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Zhou B, Ning C, McCann CD, Liao Y, Yang X, Zou Y, Jiang J, Liang B, Abdullah AS, Qin B, Upur H, Zhong C, Ye L, Liang H. Impact of Educational Interventions on Acceptance and Uptake of Male Circumcision in the General Population of Western China: A Multicenter Cohort Study. Sci Rep 2017; 7:14931. [PMID: 29097659 PMCID: PMC5668315 DOI: 10.1038/s41598-017-13995-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 10/05/2017] [Indexed: 12/15/2022] Open
Abstract
To compare different intervention models for promoting male circumcision (MC) to prevent HIV transmission in Western China. A total of 1690 male participants from multiple study sites were cluster randomly allocated to three-stage (Model A), two-stage (Model B), and one-stage (Model C) educational interventions. In all three interventions models, knowledge about MC significantly increased and the reported willingness to accept MC increased to 52.6% (255/485), 67.0% (353/527), and 45.5% (219/481) after intervention, respectively (P < 0.05). Rate of MC surgery uptake was highest (23.7%; 115/485) among those who received Model A intervention, compared to those who received Model B (17.1%; 90/527) or Model C (9.4%; 45/481) interventions (P < 0.05). Multivariable Cox regression analysis identified that Model A or Model B had twice the effect of Model C on MC uptake, with relative risks of 2.4 (95%CI, 1.5-3.8) and 2.2 (95%CI, 1.3-3.6), respectively. Model B was the most effective model for improving participants' willingness to accept MC, while Model A was most successful at increasing uptake of MC surgery. Self-reported attitude towards MC uptake was not strongly correlated with actual behavior in this study focusing on the general male population in Western China.
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Affiliation(s)
- Bo Zhou
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Chuanyi Ning
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Chase D McCann
- Department of Microbiology & Immunology University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Yanyan Liao
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Xiaobo Yang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Yunfeng Zou
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Junjun Jiang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Bingyu Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Abu S Abdullah
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Guangxi, China.,Department of Medicine, Boston Medical Center, Boston University Medical Campus, Boston, United States of America
| | - Bo Qin
- The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Halmurat Upur
- School of Public Health, Xinjiang Medical University, Xinjiang, China
| | - Chaohui Zhong
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Li Ye
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Guangxi, China.
| | - Hao Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Guangxi, China.
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Huang J, Jiang J, Yang X, Liang B, Qin B, Upur H, Zhong C, Wang Q, Wang Q, Ruan Y, Deng W, Xie P, Liao Y, Xu N, Zou Y, Wei F, Ye L, Liang H. Assessment of Different Intervention Models of Male Circumcision and Their Preliminary Effectiveness in Reducing HIV Incidence Among Drug Users in Western China. AIDS Res Hum Retroviruses 2016; 32:972-980. [PMID: 27400784 DOI: 10.1089/aid.2016.0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
World Health Organization (WHO) and Joint United Nations Program on AIDS (UNAIDS) recommend male circumcision (MC) as an additional HIV prevention measure. This study aimed to assess three models of promoting MC and their effects on preventing HIV infection among drug users in western China. We carried out a cohort study in three provinces of western China. HIV seronegative male drug users were recruited from methadone maintenance therapy clinics and cluster randomized into three intervention models. At baseline, 6, and 9 months of follow-up, changes in MC knowledge, the acceptability of MC, MC surgery uptake, and the costs of model implementation were analyzed. Of 1,304 male drug users who were screened, 1,218 were enrolled in the study. The participants' knowledge about MC was significantly increased after interventions by all three models. The one-stage model led to the highest increase in MC acceptability and the greatest increase in MC uptake. Multivariable Cox regression analysis showed that the one-stage model was also the most effective method to promote MC uptake, compared with the two-stage model [rate ratio (RR) = 0.602; 95% confidence interval (CI), 0.420-0.862] and three-stage model (RR = 0.555; 95% CI, 0.382-0.807). The HIV incidence rate in the MC group was lower than that in the non-MC group (RR = 0.234; 95% CI, 0.056-0.974). Moreover, the one-stage model required the lowest cost per circumcision. The one-stage model is the most effective and the most cost-effective intervention to increase MC uptake among male drug users in western China and could decrease the HIV incidence rate, based on a short follow-up investigation.
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Affiliation(s)
- Jiegang Huang
- Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Junjun Jiang
- Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Xiaobo Yang
- Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Bingyu Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Bo Qin
- The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Halmurat Upur
- School of Public Health, Xinjiang Medical University, Urumqi, China
| | - Chaohui Zhong
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Qianqiu Wang
- National Center for STD Control, China Centers for Disease Control and Prevention, Nanjing, China
| | - Qian Wang
- School of Public Health, Xinjiang Medical University, Urumqi, China
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Wei Deng
- Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Peiyan Xie
- Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Yanyan Liao
- Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Na Xu
- Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Yunfeng Zou
- Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Fumei Wei
- Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Li Ye
- