The (mis)reporting of male circumcision status among men and women in Zambia and Swaziland: a randomized evaluation of interview methods.
BACKGROUND
To date, male circumcision prevalence has been estimated using surveys of men self-reporting their circumcision status. HIV prevention trials and observational studies involving female participants also collect data on partners' circumcision status as a risk factor for HIV/STIs. A number of studies indicate that reports of circumcision status may be inaccurate. This study assessed different methods for improving self- and partner reporting of circumcision status.


RESULTS
The study was conducted in urban and rural Zambia and urban Swaziland. Men (N = 1264) aged 18-50 and their female partners (N = 1264), and boys (N = 840) aged 13-17 were enrolled. Participants were recruited from HIV counseling and testing sites, health centers, and surrounding communities. The study experimentally assessed methods for improving the reporting of circumcision status, including: a) a simple description of circumcision, b) a detailed description of circumcision, c) an illustration of a circumcised and uncircumcised penis, and d) computerized self-interviewing. Self-reports were compared to visual examination. For men, the error in reporting was largely unidirectional: uncircumcised men more often reported they were circumcised (2-7%), depending on setting. Fewer circumcised men misrepresented their status (0.05-5%). Misreporting by women was significantly higher (11-15%), with the error in both directions. A sizable number of women reported that they did not know their partner's circumcision status (3-8%). Computerized interviewing did not improve accuracy. Providing an illustration, particularly for illiterate participants, significantly improved reporting of circumcision status, decreasing misreporting among illiterate participants from 13% to 10%, although misreporting was not eliminated.


CONCLUSIONS
Study results suggest that the prevalence of circumcision may be overestimated in Zambia and Swaziland; the error in reporting is higher among women than among men. Improved reporting when a description or illustration is provided suggests that the source of the error is a lack of understanding of male circumcision.
HIV-AIDS Program, Population Council, Lusaka, Zambia. phewett@popcouncil.org
Paul C
PC
Hewett
Nicole
N
Haberland
Lou
L
Apicella
Barbara S
BS
Mensch
D000293:Adolescent; D000328:Adult; D002944:Circumcision, Male / Q000706:statistics & numerical data*; D003376:Counseling; D013541:Eswatini; D005260:Female; D015658:HIV Infections / Q000517:prevention & control; D006679:HIV Seropositivity; D006801:Humans; D007407:Interviews as Topic / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D057566:Self Report; D015024:Zambia