title: How willing are men who have sex with men in China to be circumcised for the sake of protecting his female sex partner?
abstract: BACKGROUND
  The HIV prevalence among men who have sex with men (MSM) is increasing sharply in China. Many MSM have female sexual partners, representing a bridge of transmitting HIV to the general population. Circumcision reduces the risk of HIV prevention via heterosexual intercourse.
  
  
  OBJECTIVE
  The study investigated the prevalence and factors related to willingness to undergo circumcision when MSM were informed that circumcision could reduce risk of heterosexual HIV transmission.
  
  
  METHODS
  An anonymous cross-sectional survey was conducted in Jiangsu, China. A total of 157 MSM with bisexual behaviors in the last six months were recruited using snowball sampling.
  
  
  METHODS
  Self-reported circumcision status and foreskin conditions were recorded. HIV-related knowledge, risk perceptions, risky sexual behaviors, cognitive and behavioral intention factors regarding circumcision were assessed.
  
  
  RESULTS
  Among all respondents, 5.7% were circumcised. In the uncircumcised subsample, the willingness to be circumcised increased from 8.1% to 35.1% after they were informed about the 50% risk reduction effect of circumcision regarding heterosexual HIV transmission. Risk behaviors, uncertainty about the prevalence of HIV among MSM, perception of overly long foreskin, peer's suggestion, disagreement with the statements "MSM in general are not willing to be circumcised" and "circumcisions are for children, not for adults" and self-efficacy for circumcision were significantly associated with willingness for circumcision given the hypothetical risk reduction effect (OR = 2.37 and 3.11, respectively, P < 0.05). Perception of overly long foreskin, self-efficacy, and having used a condom in the last episode of sex with a woman remained significantly associated with the conditional willingness for circumcision in the multivariate analysis (OR = 3.03, 2.84 and 2.42, respectively, P < 0.05).
  
  
  CONCLUSIONS
  Interventions promoting circumcision among bisexual MSM, based on the risk reduction effect on heterosexual HIV transmission, are likely to be successful. Such programs should focus on increasing self-efficacy and may consider utilizing a peer educator approach.
authors.affiliation: Centre for Health Behaviours Research, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Joseph T F
authors.initials: JT
authors.lastname: Lau
authors.forename: Hongjing
authors.initials: H
authors.lastname: Yan
authors.forename: Chunqing
authors.initials: C
authors.lastname: Lin
authors.forename: Jun
authors.initials: J
authors.lastname: Zhang
authors.forename: Kai-Chow
authors.initials: KC
authors.lastname: Choi
authors.forename: Zhijun
authors.initials: Z
authors.lastname: Wang
authors.forename: Chun
authors.initials: C
authors.lastname: Hao
authors.forename: Xiping
authors.initials: X
authors.lastname: Huan
authors.forename: Haitao
authors.initials: H
authors.lastname: Yang
mesh_terms: D000328:Adult; D001294:Attitude to Health; D002681:China; D002944:Circumcision, Male / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D052816:Foreskin / Q000033:anatomy & histology; D015658:HIV Infections / Q000517:prevention & control / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D008297:Male; D017533:Marital Status; D012307:Risk Factors; D047568:Unsafe Sex / Q000523:psychology; D055815:Young Adult