revealed that women who had experienced the circumcision gave legitimization and cognitive rationalization to it. In contrast, the semi-structured interview revealed that these same subjects reported insult: traumatization, direct negative influences, and narcissistic insult, and described emotional difficulties during the research interviews. The findings indicated that they had difficulties in mother-daughter relationships and trust. Implications of the ritual on the continuity of polygamy and marital/sexual problems are discussed.

  3. Risk Factors for Urethral Condyloma among Heterosexual Young Male Patients with Condyloma Acuminatum of Penile Skin

    PubMed Central

    2016-01-01

    To our knowledge, this is the first study that focuses on risk factor of urethral condyloma (UC). The subjects of our study included genital warts patients who had been diagnosed as having condyloma acuminatum of penile skin (CAPS) with/without UC. Relationship with UC of number of life time female partners, co-infection with urethritis, circumcision status, number of CAPS and wart diameter were studied by use of multivariate analysis. Co-infection with urethritis, circumcision status were risk factors of UC in heterosexual young male patients with CAPS. This information will be helpful for providing more professional counseling to patients with genital warts. PMID:27659432

  4. Somatosensory evoked potentials assess the efficacy of circumcision for premature ejaculation.

    PubMed

    Xia, J-D; Jiang, H-S; Zhu, L-L; Zhang, Z; Chen, H; Dai, Y-T

    2016-07-01

    To assess the efficacy and mechanism of circumcision in the treatment of premature ejaculation (PE) with redundant prepuce, we enrolled a total of 81 PE patients who received circumcision. The patients' ejaculatory ability and sexual performances were evaluated before and after circumcision by using questionnaires (Intravaginal ejaculation latency time (IELT), Chinese Index of PE with 5 questions (CIPE-5) and International Index of Erectile function- 5 (IIEF-5)). Furthermore, somatosensory evoked potentials (SEPs) including dorsal nerve (DNSEP) and glans penis (GPSEP) of the patients were also measured. The mean IELTs of preoperation and post operation were 1.10±0.55 and 2.48±2.03 min, respectively (P<0.001). In addition, the geometric mean IELT after operation was 2.16 min, compared with the baseline 1.07 min before the operation, the fold increase of the IELT was 2.02. Compared with the uncircumcised status, scores of CIPE-5 showed a significant increase after circumcision (P<0.001). The mean latencies (and amplitudes) of GPSEP and DNSEP were 38.1±4.0 ms (3.0±1.9 uV) and 40.5±3.4 ms (2.8±1.6 uV) before circumcision, respectively; and 42.8±3.3 ms (2.8±1.6 uV) and 40.5±4.1 ms (2.4±1.2 uV) in the follow-up end point after circumcision. Only the latencies of GPSEP showed significant prolongation before and after circumcision (P<0.001). The ejaculation time improvement after circumcision is so small, and equal to placebo response, therefore it could not be interpreted as a therapeutic method in men with PE.

  5. Somatosensory evoked potentials assess the efficacy of circumcision for premature ejaculation.

    PubMed

    Xia, J-D; Jiang, H-S; Zhu, L-L; Zhang, Z; Chen, H; Dai, Y-T

    2016-07-01

    To assess the efficacy and mechanism of circumcision in the treatment of premature ejaculation (PE) with redundant prepuce, we enrolled a total of 81 PE patients who received circumcision. The patients' ejaculatory ability and sexual performances were evaluated before and after circumcision by using questionnaires (Intravaginal ejaculation latency time (IELT), Chinese Index of PE with 5 questions (CIPE-5) and International Index of Erectile function- 5 (IIEF-5)). Furthermore, somatosensory evoked potentials (SEPs) including dorsal nerve (DNSEP) and glans penis (GPSEP) of the patients were also measured. The mean IELTs of preoperation and post operation were 1.10±0.55 and 2.48±2.03 min, respectively (P<0.001). In addition, the geometric mean IELT after operation was 2.16 min, compared with the baseline 1.07 min before the operation, the fold increase of the IELT was 2.02. Compared with the uncircumcised status, scores of CIPE-5 showed a significant increase after circumcision (P<0.001). The mean latencies (and amplitudes) of GPSEP and DNSEP were 38.1±4.0 ms (3.0±1.9 uV) and 40.5±3.4 ms (2.8±1.6 uV) before circumcision, respectively; and 42.8±3.3 ms (2.8±1.6 uV) and 40.5±4.1 ms (2.4±1.2 uV) in the follow-up end point after circumcision. Only the latencies of GPSEP showed significant prolongation before and after circumcision (P<0.001). The ejaculation time improvement after circumcision is so small, and equal to placebo response, therefore it could not be interpreted as a therapeutic method in men with PE. PMID:27193064

  6. Neonatal circumcision in severe haemophilia: a survey of paediatric haematologists at United States Hemophilia Treatment Centers.

    PubMed

    Kearney, S; Sharathkumar, A; Rodriguez, V; Chitlur, M; Valentino, L; Boggio, L; Gill, J

    2015-01-01

    Neonatal circumcision in patients with severe haemophilia has not been well studied. We performed a survey of paediatric haematologists from Hemophilia Treatment Centers (HTC) across the United States to better understand the attitudes toward and management of neonatal circumcision in haemophilia patients. Response rate to our survey was 40% (n = 64/159). Thirty-eight percent of respondents (n = 24) said that they would allow this procedure in the newborn period but in many cases this was against medical advice. The most reported concern regarding neonatal circumcision in haemophilia patients was the risk of development of an inhibitor (n = 25; 39%) followed by the concern for bleeding (n = 22; 34%) and issues related to vascular access in the neonate (n = 11; 17%). All respondents recommended at least one preprocedure dose of factor replacement. Twenty-two percent (n = 14) of respondents did not use more than one dose of factor replacement but 32% (n = 21) used 1-2 postoperative doses. The remainder of paediatric haematologists surveyed recommended between 3-5 (16%; n = 10) and 6-10 (3%, n = 2) additional days postoperatively. There was wide variation in both techniques of circumcision as well as adjuvant haemostatic agents used. Only 22% of respondents said that they had an established protocol for management of circumcision in the newborn haemophilia patient. These survey results highlight the need for evidence-based guidelines regarding the optimal management of circumcision in neonates with severe haemophilia.

  7. Plastibell circumcision supported by a calcium-alginate fibre dressing to reduce bleeding

    PubMed Central

    Pillai, Ravisankar G.; Al Naieb, Ziad

    2015-01-01

    Objective To assess the benefit of a new technique of a Plastibell circumcision supported by a ventral calcium-alginate fibre dressing, to reduce bleeding from the frenular vessels, the commonest complication of Plastibell circumcision. Patients and methods This was a retrospective study of 200 neonates circumcised in the Royal Bahrain Hospital over a 2-year period from 2012 to 2014. They had a standard Plastibell circumcision, but a calcium-alginate fibre dressing (Hypo-sorb, Plastod, Italy) was placed over the glans and under the foreskin, to help control bleeding from the frenular vessels. Results Circumcision using the calcium-alginate fibre dressing reduced the bleeding complication rate to zero. The delayed separation of the bell was 2.9% when using the new technique and 2.5% from our previous data. There were no cases of urinary retention reported, compared to two in the previous results. Conclusion A Plastibell circumcision supported by the calcium-alginate fibre dressing was a safe technique to reduce bleeding. PMID:26413343

  8. Examining Differences in Types and Location of Recruitment Venues for Young Males and Females from Urban Neighborhoods: Findings from a Multi-Site HIV Prevention Study

    PubMed Central

    Chutuape, Kate S.; Ziff, Mauri; Auerswald, Colette; Castillo, Marné; McFadden, Antionette

    2008-01-01

    Finding and accessing members of youth subpopulations, such as young men who have sex with men (YMSM) of color or young females of color, for behavioral or disease surveillance or study recruitment, pose particular challenges. Venue-based sampling strategies—which hinge on where individuals congregate or “hang out” rather than where they live—appear to be effective alternatives. Methods used to identify venues focus on engaging members of social networks to learn where targeted populations congregate. However, it is not always clear if and how these methods differ according to gender, whether the youth accessed at a venue are actually from neighborhoods in which the venues are found, and whether the location of venues relative to neighborhoods of residence is different for young men and young women. This study illustrates the gender differences in venue type and venue location where eligible youth study participants from high-risk neighborhoods could be accessed for HIV research across 15 research sites (sites). The findings indicate that the study’s method led to identifying venues where one quarter or more of the youth were eligible study participants and from the high-risk neighborhoods. Sites targeting young women of color had a higher proportion of eligible study participants who were also from the high-risk neighborhoods than sites targeting YMSM. Clubs were most commonly identified by sites targeting YMSM as recruitment venues, whereas neighborhood-based service or commercial centers were more common venues for young women of color. This study reveals how venue-based recruitment strategies can be tailored and resources maximized by understanding the key differences in the types of venues preferred by males and females and by recognizing that female-preferred venues are more likely to be closer to home. PMID:18972210

  9. Penile herpes simplex virus type 1 infection presenting two and a half years after Jewish ritual circumcision of an infant.

    PubMed

    Yossepowitch, Orit; Gottesman, Tamar; Schwartz, Orna; Stein, Michal; Serour, Francis; Dan, Michael

    2013-06-01

    The association between Jewish ritual circumcision and genital herpes simplex virus type 1 infection has been well described. We report a case of genital herpes that first presented at the age of 2½ years. We believe that the infection was acquired asymptomatically through direct orogenital suction performed during circumcision in the newborn period.

  10. Effects of 8 weeks of military training on lower extremity and lower back clinical findings of young Iranian male recruits: A prospective case series

    PubMed Central

    Boroujeni, Amir Momeni; Yousefi, Elham; Moayednia, Amir; Tahririan, Mohammad Ali

    2014-01-01

    Background: In this prospective case series we have assessed the clinical effects of 8 weeks military training on the lower extremity of the recruits. Materials and Methods: Military recruits who met the eligibility criteria and gave informed consent were entered into the study. They were asked to fill out a self-reporting pain and functionality questionnaire before and after their training. They were also examined by a physician before and after their military training. The questionnaire and examination were concentrated on three blocs: lower back, knee, and foot. Results: Three-hundred and seventy-three study subjects were evaluated. The study showed that there is a significant difference in reporting lower back pain after the training compared to the rate of complaints prior to the training (P < 0.001), knee pain, and foot pain also increased significantly (P < 0.1 and P < 0.0001, respectively) The difference was most prominent in foot complaints. Physical examination also showed significant increase in lower extremity findings following the training (P < 0.05). Conclusion: Our study shows that there is a need for a new approach to military training of male recruits in Iran in order to minimize the adverse health effects. PMID:24600600

  11. Rare diploid females coexist with rare males: a novel finding in triploid parthenogenetic populations in the psyllid Cacopsylla myrtilli (W. Wagner, 1947) (Hemiptera, Psylloidea) in northern Europe.

    PubMed

    Nokkala, C; Kuznetsova, V G; Nokkala, S

    2015-10-01

    Using a cytological approach, diploid females were found coexisting with rare males in triploid apomictic parthenogenetic populations of the psyllid Cacopsylla myrtilli (W. Wagner, 1947) in Norway, Sweden, Finland and northwest Russia. Diploid females were easily distinguished from triploid apomictic females by the presence of 13 chiasmate bivalents instead of 39 univalent chromosomes at metaphase I. Abundance equaled that of males, but the proportion of males and diploid females was significantly greater in high altitude compared with low altitude populations. Males mated with females but showed no mating preference for diploid females. Lack of genuine bisexual reproduction owing to either asynaptic meiosis in males, or rarity of males with normal meiosis, suggests that diploids are produced in every generation by parthenogenetic females as reversals from triploidy, with their production being enhanced by environmental factor(s) associated with high altitude. This is further supported by the observation that within a population the COI haplotype found in rare males was the same as that in parthenogenetic triploid females. Thus, in northern Europe parthenogenesis in C. myrtilli is obligate, geographic parthenogenesis. Bisexual populations of C. myrtilli should be looked for in Central and Southern Europe. From the evolutionary point of view, the presence of males and diploid females with normal meiosis in parthenogenetic populations could be significant as they exhibit the potential to re-evolve either a new sexual species of parthenogenetic ancestry or a new parthenogenetic species by contagious parthenogenesis.

  12. Does Grade Level Relate to School-Based Youth Health Center Utilization among Male Youth? Quantitative Findings from a Mixed-Methods Study in Nova Scotia, Canada

    ERIC Educational Resources Information Center

    Gahagan, Jacqueline C.; Jason, Timothy; Leduc, Derek

    2012-01-01

    Background: Male adolescents underutilize youth health centers' (YHC) services despite facing a variety of significant health issues. The purpose of our study was to explore adolescent males' perceptions of health service needs, utilization of YHC services, and barriers and facilitators for such utilization as a function of school grade…

  13. The Preliminary Findings of a Study Exploring the Perceptions of a Sample of Young Heterosexual Males regarding HIV Prevention Education Programming in Nova Scotia, Canada

    ERIC Educational Resources Information Center

    Gahagan, Jacqueline; Rehman, Laurene; Barbour, Laura; McWilliam, Susan

    2007-01-01

    Despite the increasing numbers of young Canadian females becoming infected with HIV through heterosexual transmission with an infected male sexual partner, the majority of current HIV prevention programs and services in Canada continue to ignore the needs of young heterosexual males. This research is derived from 30 in-depth interviews, 9 focus…

  14. Associations between birth characteristics and eating disorders across the life course: findings from 2 million males and females born in Sweden, 1975-1998.

    PubMed

    Goodman, Anna; Heshmati, Amy; Malki, Ninoa; Koupil, Ilona

    2014-04-01

    Birth characteristics predict a range of major physical and mental disorders, but findings regarding eating disorders are inconsistent and inconclusive. This total-population Swedish cohort study identified 2,015,862 individuals born in 1975-1998 and followed them for anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified until the end of 2010. We examined associations with multiple family and birth characteristics and conducted within-family analyses to test for maternal-level confounding. In total, 1,019 males and 15,395 females received an eating disorder diagnosis. Anorexia nervosa was independently predicted by multiple birth (adjusted hazard ratio = 1.33, 95% confidence interval: 1.15, 1.53) for twins or triplets vs. singletons) and lower gestational age (adjusted hazard ratio = 0.96, 95% confidence interval: 0.95, 0.98) per extra week of gestation, with a clear dose-response pattern. Within-family analyses provided no evidence of residual maternal-level confounding. Higher birth weight for gestational age showed a strong, positive dose-response association with bulimia nervosa (adjusted hazard ratio = 1.15, 95% confidence interval: 1.09, 1.22, per each standard-deviation increase), again with no evidence of residual maternal-level confounding. We conclude that some perinatal characteristics may play causal, disease-specific roles in the development of eating disorders, including via perinatal variation within the normal range. Further research into the underlying mechanisms is warranted. Finally, several large population-based studies of anorexia nervosa have been conducted in twins; it is possible that these studies considerably overestimate prevalence.

  15. Glans ischemia after circumcision and dorsal penile nerve block: Case report and review of the literature

    PubMed Central

    Garrido-Abad, Pablo; Suárez-Fonseca, Carlos

    2015-01-01

    Circumcision is an easy commonly performed surgical procedure in childhood. However, it is not free of a low number of complications, (1-5-5%). Here we report a case of a 3-year-old boy with glans superficial necrosis after circumcision, managed with topical (nitroglycerin, gentamicin), oral (pentoxifylline) and epidural (urgent caudal block with bupivacaine) treatment. A review of the literature and the different treatments reported by other authors was done. After 7 days of treatment, local signs of ischemia and severe pain disappeared, without adverse events related to treatment. Although the ischemia or necrosis of the glans after circumcision are rare, we may suspect them in case of presence of severe acute pain or dark color. We report the successful management of this complication. PMID:26692685

  16. Religious circumcision, invasive rites, neutrality and equality: bearing the burdens and consequences of belief.

    PubMed

    Johnson, Matthew Thomas

    2013-07-01

    The decision of the German regional court in Cologne on 26 June 2012 to prohibit the circumcision of minors is important insofar as it recognises the qualitative similarities between the practice and other prohibited invasive rites, such as female genital cutting. However, recognition of similarity poses serious questions with regard to liberal public policy, specifically with regard to the exceptionalist treatment demanded by certain circumcising groups. In this paper, I seek to advance egalitarian means of dealing with invasive rites which take seriously cultural diversity, minimise harm and place responsibility for the burdens and consequences of beliefs upon those who promote practices.

  17. Australian midwives' perspectives on managing obstetric care of women living with female genital circumcision/mutilation.

    PubMed

    Ogunsiji, Olayide

    2016-10-01

    Female genital mutilation (FGM) or female circumcision is a global health issue with increasing international migration of affected women and girls to countries unfamiliar with the practice. Western health care providers are unfamiliar with FGM, and managing obstetric care presents challenges to midwives who are in the forefront of care provision for the women. The participants in this Heideggerian qualitative interpretive study elucidated the strategies they used in overcoming the particular physical, emotional, and gynecological health issues with which mutilated women present. Ongoing emphases on women-centered, culturally competent maternity care are germane to optimal maternity care of circumcised women.

  18. Reliability and Construct Validity of the Dutch Psychopathy Checklist: Youth Version--Findings from a Sample of Male Adolescents in a Juvenile Justice Treatment Institution

    ERIC Educational Resources Information Center

    Das, Jacqueline; de Ruiter, Corine; Doreleijers, Theo; Hillege, Sanne

    2009-01-01

    The present study examines the reliability and construct validity of the Dutch version of the Psychopathy Check List: Youth Version (PCL:YV) in a sample of male adolescents admitted to a secure juvenile justice treatment institution (N = 98). Hare's four-factor model is used to examine reliability and validity of the separate dimensions of…

  19. Sexual Health in Male and Female Iraq and Afghanistan U. S. War Veterans With and Without PTSD: Findings From the VALOR Cohort

    PubMed Central

    Breyer, Benjamin N.; Fang, Shona C.; Seal, Karen H.; Ranganathan, Gayatri; Marx, Brian P.; Keane, Terence M.; Rosen, Raymond C.

    2016-01-01

    We sought to determine whether posttraumatic stress disorder (PTSD) was associated with sexual health in returned warzone-deployed veterans from the recent Iraq and Afghanistan conflicts. We studied 1,581 males and females from the Veterans After-Discharge Longitudinal Registry, a gender-balanced U.S. Department of Veterans Affairs registry of health care-seeking veterans with and without PTSD. Approximately one quarter (25.1%) of males (n = 198) and 12.7% of females (n = 101) had a sexual dysfunction diagnosis and/or prescription treatment for sexual dysfunction. Both genders were more likely to have a sexual dysfunction diagnosis and/or prescription treatment if they had PTSD compared with those without PTSD (male: 27.3% vs. 21.1%, p = .054; female: 14.9% vs. 9.4%, p = .022). Among the 1,557 subjects analyzed here, males with PTSD had similar levels of sexual activity compared to those without PTSD (71.2% vs. 75.4%, p = .22), whereas females with PTSD were less likely to be sexually active compared to females without PTSD (58.7% vs. 72.1%, p < .001). Participants with PTSD were also less likely to report sex-life satisfaction (male: 27.6% vs. 46.0%, p < .001; female: 23.0% vs. 45.7%, p < .001) compared with those without PTSD. Although PTSD was not associated with sexual dysfunction after adjusting for confounding factors, it was significantly negatively associated with sex-life satisfaction in female veterans with a prevalence ratio of .71, 95% confidence interval [.57, .90]. PMID:27128485

  20. Relations between circumcision status, sexually transmitted infection history, and HIV serostatus among a national sample of men who have sex with men in the United States.

    PubMed

    Jozkowski, Kristen; Rosenberger, Joshua G; Schick, Vanessa; Herbenick, Debby; Novak, David S; Reece, Michael

    2010-08-01

    Circumcision's potential link to HIV/sexually transmitted infections (STI) has been at the center of recent global public health debates. However, data related to circumcision and sexual health remain limited, with most research focused on heterosexual men. This study sought to assess behavioral differences among a large sample of circumcised and noncircumcised men who have sex with men (MSM) in the United States. Data were collected from 26,257 U.S. MSM through an online survey. Measures included circumcision status, health indicators, HIV/STI screening and diagnosis, sexual behaviors, and condom use. Bivariate and regression analyses were conducted to determine differences between HIV/STI status, sexual behaviors, and condom use among circumcised and noncircumcised men. Circumcision status did not significantly predict HIV testing (p > 0.05), or HIV serostatus (p > 0.05), and there were no significant differences based on circumcision status for most STI diagnosis [syphilis, gonorrhea, chlamydia, human papilloma virus (HPV)]. Being noncircumcised was predictive of herpes-2 diagnosis, however, condom use mediated this relationship. These data provide one of the first large national assessments of circumcision among MSM. While being noncircumcised did not increase the likelihood of HIV and most STI infections, results indicated that circumcision was associated with higher rates of condom use, suggesting that those who promote condoms among MSM may need to better understand condom-related behaviors and attitudes among noncircumcised men to enhance the extent to which they are willing to use condoms consistently.

  1. Inconsistent condom use by male clients during anal intercourse with occasional and regular female sex workers (FSWs): survey findings from southern states of India

    PubMed Central

    Ramanathan, Shreena; Nagarajan, Karikalan; Ramakrishnan, Lakshmi; Mainkar, Mandar K; Goswami, Prabuddhagopal; Yadav, Diwakar; Sen, Shrabanti; George, Bitra; Rachakulla, Harikumar; Subramanian, Thilakavathi; Paranjape, Ramesh S

    2014-01-01

    Objectives Self-reported anal intercourse by female sex workers (FSWs) documented in recent studies from India range between 11.9% and 22%. However, comparable data on anal intercourse and condom use from male clients of FSWs is lacking. Using data from a bio-behavioural survey (2009–2010), we examined prevalence of anal intercourse, male clients’ self-reported inconsistent condom use during anal intercourse with FSWs, and correlates of this behaviour in India's high HIV prevalence southern states (Andhra Pradesh, Maharashtra and Tamil Nadu combined). Methods Using two-stage time location cluster sampling, we recruited 4803 clients of FSWs, ages 18–60 years, who had purchased sex from an FSW in the past month. After obtaining informed consent, respondents were interviewed and tested for HIV and sexually transmitted infections (syphilis, gonorrhoea and chlamydia). Logistic regression analysis was used to identify the factors associated with inconsistent condom use during anal intercourse (in the past 6 months) with FSWs. Results Overall, 12.3% clients reported anal intercourse in the past 6 months, of whom 48.4% used condoms inconsistently. Clients of FSWs who were ages 26 years or older (AOR 2.68, p=0.032); employed as manual labourers (AOR 2.43, p=0.013); consumed alcohol (AOR 2.63, p=0.001); reported five or more sex acts with FSWs in the past month (AOR 2.53, p=0.031); and perceived themselves to be at higher risk for HIV (AOR 4.82, p=0.001) were more likely to inconsistently use condoms during anal intercourse. Conclusions The results suggest that sex workers and their clients commonly practice anal intercourse, but a relatively high proportion of clients do not consistently use condoms, leading to a greater risk of acquiring HIV and its further transmission to other male and female sexual partners. Given the multidirectional risk, safer sex communication on heterosexual anal intercourse must be incorporated into HIV prevention programmes. PMID

  2. Distinct Relationships of Intramuscular and Subcutaneous Fat With Cortical Bone: Findings From a Cross-Sectional Study of Young Adult Males and Females

    PubMed Central

    Deere, K.; Sayers, A.; Viljakainen, H. T.; Lawlor, D. A.; Sattar, N.; Kemp, J. P.; Fraser, W. D.

    2013-01-01

    Context: Intracellular fat within muscle and visceral tissue has been suggested to adversely influence bone development. Objective: The aim of the study was to evaluate associations between im fat, as reflected by muscle density as measured by peripheral quantitative computed tomography, and cortical bone parameters in young adults. Design/Setting/Participants: We conducted a cross-sectional analysis of 1703 males and 2243 females aged 17.8 years from the Avon Longitudinal Study of Parents and Children. Outcome Measures: We measured cortical bone parameters from midtibial peripheral quantitative computed tomography scans. Results: Muscle density (inversely related to im fat) was inversely associated with periosteal circumference (PC) (beta = −0.07 [95% confidence interval (CI), −0.1, −0.04]), cortical bone mineral density (BMDC) (beta = −0.21 [95% CI, −0.26, −0.17]), and cortical thickness (CT) (beta = −0.37 [95% CI, −0.42, −0.33]) (males and females combined, adjusted for age, height, gender, and muscle cross-sectional area). In contrast, sc fat area was positively associated with PC (beta = 0.10 [95% CI, 0.07, 0.12]), but no association was seen with BMDC or CT. To examine the role of candidate intermediary metabolic pathways, analyses were repeated after adjustment for insulin, C-reactive protein, and β-C-telopeptides of type I collagen. Whereas similar associations were observed after adjustment for insulin and C-reactive protein, the association between muscle density and BMDC was partially attenuated by adjustment for β-C-telopeptides of type I collagen (beta = −0.14 [95% CI, −0.20, −0.08]). Conclusion: Although im and sc fat were both positively associated with cortical bone mass, the nature of these relationships differed in that im fat was predominantly associated with CT and BMDC, whereas sc fat was mainly associated with PC. These relationships were largely independent of candidate metabolic pathways, such as altered bone

  3. Methemoglobinemia due to application of prilocaine during circumcision and the effect of ascorbic acid.

    PubMed

    Boran, Perran; Tokuc, Gulnur; Yegin, Zeliha

    2008-12-01

    Local anesthesia with prilocaine has become a routine part of ambulatory circumcision procedures. Methemoglobinemia is a rare but potentially lethal complication of local anesthetics. We report the case of a 42-day-old boy who presented with cyanosis after receiving local anesthesia with prilocaine. Methemoglobin level revealed severe methemoglobinemia (methemoglobin=44.5%). His cyanosis promptly resolved after intravenous administration of ascorbic acid. Cases of local anesthetic-induced methemoglobinemia in urology are under recognized. Although the association between prilocaine use and methemoglobinemia has generally restricted prilocaine use in infants, it is still widely used in ambulatory procedures, especially during circumcision in the neonatal period. Prilocaine should not be used in infants less than 3 months of age because of the risk of methemoglobinemia and alternative local analgesics should be considered among this age group. We also discuss the use of ascorbic acid during treatment in light of the literature.

  4. Why are current efforts to eliminate female circumcision in Ethiopia misplaced?

    PubMed

    Boyden, Jo

    2012-01-01

    This paper discusses the eradication challenges of female circumcision in Ethiopia. It argues that despite an overall decline in the practice nationally, eradication efforts have caused significant quandaries for girls and their families. The most common justification by far for its continuance is that circumcision confirms a girl's social place by proving her readiness for marriage and adulthood and thereby ensures her protection against material want. Hence, intervention has often resulted in the transformation, rather than the elimination, of the practice, the exchange of one type of risk for another, or even increased risk to girls. In discussing policy, the paper argues that there has been a misapplication of the risk concept in the promotion of change in Ethiopia. It calls for risk definitions and interventions that are more holistic, correspond more closely with children's social realities and take into account the phenomenological dimensions of experience. PMID:23030606

  5. [The use of preputial skin as cutaneous graft after circumcision. Report of 30 clinical cases].

    PubMed

    Chlihi, A; Benbrahim, A; Diouri, M; Terrab, S; Bahechar, N; Boukind, E H

    2002-06-01

    Through a study of 30 clinical cases, collected at the service center of plastic surgery and burns in Averroes University hospital at Casablanca, the authors underline the interest of using preputial skin as full-thickness skin graft for the treatment of burns and their sequelaes in non-circumcised boys, whose age ranged from one to four years. At this age, they are more exposed to domestic accidents. The preputial skin graft gives the advantage of the absence of scare prejudice at the donor site each time the circumcision is possible; and provides a skin of good elastic quality avoiding secondary retraction with a very favorable rate of graft intake. Although the application of this technique for other affections is possible, but remains limited by the hyperpigmentation of the graft. PMID:12148228

  6. Gay Xhosa men's experiences of ulwaluko (traditional male initiation).

    PubMed

    Ntozini, Anathi; Ngqangweni, Hlonelwa

    2016-11-01

    This paper explores the lives of gay men undergoing traditional initiation in the Eastern Cape. Nine participants aged between 18 and 26 reported their reasons for becoming traditionally circumcised, which included personal validation of cultural manhood, the desire to conform to societal norms and expectations, and pressure from family members to 'convert' them to heterosexuality. While homosexuality remains a target for vilification and abuse both in Southern Africa and across the African continent, practices such as ulwaluko (traditional male initiation) must surely be among the most threatening to a young gay Xhosa man's self-esteem. PMID:27232591

  7. Plastibell Device Circumcision versus Bone Cutter Technique in terms of Operative Outcomes and Parent’s Satisfaction

    PubMed Central

    Mehmood, Tahir; Azam, Hammad; Tariq, Muhammad; Iqbal, Zafar; Mehmood, Hassan; Shah, Syed Asif Hussain

    2016-01-01

    Objective: To compare the rate of complications of Plastibell and bone cutter circumcision technique and recognition of top worries and satisfaction rate in the mind of parents before and after the procedure of Plastibell device (PD) circumcision in infants less than 6 months of age. Methods: It was a descriptive prospective study conducted at department of surgery Sheikh Zayed Hospital, Rahim Yar Khan. Two hundred parents of infants of less than six months of age were recruited for this study. Infants were divided into two equal groups. Group I included Plastibell circumcision technique and Group II included Bone Cutter Circumcision technique. Data was analyzed using SPSS Version 17. Independent sample t-test and chi-square test was used to compare quantitative and qualitative variables respectively. P-value <0.05 was taken as significant difference. Results: Total number of two hundred infants were included in this study. Most common worries of parents about Plastibell Device circumcision were; fear of fever (42.0%). Fear of pain and bleeding (66.0%). Plastibell Device method was associated with less operation time and bleeding as compared to bone cutter method (P-value <0.0001 and <0.0001 respectively). Incidence of complications other than bleeding and infection was 3.0% in bone cutter method and 1.0% in Plastibell device method. Pain score was significantly less in plastibell device group (p-value <0.0001). Post-operatively, 98% parents showed complete procedural satisfaction in Plastibell group versus 87% parents in bone cutter one month after surgery (P-value 0.003). About 4% parents in bone cutter method group showed cosmetic displeasure versus only 1% parents in plastibell device group. Conclusion: The study concluded that Plastibell Device circumcision is a safer technique for circumcision and is associated with highest level of parent’s satisfaction. PMID:27182237

  8. What is the efficacy of circumcision in boys with complex urinary tract abnormalities?

    PubMed

    Bader, Mohammed; McCarthy, Liam

    2013-12-01

    The risk of urinary tract infection (UTI) in normal boys is 1%. This risk is significantly increased in boys with congenital abnormalities of the urinary tract, which includes such abnormalities as vesico-ureteric reflux, obstructive megaureter (VUJO) and posterior urethral valves. UTI in these boys can lead to urosepsis, a potentially life-threatening complication, and in the longer term renal scarring complicating pyelonephritis can lead to chronic renal impairment or even end-stage renal disease. Circumcision has been shown in normal boys to reduce the risk of UTI by 90%, and potentially could be a simple intervention to reduce the risk of urosepsis and renal scarring. In order to make this decision a clinician really needs to have the answers to two questions: 1) What is the risk of UTI in this particular boy? 2) What is the evidence of efficacy of circumcision in this particular condition? This article reviews what evidence exists to make a calculation of the risk/benefit ratio for circumcision in boys with abnormalities of the urinary tract.

  9. [Review of clinical experience for a new preputioplasty technique as circumcision alternative].

    PubMed

    Binet, A; François-Fiquet, C; Bouche-Pillon, M A

    2016-02-01

    Surgery is required for phimosis with a contracted fibrous ring or when the medical treatment with steroids has been unsuccessful. Surgical teams often opt for circumcision when a conservative technique can be used. This surgery could have some psychologic consequences, and when the circumcision in not according to religious convictions, it cannot be live well for the patient and his family. Furthermore, some surgery procedures for prepuce conservation seem to give some unaesthesics aspects with cutaneous excess. The objective of this study was to evaluate our new preputioplasty technique according to the initial diagnosis (phimosis with scarred foreskin or long and narrow foreskin), in situation where circumcision is required currently. Outcome evaluated was: easy and painless foreskin retraction, absence of postoperative phimosis as well as cosmetic aspects of the penis. In this study, 90 children benefited from this technique and subsequent follow-up. The mean age was 7.9 years for the 32 children in the sclerotic phimosis group and 6.8 years for the 58 children in the long and narrow foreskin group. We observed complete foreskin retraction without any recurrence in 100% of children with a phimosis resistant to medical treatment which consisted of progressive foreskin retraction and application of topical steroids, with a mean postoperative follow-up of 1.4 years. Results showed an excellent cosmetic aspect of the penis with absence of enlarged foreskin in all our subjects. This study underlines the relevance of this surgical technique. PMID:25708731

  10. Frenulum Sparing Circumcision: Step-By-Step Approach of a Novel Technique

    PubMed Central

    Marla, Prashanth Kallaje; Sharma, Pritham; Bhat, Narayana; Rao, Amrith Raj

    2015-01-01

    Objective Circumcision, by most conventional methodologies, involves division of the frenulum and excision of the entire foreskin covering the glans. This seemingly simple procedure is occasionally associated with dreadful and devastating complications. We describe a new frenulum-sparing technique that circumvents some of the potential complications of conventional techniques and could also potentially help preserve preputial role in sexual function. Materials and Methods An initial dorsal slit, three fourths of the way up to the corona is extended laterally and obliquely on either side, to meet the preputial edge, 3-4 mm from the frenulum. A broad sleeve of sub-coronal mucosa is thus preserved. The frenulum is left untouched, leaving a wide skin bridge connecting the mucosal sleeve with the shaft skin. The raw area is closed with interrupted, synthetic absorbable sutures. Over a three year period, 42 patients were circumcised using this technique. Results No significant complications like frenular bleed, painful postoperative erections, chordee, meatal stenosis, or urethra-cutaneous fistula were observed in any patient. The cosmetic results were pleasing. Conclusion The frenulum-sparing technique of circumcision is a promising modification to the various existing techniques. The method described is technically easier to perform than conventional frenulum-dividing procedures and has an acceptable cosmesis. Further randomised controlled studies on larger cohorts are necessary to establish the true benefits of this technique over established procedures. PMID:26816940

  11. Predictive Factors of Postoperative Pain and Postoperative Anxiety in Children Undergoing Elective Circumcision: A Prospective Cohort Study

    PubMed Central

    Tsamoudaki, Stella; Ntomi, Vasileia; Yiannopoulos, Ioannis; Christianakis, Efstratios; Pikoulis, Emmanuel

    2015-01-01

    Background Although circumcision for phimosis in children is a minor surgical procedure, it is followed by pain and carries the risk of increased postoperative anxiety. This study examined predictive factors of postoperative pain and anxiety in children undergoing circumcision. Methods We conducted a prospective cohort study of children scheduled for elective circumcision. Circumcision was performed applying one of the following surgical techniques: sutureless prepuceplasty (SP), preputial plasty technique (PP), and conventional circumcision (CC). Demographics and base-line clinical characteristics were collected, and assessment of the level of preoperative anxiety was performed. Subsequently, a statistical model was designed in order to examine predictive factors of postoperative pain and postoperative anxiety. Assessment of postoperative pain was performed using the Faces Pain Scale (FPS). The Post Hospitalization Behavior Questionnaire study was used to assess negative behavioral manifestations. Results A total of 301 children with a mean age of 7.56 ± 2.61 years were included in the study. Predictive factors of postoperative pain measured with the FPS included a) the type of surgical technique, b) the absence of siblings, and c) the presence of postoperative complications. Predictive factors of postoperative anxiety included a) the type of surgical technique, b) the level of education of mothers, c) the presence of preoperative anxiety, and d) a history of previous surgery. Conclusions Although our study was not without its limitations, it expands current knowledge by adding new predictive factors of postoperative pain and postoperative anxiety. Clearly, further randomized controlled studies are needed to confirm its results. PMID:26495079

  12. Circumcision during the phallic period: does it affect the psychosexual functions in adulthood?

    PubMed

    Armagan, A; Silay, M S; Karatag, T; Akman, T; Tepeler, A; Ersoz, C; Akcay, M

    2014-04-01

    The aim of this study was to elucidate whether circumcision during the phallic period (3-to 6-year old) has a negative impact on psychosexual functions in adulthood. Over a 6-month period, healthy and sexually active men between 30 and 40 years without any comorbidities were involved. Participants were evaluated with detailed history, physical examination, International Index of Erectile Function (IIEF), Premature Ejaculation Diagnostic Tool (PEDT) and Beck Depression Inventory. Cases were divided into two groups according to the age at circumcision (group-1: phallic period, group-2: nonphallic period). Student's t-test and Kruskall-Wallis were used for statistical analysis. Of the 321 participants, a total of 302 men were eligible for the study (group-1: n = 135, group-2: n = 167). No statistical difference was found between the mean total IIEF scores (group-1: 25.1 ± 4.8, group-2: 25.4 ± 4.6, P > 0.05). The subdomains of IIEF; erectile function, orgasm, sexual desire, intercourse satisfaction, overall satisfaction were also found to be comparable. Additionally, the PEDT scores were similar between the two groups (group-1: 8.2 ± 4.8, group-2: 8.7 ± 5.4, P > 0.05). Finally, Beck depression scores were also found to be comparable between the groups (group-1: 10.8 ± 10.4, group-2: 9.8 ± 8.9, P > 0.05). Our results suggest that circumcision during the phallic period does not negatively affect the psychosexual functions in adulthood.

  13. Reconciling international human rights and cultural relativism: the case of female circumcision.

    PubMed

    James, Stephen A

    1994-01-01

    How can we reconcile, in a non-ethnocentric fashion, the enforcement of international, universal human rights standards with the protection of cultural diversity? Examining this question, taking the controversy over female circumcision as a case study, this article will try to bridge the gap between the traditional anthropological view that human rights are non-existent -- or completely relativised to particular cultures -- and the view of Western naturalistic philosophers (including Lockeian philosophers in the natural rights tradition, and Aquinas and neo-Thomists in the natural law tradition) that they are universal -- simply derived from a basic human nature we all share. After briefly defending a universalist conception of human rights, the article will provide a critique of female circumcision as a human rights violation by three principal means: by an internal critique of the practice using the condoning cultures' own functionalist criteria; by identifying supra-national norms the cultures subscribe to which conflict with the practice; and by the identification of traditional and novel values in the cultures, conducive to those norms. Through this analysis, it will be seen that cultural survival, diversity and flourishing need not be incompatible with upholding international, universal human rights standards.

  14. A case of vulval swelling secondary to female circumcision posing a diagnostic dilemma

    PubMed Central

    Amu, Okwudili C.; Udeh, Emeka I.; Ugochukwu, Anthony I.; Madu, Chukwudi; Nzegwu, Martin A.

    2012-01-01

    INTRODUCTION The practice of FGM is most prevalent in the African countries such as Nigeria, Ethiopia, Sudan, Egypt, and some area of the Middle East. It is not restricted to any ethnic, religious or socioeconomic class. There are many reasons for perpetuation of this practice; the most common are cultural and religious beliefs. The aim of this paper is to highlight the diagnostic dilemma associated with this type of case and the psychological trauma of a patient following her unfortunate genital mutilations. PRESENTATION OF CASE We present the case of epidermal inclusion dermoid cyst in an 18-year-old teenage girl referred to us from the gynecologist as a case of hydrocoele of the canal of Nuck involving the left labia majora. Patient was previously seen by general practitioner who diagnosed a left Bartholins cyst. Excision of the mass, revealed a well encapsulated cystic mass containing serous fluid with no extension to the inguinal area, measured 10 cm × 8 cm. Histology showed epidermoid inclusion dermoid cyst probably related to circumcision (female genital mutilation). DISCUSSION Implantation dermoid cyst though a recognized complication of FGM is rare in our environment and a high index of suspicion is required any time a girl presents with a vulval swelling. Cosmesis still remains the watchword to assuage the psychological impact on the patient. CONCLUSION There is need for more public health campaigns to educate communities about the harms of circumcision with the goal of eradicating the practice. PMID:22705937

  15. Traumatic Penile Injury: From Circumcision Injury to Penile Amputation

    PubMed Central

    Park, Jae Young; Song, Yun Seob

    2014-01-01

    The treatment of external genitalia trauma is diverse according to the nature of trauma and injured anatomic site. The classification of trauma is important to establish a strategy of treatment; however, to date there has been less effort to make a classification for trauma of external genitalia. The classification of external trauma in male could be established by the nature of injury mechanism or anatomic site: accidental versus self-mutilation injury and penis versus penis plus scrotum or perineum. Accidental injury covers large portion of external genitalia trauma because of high prevalence and severity of this disease. The aim of this study is to summarize the mechanism and treatment of the traumatic injury of penis. This study is the first review describing the issue. PMID:25250318

  16. Transient Peripheral Immune Activation follows Elective Sigmoidoscopy or Circumcision in a Cohort Study of MSM at Risk of HIV Infection

    PubMed Central

    Lama, Javier R.; Karuna, Shelly T.; Grant, Shannon P.; Swann, Edith M.; Ganoza, Carmela; Segura, Patricia; Montano, Silvia M.; Lacherre, Martin; De Rosa, Stephen C.; Buchbinder, Susan; Sanchez, Jorge; McElrath, M. Juliana; Lemos, Maria P.

    2016-01-01

    Background Rectal and genital sampling in HIV prevention trials permits assessments at the site of HIV entry. Yet the safety and acceptability of circumcision and sigmoidoscopy (and associated abstinence recommendations) are unknown in uncircumcised men who have sex with men (MSM) at high risk of HIV infection. Methods Twenty-nine HIV-seronegative high-risk Peruvian MSM agreed to elective sigmoidoscopy biopsy collections (weeks 2 and 27) and circumcision (week 4) in a 28-week cohort study designed to mimic an HIV vaccine study mucosal collection protocol. We monitored adherence to abstinence recommendations, procedure-related complications, HIV infections, peripheral immune activation, and retention. Results Twenty-three (79.3%) underwent a first sigmoidoscopy, 21 (72.4%) were circumcised, and 16 (55.2%) completed a second sigmoidoscopy during the study period. All who underwent procedures completed the associated follow-up safety visits. Those completing the procedures reported they were well tolerated, and complication rates were similar to those reported in the literature. Immune activation was detected during the healing period (1 week post-sigmoidoscopy, 6 weeks post-circumcision), including increases in CCR5+CD4+T cells and α4β7+CD4+T cells. Most participants adhered to post-circumcision abstinence recommendations whereas reduced adherence occurred post-sigmoidoscopy. Conclusion Rectosigmoid mucosal and genital tissue collections were safe in high-risk MSM. Although the clinical implications of the post-procedure increase in peripheral immune activation markers are unknown, they reinforce the need to provide ongoing risk reduction counseling and support for post-procedure abstinence recommendations. Future HIV vaccine studies should also consider the effects of mucosal and tissue collections on peripheral blood endpoints in trial design and analysis. Trial Registration ClinicalTrials.gov NCT02630082 PMID:27536938

  17. Male contraception

    PubMed Central

    Mathew, Vivek; Bantwal, Ganapathi

    2012-01-01

    Contraception is an accepted route for the control of population explosion in the world. Traditionally hormonal contraceptive methods have focused on women. Male contraception by means of hormonal and non hormonal methods is an attractive alternative. Hormonal methods of contraception using testosterone have shown good results. Non hormonal reversible methods of male contraception like reversible inhibition of sperm under guidanceare very promising. In this article we have reviewed the current available options for male contraception. PMID:23226635

  18. Gay Xhosa men’s experiences of ulwaluko (traditional male initiation)

    PubMed Central

    Ntozini, Anathi; Ngqangweni, Hlonelwa

    2016-01-01

    Abstract This paper explores the lives of gay men undergoing traditional initiation in the Eastern Cape. Nine participants aged between 18 and 26 reported their reasons for becoming traditionally circumcised, which included personal validation of cultural manhood, the desire to conform to societal norms and expectations, and pressure from family members to ‘convert’ them to heterosexuality. While homosexuality remains a target for vilification and abuse both in Southern Africa and across the African continent, practices such as ulwaluko (traditional male initiation) must surely be among the most threatening to a young gay Xhosa man’s self-esteem. PMID:27232591

  19. Condoms - male

    MedlinePlus

    ... Rubbers; Male condoms; Contraceptive - condom; Contraception - condom; Barrier method - condom ... infections.) Latex rubber Polyurethane Condoms are the only method of birth control for men that are not ...

  20. Female circumcision and its health implications: a study of the Uruan Local Government Area of Akwa Ibom State, Nigeria.

    PubMed

    Ebong, R D

    1997-04-01

    A total of 400 subjects was randomly selected from 40 villages in the Uruan Local Government Area of Akwa Ibom State for the study. The purposes of the study were to: i. identify the 'established benefits' of female circumcision; ii. identify the health hazards that accompany the practice; and iii. create awareness among community members of the ill-effects of the practice. The study discovered a strong belief in the established benefits and poor appreciation of the health hazards of female circumcision by the participants. Recommendations were made for more efforts in public health education programmes on the ill-effects of the practice. Studies were also recommended to be conducted in other parts of the country to assess the level of awareness on the ill-effects of such an operation and the institution of educational programmes where applicable. PMID:9223848

  1. A fast, easy circumcision procedure combining a CO2 laser and cyanoacrylate adhesive: a non-randomized comparative trial

    PubMed Central

    Gorgulu, Tahsin; Olgun, Abdulkerim; Torun, Merve; Kargi, Eksal

    2016-01-01

    ABSTRACT Background Circumcision is performed as a routine operation in many countries, more commonly for religious and cultural reasons than for indicated conditions, such as phimosis and balanitis. There are many techniques available, and recently electrocautery and both Nd:YAG and CO2 lasers, instead of blades, have been used for skin and mucosal incisions. However, the infection risk in circumcisions performed using a CO2 laser was 10% higher. There are also reports of sutureless procedures using cyanoacrylate, but these have higher risks of hematoma and hemorrhage. We combined a CO2 laser and cyanoacrylate to shorten the operation time and to decrease bleeding complications. Materials and Methods : Circumcisions were performed under general anesthesia with CO2 laser and cyanoacrylate combination in 75 6–9-year-old boys between May 2013 and August 2014 only for religious reasons. As a control, we compared them retrospectively with 75 age-matched patients who were circumcised using the conventional guillotine method in our clinic. Results No hematomas, bleeding, or wound infections were observed. One wound dehiscence (1.33%) occurred during the early postoperative period and healed without any additional procedures. The median operating time was 7 (range 6–9) minutes. The conventional guillotine group comprised one hematoma (1.3%), two wound dehiscences (2.6%), and two hemorrhages (2.6%), and the median operating time was 22 (range 20–26) minutes. The difference in surgical time was significant (p<0.001), with no significant difference in the rate of complications between the two groups. Conclusion The combined CO2 laser and cyanoacrylate procedure not only decreased the operating time markedly, but also eliminated the disadvantages associated with each individual procedure alone. PMID:27136476

  2. True hermaphroditism in a 46, XY individual, caused by a postzygotic somatic point mutation in the male gonadal sex-determining locus (SRY): Molecular genetics and histological findings in a sporadic case

    SciTech Connect

    Braun, A.; Kammerer, S.; Cleve, H.; Loehrs, U.; Schwarz, H.P.; Kuhnle, U. )

    1993-03-01

    Recently, the gene for the determination of maleness has been identified in the sex-determining region on the short arm of the Y chromosome (SRY) between the Y-chromosomal pseudoautosomal boundary (PABY) and the ZFY gene locus. Experiments with transgenic mice confirmed that SRY is a part of the testis-determining factor (TDF). The authors describe a sporadic case of a patient with intersexual genitalia and the histological finding of ovotestes in the gonad, which resembles the mixed type of gonadal tissue without primordial follicle structures. The karyotype of the patient was 46,XY. By PCR amplification, they tested for the presence of SRY by using DNA obtained from histological gonadal slices. The SRY products of both DNA preparations were further analyzed by direct sequencing. All three parts of the sex-determining region of the Y chromosome could be amplified from leukocytic DNA. The patient's and the father's SRY sequences were identical with the published sequence. In the SRY PCR product of gonadal DNA, the wild-type and two point mutations were present in the patient's sequence, simulating a heterozygous state of a Y-chromosomal gene: one of the mutations was silent, while the other encoded for a nonconservative amino acid substitution from leucine to histidine. Subcloning procedures showed that the two point mutations always occurred together. The origin of the patient's intersexuality is a postzygotic mutation of the SRY occurring in part of the gonadal tissue. This event caused the loss of the testis-determining function in affected cells. 37 refs., 6 figs.

  3. Findings from Integrated Behavioral and Biologic Survey among Males Who Inject Drugs (MWID) — Vietnam, 2009–2010: Evidence of the Need for an Integrated Response to HIV, Hepatitis B Virus, and Hepatitis C Virus

    PubMed Central

    Nadol, Patrick; O’connor, Siobhan; Duong, Hao; Le, Linh-Vi N.; Thang, Pham Hong; Tram, Tran Hong; Ha, Hoang Thi Thanh; Mcconnell, Michelle S.; Partridge, Jeff; Kaldor, John; Law, Matthew; Nguyen, Tuan Anh

    2015-01-01

    Introduction Given the overlapping modes of transmission of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV), understanding the burden and relationship of these infections is critical for an effective response. Representative data on these infections among males who inject drugs (MWID), the key high-risk population for HIV in Vietnam, are currently lacking. Methods Data and stored specimens from Vietnam’s 2009-2010 Integrated Biologic and Behavioral Survey, a cross-sectional study among high-risk populations, were used for this analysis. Plasma samples were tested for HIV, HBV, and HCV using commercial assays. A questionnaire was administered to provide demographic, behavior, and service-uptake information. Provincial-level analyses were conducted to profile MWID enrollees and to provide estimates on the prevalence of HIV, HBV, and HCV infection. Results Among 3010 MWID sampled across 10 provinces, the median (range) HIV prevalence was 28.1% (1.0%-55.5%). Median prevalence for current HBV infection (HBsAg+) was 14.1% (11.7%-28.0%), for previous exposure to HBV (total anti-HBc+) was 71.4% (49.9%-83.1%), and for current or past HCV infection (HCV Ag/Ab+) was 53.8% (10.9%-80.8%). In adjusted analysis, HBsAg+ (aOR: 2.09, 1.01-4.34) and HCV Ag/Ab+ (aOR: 19.58, 13.07-29.33) status were significantly associated with HIV infection; the association with total anti-HBc+ approached significance (aOR: 1.29, 0.99-1.68). Conclusion The prevalence and association between HIV, HBV, and HCV are high among MWID in Vietnam. These findings indicate the need for integrated policies and practice that for the surveillance, prevention, screening, and treatment of both HIV and viral hepatitis among MWID in Vietnam. PMID:25692469

  4. Male hypogonadism.

    PubMed

    Isidori, Andrea M; Giannetta, Elisa; Lenzi, Andrea

    2008-01-01

    The hypothalamic-pituitary-gonadal (HPG) axis regulates the development, endocrine and reproductive function of the gonads throughout all phases of life. Male hypogonadism is defined an inadequate gonadal function, as manifested by deficiency in gametogenesis and/or secretion of gonadal hormones. In most cases, male hypogonadism is diagnosed through detailed history, physical examination and a few basic hormonal evaluations. In selected cases, however, additional tests are needed to define the aetiology and the extent of HPG axis dysfunction. These include semen analysis, pituitary imaging studies, genetic studies, bone densitometry, testicular ultrasonography, testicular biopsy and hormonal dynamic testing. The stimulation tests of the HPG are of particular importance in the differential diagnosis of congenital delayed puberty versus pre-pubertal hypogonadism in children. This review will focus on the methods, indications and limitations of endocrine testing in the characterisation and differential diagnosis of male hypogonadism at various ages. A practical hands-on guide on how to perform these tests is also provided.

  5. Male-male pheromone signalling in a lekking Drosophila.

    PubMed

    Widemo, Fredrik; Johansson, Björn G

    2006-03-22

    Interest in sex pheromones has mainly been focused on mate finding, while relatively little attention has been given to the role of sex pheromones in mate choice and almost none to competition over mates. Here, we study male response to male pheromones in the lekking Drosophila grimshawi, where males deposit long-lasting pheromone streaks that attract males and females to the leks and influence mate assessment. We used two stocks of flies and both stocks adjusted their pheromone depositing behaviour in response to experimental manipulation, strongly indicating male ability to distinguish between competitors from qualitative differences in pheromone streaks alone. This is the first example of an insect distinguishing between individual odour signatures. Pheromone signalling influenced competition over mates, as males adjusted their investment in pheromone deposition in response to foreign pheromone streaks. Both sexes adapt their behaviour according to information from olfactory cues in D. grimshawi, but the relative benefits from male-female, as compared to male-male signalling, remain unknown. It seems likely that the pheromone signalling system originally evolved for attracting females to leks. The transition to a signalling system for conveying information about individuals may well, however, at least in part have been driven by benefits from male-male signalling.

  6. Rock Finding

    ERIC Educational Resources Information Center

    Rommel-Esham, Katie; Constable, Susan D.

    2006-01-01

    In this article, the authors discuss a literature-based activity that helps students discover the importance of making detailed observations. In an inspiring children's classic book, "Everybody Needs a Rock" by Byrd Baylor (1974), the author invites readers to go "rock finding," laying out 10 rules for finding a "perfect" rock. In this way, the…

  7. Effectiveness of a website and mobile phone based physical activity and nutrition intervention for middle-aged males: Trial protocol and baseline findings of the ManUp Study

    PubMed Central

    2012-01-01

    Background Compared to females, males experience higher rates of chronic disease and mortality, yet few health promotion initiatives are specifically aimed at men. Therefore, the aim of the ManUp Study is to examine the effectiveness of an IT-based intervention to increase the physical activity and nutrition behaviour and literacy in middle-aged males (aged 35–54 years). Method/Design The study design was a two-arm randomised controlled trial, having an IT-based (applying website and mobile phones) and a print-based intervention arm, to deliver intervention materials and to promote self-monitoring of physical activity and nutrition behaviours. Participants (n = 317) were randomised on a 2:1 ratio in favour of the IT-based intervention arm. Both intervention arms completed assessments at baseline, 3, and 9 months. All participants completed self-report assessments of physical activity, sitting time, nutrition behaviours, physical activity and nutrition literacy, perceived health status and socio-demographic characteristics. A randomly selected sub-sample in the IT-based (n = 61) and print-based (n = 30) intervention arms completed objective measures of height, weight, waist circumference, and physical activity as measured by accelerometer (Actigraph GT3X). The average age of participants in the IT-based and print-based intervention arm was 44.2 and 43.8 years respectively. The majority of participants were employed in professional occupations (IT-based 57.6%, Print-based 54.2%) and were overweight or obese (IT-based 90.8%, Print-based 87.3%). At baseline a lower proportion of participants in the IT-based (70.2%) group agreed that 30 minutes of physical activity each day is enough to improve health compared to the print-based (82.3%) group (p = .026). The IT-based group consumed a significantly lower number of serves of red meat in the previous week, compared to the print-based group (p = .017). No other significant between

  8. Consistent condom use with regular, paying, and casual male partners and associated factors among men who have sex with men in Tamil Nadu, India: findings from an assessment of a large-scale HIV prevention program

    PubMed Central

    2013-01-01

    Background Men who have sex with men (MSM) are a marginalized population at high risk for HIV infection. Promoting consistent condom use (CCU) during anal sex is a key risk reduction strategy for HIV prevention among MSM. To inform effective HIV prevention interventions, we examined the factors associated with CCU among MSM with their regular, paying, and casual partners, as well as with all three types of partners combined. Methods Data for this analysis were from a large-scale bio-behavioural survey conducted during 2009–2010 in Tamil Nadu, India. MSM aged 18 years or older were recruited for the survey using time-location cluster sampling at cruising sites in four districts of Tamil Nadu. Binary logistic regression analyses were conducted to assess the association of CCU with selected socio-demographic characteristics and other contextual factors. Results Among 1618 MSM interviewed, CCU during anal sex with regular, paying, and a casual male partner was 45.3%, 50.8% and 57.9%, respectively. CCU with all three types of partners combined was 52.6%. Characteristics associated with increased odds for CCU with MSM having all three types of partners combined were frequent receptive anal sex acts with regular partners (adjusted odds ratio [AOR] 2.17, 95% confidence interval [CI] 1.01-4.65), fewer number of casual partners (AOR 3.41, 95% CI 1.50-7.73) and membership in a community-based organization (CBO) for MSM (AOR 3.54, 95% CI 1.62-7.74). CCU with regular partners was associated with membership in a CBO (AOR 1.96, 95% CI 1.23-3.11), whereas CCU with paying, and casual male partners was associated with perceived higher risk of acquiring HIV (AOR 1.92, 95% CI 1.22-3.01) and exposure to any HIV prevention intervention (AOR 3.62, 95% CI 1.31-10.0), respectively. Being aged 26 years or older, being in debt, and alcohol use were factors associated with inconsistent condom use across partner types. Conclusion HIV interventions among MSM need to promote CCU with all

  9. Male contraception.

    PubMed

    Chao, Jing; Page, Stephanie T; Anderson, Richard A

    2014-08-01

    Clear evidence shows that many men and women would welcome new male methods of contraception, but none have become available. The hormonal approach is based on suppression of gonadotropins and thus of testicular function and spermatogenesis, and has been investigated for several decades. This approach can achieve sufficient suppression of spermatogenesis for effective contraception in most men, but not all; the basis for these men responding insufficiently is unclear. Alternatively, the non-hormonal approach is based on identifying specific processes in sperm development, maturation and function. A range of targets has been identified in animal models, and targeted effectively. This approach, however, remains in the pre-clinical domain at present. There are, therefore, grounds for considering that safe, effective and reversible methods of contraception for men can be developed. PMID:24947599

  10. Male contraception

    PubMed Central

    Chao, Jing; Page, Stephanie T.; Anderson, Richard A.

    2015-01-01

    Clear evidence shows that many men and women would welcome new male methods of contraception, but none have become available. The hormonal approach is based on suppression of gonadotropins and thus of testicular function and spermatogenesis, and has been investigated for several decades. This approach can achieve sufficient suppression of spermatogenesis for effective contraception in most men, but not all; the basis for these men responding insufficiently is unclear. Alternatively, the nonhormonal approach is based on identifying specific processes in sperm development, maturation and function. A range of targets has been identified in animal models, and targeted effectively. This approach, however, remains in the pre-clinical domain at present. There are, therefore, grounds for considering that safe, effective and reversible methods of contraception for men can be developed. PMID:24947599

  11. Male hypogonadism.

    PubMed

    Basaria, Shehzad

    2014-04-01

    Male hypogonadism is a clinical syndrome that results from failure to produce physiological concentrations of testosterone, normal amounts of sperm, or both. Hypogonadism may arise from testicular disease (primary hypogonadism) or dysfunction of the hypothalamic-pituitary unit (secondary hypogonadism). Clinical presentations vary dependent on the time of onset of androgen deficiency, whether the defect is in testosterone production or spermatogenesis, associated genetic factors, or history of androgen therapy. The clinical diagnosis of hypogonadism is made on the basis of signs and symptoms consistent with androgen deficiency and low morning testosterone concentrations in serum on multiple occasions. Several testosterone-replacement therapies are approved for treatment and should be selected according to the patient's preference, cost, availability, and formulation-specific properties. Contraindications to testosterone-replacement therapy include prostate and breast cancers, uncontrolled congestive heart failure, severe lower-urinary-tract symptoms, and erythrocytosis. Treatment should be monitored for benefits and adverse effects. PMID:24119423

  12. Males adjust their signalling behaviour according to experience of male signals and male-female signal duets.

    PubMed

    Rebar, D; Rodríguez, R L

    2016-04-01

    Sexual signals are conspicuous sources of information about neighbouring competitors, and species in which males and females signal during pair formation provide various sources of public information to which individuals can adjust their behaviour. We performed two experiments with a duetting vibrational insect, Enchenopa binotata treehoppers (Hemiptera: Membracidae), to ask whether males adjust their signalling behaviour according to (1a) their own experience of competitors' signals, (1b) how females adjust their mate preferences on the basis of their experience of male signals (described in prior work), and/or (2) their own experience of female response signals to competitors' signals. We presented males with synthetic male signals of different frequencies and combinations thereof for 2 weeks. We recorded males a day after their last signal exposure, finding that (1a) male signal rate increased in response to experience of attractive competitors, but that (1b) male signal frequency did not shift in a manner consistent with how females adjust their mate preferences in those experience treatments. Second, we presented males with different male-female duets for 2 weeks, finding that (2) male signal length increased from experience of female duets with attractive competitors. Males thus make two types of adjustment according to two sources of public information: one provided by experience of male signals and another by experience of female responses to male signals. Signalling plasticity can generate feedback loops between the adjustments that males and females make, and we discuss the potential consequences of such feedback loops for the evolution of communication systems.

  13. [Male contraception].

    PubMed

    Demoulin, A

    1984-04-01

    Among the reasons why male hormonal contraception has lagged behind female methods are the necessity of preserving virility, the fact that spermatogenesis is a continuous process, the need to control secondary effects and toxicity, and the requirement that modes of administration be acceptable to both partners. Among currently available reversible mehtods, withdrawal is undoubtedly the most ancient. It is still widespread but cannot be recommended because of its limited effectiveness. The condom is used by about 10% of couples worldwide as a principal or temporary method, but its inter-ference with sensation has limited its acceptance. Condoms are nevertheless highly effective when used with a spermicide. Various androgens are currently under investigation. High doses of testosterone can induce azoospermia without affecting libido but their side effects may be serious. The use of combinations of steroids permits doses to be reduced and offers promise for the future. The combination of oral medroxyprogesterone acetate and percutaneous testosterone is one of the better approaches; the combination is effective and nontoxic but has the disadvantage of percutaneous administration. Gossypol, a pigment extracted from the cotton plant, has been used as a contraceptive in China with a reported efficacy of 99.89%, recovery of fertility within 3 months, and no effect on future fertility. However, its toxicity appears to be significant in the animal and its reversibility is uncertain. A search is on for analogs which would preserve the contraceptive effects while eliminating toxic effects. Several gonadotropin releasing hormone (GnRH) analogs under investigation for their interference with spermatogenesis have given promising results. Several chemicals tested for contraceptive effects have had unacceptably high toxicity. Chinese investigators have reported good results with various physical methods of interfering with sperm production, but their reversibility and innocuity

  14. African American Males Navigate Racial Microaggressions

    ERIC Educational Resources Information Center

    Hotchkins, Bryan K.

