title: 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.
abstract: 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.
authors.affiliation: Institut National de la Santé et de la Recherche Médicale, Unit 1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.|Faculty of medicine, Research Unit 4184, Faculty of Medicine, University of Burgundy, Dijon, France.
authors.forename: Esaie
authors.initials: E
authors.lastname: Marshall
authors.affiliation: Progressus Research and Development, Johannesburg, South Africa.
authors.forename: Reathe
authors.initials: R
authors.lastname: Rain-Taljaard
authors.affiliation: Progressus Research and Development, Johannesburg, South Africa.
authors.forename: Motlalepule
authors.initials: M
authors.lastname: Tsepe
authors.affiliation: Progressus Research and Development, Johannesburg, South Africa.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Monkwe
authors.affiliation: Progressus Research and Development, Johannesburg, South Africa.
authors.forename: Florence
authors.initials: F
authors.lastname: Hlatswayo
authors.affiliation: Progressus Research and Development, Johannesburg, South Africa.
authors.forename: Simphiwe
authors.initials: S
authors.lastname: Tshabalala
authors.affiliation: Progressus Research and Development, Johannesburg, South Africa.
authors.forename: Simphiwe
authors.initials: S
authors.lastname: Khela
authors.affiliation: Progressus Research and Development, Johannesburg, South Africa.
authors.forename: Lindo
authors.initials: L
authors.lastname: Xulu
authors.affiliation: Progressus Research and Development, Johannesburg, South Africa.
authors.forename: Dumazile
authors.initials: D
authors.lastname: Xaba
authors.affiliation: Progressus Research and Development, Johannesburg, South Africa.
authors.forename: Tebogo
authors.initials: T
authors.lastname: Molomo
authors.affiliation: Progressus Research and Development, Johannesburg, South Africa.
authors.forename: Thobile
authors.initials: T
authors.lastname: Malinga
authors.affiliation: National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.|Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Adrian
authors.initials: A
authors.lastname: Puren
authors.affiliation: Institut National de la Santé et de la Recherche Médicale, Unit 1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.|Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt, France.|Faculty of Medicine, University of Versailles-Saint Quentin, Versailles, France.
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 / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D015995:Prevalence; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult