title: Adult male circumcision as an intervention against HIV: an operational study of uptake in a South African community (ANRS 12126).
abstract: BACKGROUND
  To evaluate the knowledge, attitudes and beliefs about adult male circumcision (AMC), assess the association of AMC with HIV incidence and prevalence, and estimate AMC uptake in a Southern African community.
  
  
  METHODS
  A cross-sectional biomedical survey (ANRS-12126) conducted in 2007-2008 among a random sample of 1198 men aged 15 to 49 from Orange Farm (South Africa). Face-to-face interviews were conducted by structured questionnaire. Recent HIV infections were evaluated using the BED incidence assay. Circumcision status was self-reported and clinically assessed. Adjusted HIV incidence rate ratios (aIRR) and prevalence ratios (aPR) were calculated using Poisson regression.
  
  
  RESULTS
  The response rate was 73.9%. Most respondents agreed that circumcised men could become HIV infected and needed to use condoms, although 19.3% (95%CI: 17.1% to 21.6%) asserted that AMC protected fully against HIV. Among self-reported circumcised men, 44.9% (95%CI: 39.6% to 50.3%) had intact foreskins. Men without foreskins had lower HIV incidence and prevalence than men with foreskins (aIRR = 0.35; 95%CI: 0.14 to 0.88; aPR = 0.45, 95%CI: 0.26 to 0.79). No significant difference was found between self-reported circumcised men with foreskins and other uncircumcised men. Intention to undergo AMC was associated with ethnic group and partner and family support of AMC. Uptake of AMC was 58.8% (95%CI: 55.4% to 62.0%).
  
  
  CONCLUSIONS
  AMC uptake in this community is high but communication and counseling should emphasize what clinical AMC is and its effect on HIV acquisition. These findings suggest that AMC roll-out is promising but requires careful implementation strategies to be successful against the African HIV epidemic.
authors.affiliation: CESP INSERM-UVSQ UMRS 1018, Villejuif, France.
authors.forename: Pascale
authors.initials: P
authors.lastname: Lissouba
authors.forename: Dirk
authors.initials: D
authors.lastname: Taljaard
authors.forename: Dino
authors.initials: D
authors.lastname: Rech
authors.forename: Veerle
authors.initials: V
authors.lastname: Dermaux-Msimang
authors.forename: Camille
authors.initials: C
authors.lastname: Legeai
authors.forename: David
authors.initials: D
authors.lastname: Lewis
authors.forename: Beverley
authors.initials: B
authors.lastname: Singh
authors.forename: Adrian
authors.initials: A
authors.lastname: Puren
authors.forename: Bertran
authors.initials: B
authors.lastname: Auvert
mesh_terms: D000293:Adolescent; D000328:Adult; D002944:Circumcision, Male / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D013019:South Africa; D011795:Surveys and Questionnaires; D055815:Young Adult