    2016-01-01

    Background/Context: High school educational environments find Black males experience systemic racial microaggressions in the form of discipline policies, academic tracking and hegemonic curriculum (Allen, Scott, & Lewis, 2013). Black males in high school are more likely than their White male peers to have high school truancies and be viewed as…

  15. Male-Male Clasping May Be Part of an Alternative Reproductive Tactic in Xenopus laevis

    PubMed Central

    Rhodes, Heather J.; Stevenson, Rachel J.; Ego, Courtney L.

    2014-01-01

    Male Xenopus laevis frogs have been observed to clasp other males in a sustained, amplectant position, the purpose of which is unknown. We examined three possible hypotheses for this counter-intuitive behavior: 1) clasping males fail to discriminate the sex of the frogs they clasp; 2) male-male clasping is an aggressive or dominant behavior; or 3) that males clasp other males to gain proximity to breeding events and possibly engage in sperm competition. Our data, gathered through a series of behavioral experiments in the laboratory, refute the first two hypotheses. We found that males did not clasp indiscriminately, but showed a sex preference, with most males preferentially clasping a female, but a proportion preferentially clasping another male. Males that clasped another male when there was no female present were less likely to “win” reproductive access in a male-male-female triad, indicating that they did not establish dominance through clasping. However, those males did gain proximity to oviposition by continued male-male clasping in the presence of the female. Thus, our findings are consistent with, but cannot confirm, the third hypothesis of male-male clasping as an alternative reproductive tactic. PMID:24849114

  16. A 33-year-old male patient with paternal derived duplication of 14q11.2-14q22.1~22.3: clinical course, phenotypic and genotypic findings.

    PubMed

    Wannenmacher, Bardo; Mitter, Diana; Kießling, Franziska; Liehr, Thomas; Weise, Anja; Siekmeyer, Manuela; Kiess, Wieland

    2016-05-01

    We report on a 33-year-old patient with mosaic interstitial duplication on chromosome 14q11.2-14q22.1~22.3 with severe physical and mental retardation and multiple dysmorphisms. This patient was admitted to our pediatric hospital due to severe dehydration and malnutrition as a result of food refusal. It is an actual phenomenon that patients with severe inborn clinical problems nowadays survive due to progress and care of modern medicine. Nevertheless, transition from pediatric care to adult medicine seems to remain a challenging problem. We demonstrate the clinical course as well as clinical and genetic findings of this adult patient. Comparisons are made to previously reported cases with mosaic trisomy 14 involving a proximal interstitial duplication on the long arm of chromosome 14. PMID:26824977

  17. Finding food

    PubMed Central

    Forsyth, Ann; Lytle, Leslie; Riper, David Van

    2011-01-01

    A significant amount of travel is undertaken to find food. This paper examines challenges in measuring access to food using Geographic Information Systems (GIS), important in studies of both travel and eating behavior. It compares different sources of data available including fieldwork, land use and parcel data, licensing information, commercial listings, taxation data, and online street-level photographs. It proposes methods to classify different kinds of food sales places in a way that says something about their potential for delivering healthy food options. In assessing the relationship between food access and travel behavior, analysts must clearly conceptualize key variables, document measurement processes, and be clear about the strengths and weaknesses of data. PMID:21837264

  18. The clinical spectrum of lichen sclerosus in male patients - a retrospective study.

    PubMed

    Kantere, Despina; Löwhagen, Gun-Britt; Alvengren, Gunilla; Månesköld, Anna; Gillstedt, Martin; Tunbäck, Petra

    2014-09-01

    Lichen sclerosus (LS) is a chronic dermatosis mainly localised to the anogenital area. The aim of this study was to investigate the clinical features of LS in adult men. A retrospective analysis of records from 771 patients diagnosed with LS was made and a questionnaire was sent to all patients. The results showed that the clinical spectrum was wide. Itch, tenderness and pain were frequently reported and more than half of the patients reported that LS had a negative impact on their sexual health. Phimosis was common and almost 1/3 of the patients were circumcised before or during the study period. Eight cases (1%) of penile squamous cell carcinoma were recorded. This emphasises the need for follow-up of male patients with LS. PMID:24549239

  19. Graduating Black Males

    ERIC Educational Resources Information Center

    Bell, Edward Earl

    2010-01-01

    Background: The graduation numbers for Black males are dismal, chilling, and undeniably pathetic. The nation graduates only 47% of Black males who enter the 9th grade. The infusion of federal dollars and philanthropic support will not stop the trajectory of Black males who drop out of school. Black males face an upheaval educational battle;…

  20. Lisping and male homosexuality.

    PubMed

    Van Borsel, John; Van de Putte, Anneleen

    2014-08-01

    The present study examined the popular stereotype that gay men lisp by evaluating to what extent listeners associated dental or frontal articulation/lisping with gayness. Fifteen heterosexual males and 15 heterosexual females listened to 275 samples of read speech and judged the sexual orientation of the speakers. A total of 175 of the samples were of homosexual men, 74 (42.3 %) of which had been identified with lisping in a previous study; 100 were of heterosexual men, 18 (18 %) of which had been identified with lisping previously. Based on the ratings of the listeners of the present study, lisping speakers were significantly more often judged to be homosexual. This was true for the group as a whole as well as for the subgroup of homosexual and heterosexual men separately. Furthermore, there was no significant gender difference with respect to associating lisping with gayness. Male and female judges associated lisping with gayness to a similar degree. Additional analysis showed that overall 56.2 % of the time the judges were correct in their judgment of the speakers' sexual orientation. The results of this study confirmed previous preliminary findings that suggested that frontal or dental articulation/lisping is a feature that listeners associate with gayness. The reason for this association remains to be clarified.

  1. Lisping and male homosexuality.

    PubMed

    Van Borsel, John; Van de Putte, Anneleen

    2014-08-01

    The present study examined the popular stereotype that gay men lisp by evaluating to what extent listeners associated dental or frontal articulation/lisping with gayness. Fifteen heterosexual males and 15 heterosexual females listened to 275 samples of read speech and judged the sexual orientation of the speakers. A total of 175 of the samples were of homosexual men, 74 (42.3 %) of which had been identified with lisping in a previous study; 100 were of heterosexual men, 18 (18 %) of which had been identified with lisping previously. Based on the ratings of the listeners of the present study, lisping speakers were significantly more often judged to be homosexual. This was true for the group as a whole as well as for the subgroup of homosexual and heterosexual men separately. Furthermore, there was no significant gender difference with respect to associating lisping with gayness. Male and female judges associated lisping with gayness to a similar degree. Additional analysis showed that overall 56.2 % of the time the judges were correct in their judgment of the speakers' sexual orientation. The results of this study confirmed previous preliminary findings that suggested that frontal or dental articulation/lisping is a feature that listeners associate with gayness. The reason for this association remains to be clarified. PMID:24578106

  2. [Genetic evaluation of male homosexuality].

    PubMed

    Gasztonyi, Z

    1998-02-01

    The family trees of 16 homosexual males are evaluated in the material of their Genetic Counselling Clinic. The familial cluster of three cases corresponded to the X-linked recessive inheritance. The results of family, twin and adoption studies are reviewed and the recent findings of molecular genetic and brain researches are summarised. Male homosexuality comprises of different subgroups, but one major entity is caused by X-linked recessive gene(s). This genetic background represent a predisposition which is triggered or suppressed by external factors.

  3. Patients affected by premature ejaculation due to glans hypersensitivity refuse circumcision as a potential definite treatment for their problem.

    PubMed

    Gallo, L

    2014-05-01

    The diagnosis of premature ejaculation (PE) was based on a score > 8 at the PEDT five-item questionnaire. Local anaesthetic treatment (LAT) was the first-line therapy. Subjects who obtained a normalisation of EPDT score (≤8) were considered responders to LAT and even affected by lifelong PE due glans hypersensitivity. We proposed to patients not completely satisfied with LAT to undergo circumcision as a potential definitive treatment for PE. All patients received exhaustive information about potential benefits, limitations and complications. In case of refusal, each man was asked for the reasons of his choice. A total of 152 patients were recruited. Hundred and twenty-four patients among 152 (81.6%) positively responded to LAT. Among the 124 LAT responders, 21 (17%) were completely satisfied. The remaining 103 men experienced adverse reactions. It was proposed to such patients if they would be interested to a definitive form of treatment to resolve their problem. All the patients responded positively to this question. Only four patients among them (3.9%) accepted. The remaining 99 (96.1%) refused providing the following reasons of their choice: absence of guarantees 82.8%; irreversibility of the procedure creating a permanent body alteration 75.7%; costs of the procedure 12.1%; fear of potential complications 7%.

  4. Rethinking the history of female circumcision and clitoridectomy: American medicine and female sexuality in the late nineteenth century.

    PubMed

    Rodriguez, Sarah W

    2008-07-01

    During the late nineteenth and early twentieth centuries, there was one kind of female orgasm and it was clitoral; there was also only one kind of healthy sexual instinct for a woman and it was for penetrative sex with her husband. When a woman behaved outside of this normality-by masturbating or by not responding to her husband's affections-her sexual instinct was seen as disordered. If healthy women, then, were believed only to be sexual within the marital embrace, what better way to explain these errant behaviors than by blaming the clitoris, an organ seen as key to female sexual instinct? Doctors corrected a clitoris in an unhealthy state using one of four surgeries-removing smegma or adhesions between the clitoris and its hood, removing the hood (circumcision), or removing the clitoris (clitoridectomy)-in order to correct a woman's sexual instinct in an unhealthy state. Their approach to clitoral surgery, at least as revealed in published medical works, was a cautious one that respected the importance of clitoral stimulation for healthy sexuality while simultaneously recognizing its role as cause and symptom in cases of insanity that were tied to masturbation.

  5. Bacterial Vaginosis Associated with Increased Risk of Female-to-Male HIV-1 Transmission: A Prospective Cohort Analysis among African Couples

    PubMed Central

    Cohen, Craig R.; Lingappa, Jairam R.; Baeten, Jared M.; Ngayo, Musa O.; Spiegel, Carol A.; Hong, Ting; Donnell, Deborah; Celum, Connie; Kapiga, Saidi; Delany, Sinead; Bukusi, Elizabeth A.

    2012-01-01

    Background Bacterial vaginosis (BV), a disruption of the normal vaginal flora, has been associated with a 60% increased risk of HIV-1 acquisition in women and higher concentration of HIV-1 RNA in the genital tract of HIV-1–infected women. However, whether BV, which is present in up to half of African HIV-1–infected women, is associated with an increase in HIV-1 transmission to male partners has not been assessed in previous studies. Methods and Findings We assessed the association between BV on female-to-male HIV-1 transmission risk in a prospective study of 2,236 HIV-1–seropositive women and their HIV-1 uninfected male partners from seven African countries from a randomized placebo-controlled trial that enrolled heterosexual African adults who were seropositive for both HIV-1 and herpes simplex virus (HSV)-2, and their HIV-1–seronegative partners. Participants were followed for up to 24 months; every three months, vaginal swabs were obtained from female partners for Gram stain and male partners were tested for HIV-1. BV and normal vaginal flora were defined as a Nugent score of 7–10 and 0–3, respectively. To reduce misclassification, HIV-1 sequence analysis of viruses from seroconverters and their partners was performed to determine linkage of HIV-1 transmissions. Overall, 50 incident HIV-1 infections occurred in men in which the HIV-1–infected female partner had an evaluable vaginal Gram stain. HIV-1 incidence in men whose HIV-1–infected female partners had BV was 2.91 versus 0.76 per 100 person-years in men whose female partners had normal vaginal flora (hazard ratio 3.62, 95% CI 1.74–7.52). After controlling for sociodemographic factors, sexual behavior, male circumcision, sexually transmitted infections, pregnancy, and plasma HIV-1 RNA levels in female partners, BV was associated with a greater than 3-fold increased risk of female-to-male HIV-1 transmission (adjusted hazard ratio 3.17, 95% CI 1.37–7.33). Conclusions This study identified an

  6. Male Communication Problems in the Student Body.

    ERIC Educational Resources Information Center

    Borisoff, Deborah

    This paper summarizes seven "truths" imparted about male sex traits and sex-role stereotypes that stem from extant research reflecting primarily a dual-culture perspective. The paper includes relevant research findings and insights from male students that suggest that some of the conclusions about men's communication should be revisited. The…

  7. Diagnostic Testing for Male Factor Infertility

    MedlinePlus

    ... PATIENT FACT SHEET Diagnostic Testing for Male Factor Infertility When a couple has trouble having a baby, ... to find out what may be causing your infertility. Semen analysis Semen analysis is probably the first ...

  8. Evolution of Female Preference for Younger Males

    PubMed Central

    Beck, Christopher W.; Promislow, Daniel E. L.

    2007-01-01

    Previous theoretical work has suggested that females should prefer to mate with older males, as older males should have higher fitness than the average fitness of the cohort into which they were born. However, studies in humans and model organisms have shown that as males age, they accumulate deleterious mutations in their germ-line at an ever-increasing rate, thereby reducing the quality of genes passed on to the next generation. Thus, older males may produce relatively poor-quality offspring. To better understand how male age influences female mate preference and offspring quality, we used a genetic algorithm model to study the effect of age-related increases in male genetic load on female mate preference. When we incorporate age-related increases in mutation load in males into our model, we find that females evolve a preference for younger males. Females in this model could determine a male's age, but not his inherited genotype nor his mutation load. Nevertheless, females evolved age-preferences that led them to mate with males that had low mutation loads, but showed no preference for males with respect to their somatic quality. These results suggest that germ-line quality, rather than somatic quality, should be the focus of female preference in good genes models. PMID:17895980

  9. Causes of Male Infertility

    MedlinePlus

    ... Professional Societies and Organizations Home › Causes of Male Infertility Dr. Roger Lobo of the American Society for Reproductive Medicine covers causes of male infertility. "Understanding Infertility - The Basics" is a series of ...

  10. Male pattern baldness (image)

    MedlinePlus

    Male pattern baldness is a sex-linked characteristic that is passed from mother to child. A man can more accurately predict his chances of developing male pattern baldness by observing his mother's father than by looking ...

  11. Prostatitis and male infertility.

    PubMed

    Alshahrani, Saad; McGill, John; Agarwal, Ashok

    2013-11-01

    The prostate gland plays an important role in male reproduction. Inflammation of the prostate gland (prostatitis) is a common health problem affecting many young and middle aged men. Prostatitis is considered a correctable cause of male infertility, but the pathophysiology and appropriate treatment options of prostatitis in male infertility remain unclear. This literature review will focus on current data regarding prostatitis and its impact on male infertility.

  12. A Randomized Male Tolerance Study of Dapivirine Gel Following Multiple Topical Penile Exposures (MTN 012/IPM 010)

    PubMed Central

    Hoesley, Craig; Carballo-Diéguez, Alex; Hendrix, Craig W.; Husnik, Marla; Levy, Lisa; Hall, Wayne; Soto-Torres, Lydia; Nel, Annalene M.

    2014-01-01

    Abstract Dapivirine (DPV) is a nonnucleoside reverse transcriptase inhibitor with a favorable safety profile following vaginal application. A penile tolerance study was conducted prior to further development of DPV as a candidate vaginal microbicide. Twenty-four circumcised and 24 uncircumcised (N=48) healthy HIV-negative male participants aged 18 years or older were randomized 2:1:1 to apply DPV 0.05% gel, matched placebo gel, or universal placebo gel, respectively, to their penis once daily for 7 sequential days. The safety, acceptability, and pharmacokinetic profile of DPV 0.05% gel were assessed by the presence of Grade 2 or higher genitourinary adverse events (AEs) and systemic AEs, a behavioral questionnaire, and pharmacokinetic plasma blood draw, respectively, at the final clinic visit (FCV). There were no Grade 2 genitourinary AEs in 47 participants completing the FCV. One participant in the DPV arm failed to attend the FCV. There were 13 AEs reported; all were Grade 1 except one Grade 2 corneal laceration unrelated to study product. Participants liked the gel to a moderate extent, yet 72% reported they would be “very likely” to use a gel like the one they used in the study every time they have intercourse. DPV was detectable in plasma in all 23 DPV arm study participants at the FCV. On average, the circumcised participants' DPV concentrations were 54% of those in uncircumcised participants (p=0.07). Topical seven-day penile application of DPV 0.05% gel was locally and systemically safe, was acceptable to male participants, and resulted in systemic exposure to the drug. PMID:24070431

  13. The inner foreskin of healthy males at risk of HIV infection harbors epithelial CD4+ CCR5+ cells and has features of an inflamed epidermal barrier.

    PubMed

    Lemos, Maria P; Lama, Javier R; Karuna, Shelly T; Fong, Youyi; Montano, Silvia M; Ganoza, Carmela; Gottardo, Raphael; Sanchez, Jorge; McElrath, M Juliana

    2014-01-01

    Male circumcision provides partial protection against multiple sexually transmitted infections (STIs), including HIV, but the mechanisms are not fully understood. To examine potential vulnerabilities in foreskin epithelial structure, we used Wilcoxon paired tests adjusted using the false discovery rate method to compare inner and outer foreskin samples from 20 healthy, sexually active Peruvian males who have sex with males or transgender females, ages 21-29, at elevated risk of HIV infection. No evidence of epithelial microtrauma was identified, as assessed by keratinocyte activation, fibronectin deposition, or parakeratosis. However, multiple suprabasal tight junction differences were identified: 1) inner foreskin stratum corneum was thinner than outer (p = 0.035); 2) claudin 1 had extended membrane-bound localization throughout inner epidermis stratum spinosum (p = 0.035); 3) membrane-bound claudin 4 was absent from inner foreskin stratum granulosum (p = 0.035); and 4) occludin had increased membrane deposition in inner foreskin stratum granulosum (p = 0.042) versus outer. Together, this suggests subclinical inflammation and paracellular transport modifications to the inner foreskin. A setting of inflammation was further supported by inner foreskin epithelial explant cultures secreting higher levels of GM-CSF (p = 0.029), IP-10 (p = 0.035) and RANTES (p = 0.022) than outer foreskin, and also containing an increased density of CCR5+ and CD4+ CCR5+ cells (p = 0.022). Inner foreskin dermis also secreted more RANTES than outer (p = 0.036), and had increased density of CCR5+ cells (p = 0.022). In conclusion, subclinical changes to the inner foreskin of sexually active males may support an inflammatory state, with availability of target cells for HIV infection and modifications to epidermal barriers, potentially explaining the benefits of circumcision for STI prevention. PMID:25268493

  14. The Inner Foreskin of Healthy Males at Risk of HIV Infection Harbors Epithelial CD4+ CCR5+ Cells and Has Features of an Inflamed Epidermal Barrier

    PubMed Central

    Lemos, Maria P.; Lama, Javier R.; Karuna, Shelly T.; Fong, Youyi; Montano, Silvia M.; Ganoza, Carmela; Gottardo, Raphael; Sanchez, Jorge; McElrath, M. Juliana

    2014-01-01

    Male circumcision provides partial protection against multiple sexually transmitted infections (STIs), including HIV, but the mechanisms are not fully understood. To examine potential vulnerabilities in foreskin epithelial structure, we used Wilcoxon paired tests adjusted using the false discovery rate method to compare inner and outer foreskin samples from 20 healthy, sexually active Peruvian males who have sex with males or transgender females, ages 21–29, at elevated risk of HIV infection. No evidence of epithelial microtrauma was identified, as assessed by keratinocyte activation, fibronectin deposition, or parakeratosis. However, multiple suprabasal tight junction differences were identified: 1) inner foreskin stratum corneum was thinner than outer (p = 0.035); 2) claudin 1 had extended membrane-bound localization throughout inner epidermis stratum spinosum (p = 0.035); 3) membrane-bound claudin 4 was absent from inner foreskin stratum granulosum (p = 0.035); and 4) occludin had increased membrane deposition in inner foreskin stratum granulosum (p = 0.042) versus outer. Together, this suggests subclinical inflammation and paracellular transport modifications to the inner foreskin. A setting of inflammation was further supported by inner foreskin epithelial explant cultures secreting higher levels of GM-CSF (p = 0.029), IP-10 (p = 0.035) and RANTES (p = 0.022) than outer foreskin, and also containing an increased density of CCR5+ and CD4+ CCR5+ cells (p = 0.022). Inner foreskin dermis also secreted more RANTES than outer (p = 0.036), and had increased density of CCR5+ cells (p = 0.022). In conclusion, subclinical changes to the inner foreskin of sexually active males may support an inflammatory state, with availability of target cells for HIV infection and modifications to epidermal barriers, potentially explaining the benefits of circumcision for STI prevention. PMID:25268493

  15. The inner foreskin of healthy males at risk of HIV infection harbors epithelial CD4+ CCR5+ cells and has features of an inflamed epidermal barrier.

    PubMed

    Lemos, Maria P; Lama, Javier R; Karuna, Shelly T; Fong, Youyi; Montano, Silvia M; Ganoza, Carmela; Gottardo, Raphael; Sanchez, Jorge; McElrath, M Juliana

    2014-01-01

    Male circumcision provides partial protection against multiple sexually transmitted infections (STIs), including HIV, but the mechanisms are not fully understood. To examine potential vulnerabilities in foreskin epithelial structure, we used Wilcoxon paired tests adjusted using the false discovery rate method to compare inner and outer foreskin samples from 20 healthy, sexually active Peruvian males who have sex with males or transgender females, ages 21-29, at elevated risk of HIV infection. No evidence of epithelial microtrauma was identified, as assessed by keratinocyte activation, fibronectin deposition, or parakeratosis. However, multiple suprabasal tight junction differences were identified: 1) inner foreskin stratum corneum was thinner than outer (p = 0.035); 2) claudin 1 had extended membrane-bound localization throughout inner epidermis stratum spinosum (p = 0.035); 3) membrane-bound claudin 4 was absent from inner foreskin stratum granulosum (p = 0.035); and 4) occludin had increased membrane deposition in inner foreskin stratum granulosum (p = 0.042) versus outer. Together, this suggests subclinical inflammation and paracellular transport modifications to the inner foreskin. A setting of inflammation was further supported by inner foreskin epithelial explant cultures secreting higher levels of GM-CSF (p = 0.029), IP-10 (p = 0.035) and RANTES (p = 0.022) than outer foreskin, and also containing an increased density of CCR5+ and CD4+ CCR5+ cells (p = 0.022). Inner foreskin dermis also secreted more RANTES than outer (p = 0.036), and had increased density of CCR5+ cells (p = 0.022). In conclusion, subclinical changes to the inner foreskin of sexually active males may support an inflammatory state, with availability of target cells for HIV infection and modifications to epidermal barriers, potentially explaining the benefits of circumcision for STI prevention.

  16. Self-Concept and Psychological Adjustment Differences Between Self-Identified Male Transexuals and Male Homosexuals

    ERIC Educational Resources Information Center

    Roback, Howard B.; And Others

    1977-01-01

    Self-concept and adjustment data from anatomical males seeking sexual reassignment surgery were compared with that from a male homosexual group. Findings indicated that the homosexual group had a better self-image and was better adjusted than the sex change group. (Author)

  17. Does HIV Exploit the Inflammatory Milieu of the Male Genital Tract for Successful Infection?

    PubMed Central

    Esra, Rachel T.; Olivier, Abraham J.; Passmore, Jo-Ann S.; Jaspan, Heather B.; Harryparsad, Rushil; Gray, Clive M.

    2016-01-01

    In many parts of the World, medical male circumcision (MMC) is used as standard prevention of care against HIV infection. This is based on seminal reports made over 10 years ago that removal of the foreskin provides up to 60% protection against HIV infection in males and seems currently the best antiretroviral-free prevention strategy yet against the global epidemic. We explore the potential mechanisms by which MMC protects against HIV-1 acquisition and that one of the oldest, albeit re-invented, rituals of removing a foreskin underscores the exploitative nature of HIV on the anatomy and tissue of the uncircumcised penis. Furthermore, foreskin removal also reveals how males acquire HIV, and in reality, the underlying mechanisms of MMC are not known. We argue that the normal sequelae of inflammation in the male genital tract (MGT) for protection from sexually transmitted infections (STI)-induced pathology represents a perfect immune and microbial ecosystem for HIV acquisition. The accumulation of HIV-1 target cells in foreskin tissue and within the urethra in response to STIs, both during and after resolution of infection, suggests that acquisition of HIV-1, through sexual contact, makes use of the natural immune milieu of the MGT. Understanding immunity in the MGT, the movement of HIV-1 target cells to the urethra and foreskin tissue upon encounter with microbial signals would provide more insight into viral acquisition and lay the foundation for further prevention strategies in males that would be critical to curb the epidemic in all sexual partners at risk of infection. The global female-centric focus of HIV-1 transmission and acquisition research has tended to leave gaps in our knowledge of what determines HIV-1 acquisition in men and such understanding would provide a more balanced and complete view of viral acquisition. PMID:27446076

  18. Male Adolescent Contraceptive Utilization.

    ERIC Educational Resources Information Center

    Finkel, Madelon Lubin; Finkel, David J.

    1978-01-01

    The contraceptive utilization of a sample of sexually active, urban, high school males (Black, Hispanic, and White) was examined by anonymous questionnaire. Contraceptive use was haphazard, but White males tended to be more effective contraceptors than the other two groups. Reasons for nonuse were also studied. (Author/SJL)

  19. Islam and "female circumcision": the dispute over FGM in the Egyptian press, September 1994.

    PubMed

    Kedar, Mordechai

    2002-01-01

    In September 1994, during the United Nations Population Conference in Cairo, CNN broadcast a report about the custom of clitoridectomy in Egypt. The televised report included footage of such a ceremony performed on a ten-year-old Egyptian girl in Cairo a few days earlier. This broadcast revived the public polemics on clitoridectomy in Egypt. Secular newspapers such as al-Wafd and al-Ahali opposed this practice while religious circles used the al-Sha'b newspaper to justify it. The religious argument is based on Islamic tradition although the origin of the practice is admittedly pre-Islamic. This position maintains that the type of clitoridectomy performed involves minimal excision, but in practice it is much more radical. There are voices from within the lslamic camp, mainly those of women, that call for the abolition of this practice, basing this demand on the fact that this act is a minor rather than major principle of Islamic Law. Although the secular educated classes in Egypt tend to avoid this practice, they are a minority. The public argument continues in a low key while in reality thousands of young girls daily undergo this traumatic experience which maims them in body and in soul. Unless there is a sustained public outcry against it, this mutilation is destined to remain part of the Egyptian reality for a long time. This paper discusses the positions of the two sides to the dispute, concentrating mainly on the opinions of the Islamic faction which upholds the continuation of genital mutilation. These opinions are expressed by male Islamic elders while opposing arguments are presented by women who decry this practice. PMID:12184615

  20. Islam and "female circumcision": the dispute over FGM in the Egyptian press, September 1994.

    PubMed

    Kedar, Mordechai

    2002-01-01

    In September 1994, during the United Nations Population Conference in Cairo, CNN broadcast a report about the custom of clitoridectomy in Egypt. The televised report included footage of such a ceremony performed on a ten-year-old Egyptian girl in Cairo a few days earlier. This broadcast revived the public polemics on clitoridectomy in Egypt. Secular newspapers such as al-Wafd and al-Ahali opposed this practice while religious circles used the al-Sha'b newspaper to justify it. The religious argument is based on Islamic tradition although the origin of the practice is admittedly pre-Islamic. This position maintains that the type of clitoridectomy performed involves minimal excision, but in practice it is much more radical. There are voices from within the lslamic camp, mainly those of women, that call for the abolition of this practice, basing this demand on the fact that this act is a minor rather than major principle of Islamic Law. Although the secular educated classes in Egypt tend to avoid this practice, they are a minority. The public argument continues in a low key while in reality thousands of young girls daily undergo this traumatic experience which maims them in body and in soul. Unless there is a sustained public outcry against it, this mutilation is destined to remain part of the Egyptian reality for a long time. This paper discusses the positions of the two sides to the dispute, concentrating mainly on the opinions of the Islamic faction which upholds the continuation of genital mutilation. These opinions are expressed by male Islamic elders while opposing arguments are presented by women who decry this practice.

  1. Will male advertisement be a reliable indicator of paternal care, if offspring survival depends on male care?

    PubMed Central

    Kelly, Natasha B.; Alonzo, Suzanne H.

    2009-01-01

    Existing theory predicts that male signalling can be an unreliable indicator of paternal care, but assumes that males with high levels of mating success can have high current reproductive success, without providing any parental care. As a result, this theory does not hold for the many species where offspring survival depends on male parental care. We modelled male allocation of resources between advertisement and care for species with male care where males vary in quality, and the effect of care and advertisement on male fitness is multiplicative rather than additive. Our model predicts that males will allocate proportionally more of their resources to whichever trait (advertisement or paternal care) is more fitness limiting. In contrast to previous theory, we find that male advertisement is always a reliable indicator of paternal care and male phenotypic quality (e.g. males with higher levels of advertisement never allocate less to care than males with lower levels of advertisement). Our model shows that the predicted pattern of male allocation and the reliability of male signalling depend very strongly on whether paternal care is assumed to be necessary for offspring survival and how male care affects offspring survival and male fitness. PMID:19520802

  2. Will male advertisement be a reliable indicator of paternal care, if offspring survival depends on male care?

    PubMed

    Kelly, Natasha B; Alonzo, Suzanne H

    2009-09-01

    Existing theory predicts that male signalling can be an unreliable indicator of paternal care, but assumes that males with high levels of mating success can have high current reproductive success, without providing any parental care. As a result, this theory does not hold for the many species where offspring survival depends on male parental care. We modelled male allocation of resources between advertisement and care for species with male care where males vary in quality, and the effect of care and advertisement on male fitness is multiplicative rather than additive. Our model predicts that males will allocate proportionally more of their resources to whichever trait (advertisement or paternal care) is more fitness limiting. In contrast to previous theory, we find that male advertisement is always a reliable indicator of paternal care and male phenotypic quality (e.g. males with higher levels of advertisement never allocate less to care than males with lower levels of advertisement). Our model shows that the predicted pattern of male allocation and the reliability of male signalling depend very strongly on whether paternal care is assumed to be necessary for offspring survival and how male care affects offspring survival and male fitness. PMID:19520802

  3. Suicidal behaviors in homosexual and bisexual males.

    PubMed

    Bagley, C; Tremblay, P

    1997-01-01

    A stratified random sample of 750 males in Calgary, Canada, aged 18-27 years, were given questions on sexual activity and orientation. Mental health questions included a measure of suicidality and of acts of deliberate self-harm. A computerized response format, which has been established as a good method for eliciting sensitive personal data, ensured anonymity. Almost 13% of the males were classified as homosexual or bisexual on the basis of being currently homosexually active or by self-identification. Significantly higher rates of previous suicidal ideas and actions were reported by homosexually oriented males than by heterosexual males. Homosexually oriented males accounted for 62.5% of suicide attempters. These findings, which indicate that homosexual and bisexual males are 13.9 times more at risk for a serious suicide attempt, are consonant with previous findings. The predominant reason for the suicidality of these young males may be linked to the process of "coming out," especially for those who currently have high levels of depression. These results underscore the need for qualified services rarely available to homosexually oriented youth. PMID:9141776

  4. Predictors of male microchimerism.

    PubMed

    Kamper-Jørgensen, Mads; Mortensen, Laust Hvas; Andersen, Anne-Marie Nybo; Hjalgrim, Henrik; Gadi, Vijayakrishna K; Tjønneland, Anne

    2012-01-01

    The association between microchimerism acquired primarily through pregnancy and later disease is of increasing scientific interest. Because this line of research is new and little is known about the nature of microchimerism, studies of microchimerism are potentially vulnerable to error from confounding and reverse causation. To address the issue of confounding, we conducted an analysis of predictors of male microchimerism in 272 female participants of the Danish Diet, Cancer and Health cohort. Buffy coat DNA was tested for Y chromosome presence as a marker of male microchimerism. First, we used logistic regression and thereafter random forest modeling to evaluate the ability of a range of reproductive, lifestyle, hospital or clinic visit history, and other variables to predict whether women tested positive for male microchimerism. We found some indication that current use of contraceptive pills and hormone replacement therapy reduced the odds of testing positive for male microchimerism. However, prediction of male microchimerism presence was poor based on the available variables. Studies of the possible role of male microchimerism in maternal health and disease are therefore unlikely to be heavily confounded by the variables examined in the present investigation. More research focused on acquisition, retention and clearing of male cells in the maternal circulation is needed. PMID:22926759

  5. Predictors of male microchimerism.

    PubMed

    Kamper-Jørgensen, Mads; Mortensen, Laust Hvas; Andersen, Anne-Marie Nybo; Hjalgrim, Henrik; Gadi, Vijayakrishna K; Tjønneland, Anne

    2012-01-01

    The association between microchimerism acquired primarily through pregnancy and later disease is of increasing scientific interest. Because this line of research is new and little is known about the nature of microchimerism, studies of microchimerism are potentially vulnerable to error from confounding and reverse causation. To address the issue of confounding, we conducted an analysis of predictors of male microchimerism in 272 female participants of the Danish Diet, Cancer and Health cohort. Buffy coat DNA was tested for Y chromosome presence as a marker of male microchimerism. First, we used logistic regression and thereafter random forest modeling to evaluate the ability of a range of reproductive, lifestyle, hospital or clinic visit history, and other variables to predict whether women tested positive for male microchimerism. We found some indication that current use of contraceptive pills and hormone replacement therapy reduced the odds of testing positive for male microchimerism. However, prediction of male microchimerism presence was poor based on the available variables. Studies of the possible role of male microchimerism in maternal health and disease are therefore unlikely to be heavily confounded by the variables examined in the present investigation. More research focused on acquisition, retention and clearing of male cells in the maternal circulation is needed.

  6. The scent of inbreeding: a male sex pheromone betrays inbred males

    PubMed Central

    van Bergen, Erik; Brakefield, Paul M.; Heuskin, Stéphanie; Zwaan, Bas J.; Nieberding, Caroline M.

    2013-01-01

    Inbreeding depression results from mating among genetically related individuals and impairs reproductive success. The decrease in male mating success is usually attributed to an impact on multiple fitness-related traits that reduce the general condition of inbred males. Here, we find that the production of the male sex pheromone is reduced significantly by inbreeding in the butterfly Bicyclus anynana. Other traits indicative of the general condition, including flight performance, are also negatively affected in male butterflies by inbreeding. Yet, we unambiguously show that only the production of male pheromones affects mating success. Thus, this pheromone signal informs females about the inbreeding status of their mating partners. We also identify the specific chemical component (hexadecanal) probably responsible for the decrease in male mating success. Our results advocate giving increased attention to olfactory communication as a major causal factor of mate-choice decisions and sexual selection. PMID:23466986

  7. Flirtation reduces males' fecundity but not longevity.

    PubMed

    Esfandi, Kambiz; He, Xiong Zhao; Wang, Qiao

    2015-08-01

    Theory predicts that due to limited resources males should strategically adjust their investment in reproduction and survival. Based on different conceptual framework, experimental designs, and study species, many studies support while others contradict this general prediction. Using a moth Ephestia kuehniella whose adults do not feed and thus have fixed resources for their lifetime fitness, we investigated whether males adjusted their investment in various life activities under dynamic socio-sexual environment. We allowed focal males to perceive rivals or additional females without physical contact. We show that males do not adjust the number of sperm they transfer to mates in a given copulation at different immediate or both immediate and mean sperm competition levels. Contradictory to general predictions, our results demonstrate that cues from additional females increase males' investment in courtship and reduce their lifetime number of copulations and sperm ejaculated, whereas cues from rivals have no effect on these parameters. Males have similar longevity in all treatments. We suggest that the sex pheromone produced by multiple females overstimulate males, increasing males' costly flirtations, and reducing their lifetime copulation frequency and fecundity. This finding offers a novel explanation for the success of mating disruption strategy using sex pheromones in pest management. PMID:26133013

  8. Bladder catheterization, male (image)

    MedlinePlus

    ... kept empty (decompressed) and urinary flow assured. The balloon holds the catheter in place for a duration of time. Catheterization in males is slightly more difficult and uncomfortable than in females because of the longer urethra.

  9. Male Reproductive System

    MedlinePlus

    ... Surveillance Modules » Anatomy & Physiology » Reproductive System » Male Reproductive System Cancer Registration & Surveillance Modules Anatomy & Physiology Intro to the Human Body Body Functions & Life Process Anatomical Terminology Review Quiz ...

  10. Male Reproductive System

    MedlinePlus

    ... gamete, the egg or ovum , meet in the female's reproductive system to create a new individual. Both the male and female reproductive systems are essential for reproduction. Humans, like other organisms, ...

  11. Male Reproductive System

    MedlinePlus

    ... gamete, the egg or ovum, meet in the female's reproductive system to create a baby. Both the male and female reproductive systems are essential for reproduction. Humans pass certain characteristics ...

  12. Males and Eating Disorders

    MedlinePlus

    ... Bar Home Current Issue Past Issues Males and Eating Disorders Past Issues / Spring 2008 Table of Contents For ... this page please turn Javascript on. Photo: PhotoDisc Eating disorders primarily affect girls and women, but boys and ...

  13. Breast enlargement in males

    MedlinePlus

    Gynecomastia; Breast enlargement in a male ... The condition may occur in one or both breasts. It begins as a small lump beneath the nipple, which may be tender. One breast may be larger than the other. Enlarged breasts ...

  14. Chlamydial infections - male

    MedlinePlus

    Chlamydia infection in males is an infection of the urethra (the tube that drains urine from the ... and passes through the penis). This type of chlamydia infection is passed from one person to another ...