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Medical Male Circumcision Uptake to Prevent HIV

The last research meeting of April was on the subject of medical male circumcision (MMC), hosted by Nathan Beijneveld. He presented research of the acceptability and uptake of MMC in two adolescent populations in South Africa. This is a study with MACHO (Males Actively Choosing Healthy Options). The study investigated the uptake and acceptability of MMC in two adolescent populations. Additionally, it examined sexual risk behaviour between circumcised and uncircumcised participants.

Street Ethiopia | Rod Waddington

The WHO recommends circumcision as part of an HIV-prevention package in conjunction with other methods such as male and female condoms. (1) There are medical justifications for this procedure. The foreskin is a thin piece of skin which is susceptible to abrasions and HIV can get into the bloodstream more easily. Furthermore, the foreskin can trap bacteria and viruses. The human body naturally protects itself by having a higher density of immune cells in this region. However, HIV has found a way to bypass this protection mechanism by attaching itself to these cells.

The study looked at two cohorts of participants in two high HIV-infection risk areas: one in Cape Town and the other in Johannesburg. Each cohort was made up of 50 uncircumcised, adolescent males and their legal guardian. Each participant was asked about their knowledge of MMC and whether it can protect against HIV. The main difference between the cohorts was their cultural representations. The Cape Town group was mainly Xhosa men and the Johannesburg group was mostly Zulu.

Medical Male Circumcision to prevent HIV infographic | WHO (5)

 

The timing of circumcision in Xhosa men at the average age of 19. (2) Furthermore, more than half of these men have had sexual intercourse at the age of 18. (3) MMC is most effective at preventing HIV-infection when performed before sexual debut.

The alternative to MMC is Traditional male circumcision (TMC). TMC is a right of passage into manhood for many Sub Saharan African men. A practitioner, with no formal medical training, conducts the procedure outside of a medical setting.(4)

TMC has more known health complications than MMC such as infection, haemorrhage, and delayed wound healing. Additionally, sometimes the circumcision is incomplete and part of the foreskin remains which increases the risk of catching HIV.

Within the two cohorts, only one participant from the Cape Town study underwent TMC and nobody underwent MMC. Whereas in Johannesburg, one participant opted for TWC and over ten volunteered for MMC. There were concerns in both groups about the safety, expertise and pain of TWC, but there were differences in concerns around MMC. The Johannesburg group were barely concerned with MMC. In contrast, the Cape Town group were largely concerned that MMC went against their culture or religion and were concerned that they would ‘not be regarded as a man.’

The study concluded that Xhosa men were far less likely to volunteer for MMC, largely for cultural reasons. Beijneveld noted that this is a pilot study and that 100 participants are a small sample size and that their conclusions could change with further investigation.

We thank Beijneveld for his fascinating presentation and wish him the best of luck in his future career as a doctor.

 

Written by Caroline Reid

References

  1. http://www.who.int/hiv/topics/malecircumcision/fact_sheet/en/
  2. Maughan-Brown B, Venkataramani AS, Nattrass N, Seekings J, Whiteside AW. A Cut Above the Rest: traditional male circumcision and HIV risk among Xhosa men in Cape Town. J Acquir Immune Defic Syndr. 2011;58(5):499-505. doi:10.1097/QAI.0b013e31823584c1
  3. Shisana O. South African national HIV prevalence, HIV incidence, behaviour and communication survey, 2005. Human Sciences Research Council. http://www.hsrc.ac.za/en/research-data/view/2093. Published 2005
  4. http://www.who.int/bulletin/volumes/88/12/09-072975/en/
  5. http://www.who.int/hiv/pub/malecircumcision/vmmc-infographic/en/