Factors associated with uptake of infant male circumcision for HIV prevention in western Kenya.
OBJECTIVE
Three randomized trials demonstrated male circumcision decreases female-to-male HIV incidence by 60%. Male circumcision research in sub-Saharan Africa has focused on adolescents and adults. Modeling suggests infant male circumcision (IMC) will be cost saving for HIV prevention in high to moderate seroprevalent regions. This study examined parental decision-making and differences in characteristics of parents accepting and declining IMC services in western Kenya.


METHODS
This case-control study was conducted in 2010 at 5 government hospitals in Nyanza Province, Kenya. Cases were mothers and fathers accepting circumcision for their son. Controls were parents who declined IMC services. A questionnaire comprising 41 questions was administered.


RESULTS
A total of 627 mothers and 493 fathers enrolled. In multivariable logistic regression modeling, factors associated with accepting IMC among mothers were the following: father circumcised (odds ratio [OR] = 2.30, P < .001) and agreeing with the father about the IMC decision (OR = 4.38, P < .001). Among fathers, factors associated with accepting IMC were the following: being circumcised (OR = 1.77, P = .016) and agreeing with the mother about IMC (OR = 11.0, P < .001). Fathers were the primary decision makers in most instances (66%). Few parents (3%) reported they would prefer a future son to remain uncircumcised.


CONCLUSIONS
Fathers are important in the IMC decision-making process. Fathers, as well as mothers, should be targeted for optimal scale-up of IMC services. Circumcision programs should offer services for males of all ages, as male circumcision at some age is highly acceptable to both men and women.
Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Illinois, USA. myoung22@uic.edu
Marisa R
MR
Young
Elijah
E
Odoyo-June
Sherry K
SK
Nordstrom
Tracy E
TE
Irwin
Dedan O
DO
Ongong'a
Betha
B
Ochomo
Kawango
K
Agot
Robert C
RC
Bailey
D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002944:Circumcision, Male / Q000523:psychology*; D003657:Decision Making; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D019538:Health Care Surveys; D006801:Humans; D007231:Infant, Newborn; D007630:Kenya; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010290:Parents / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult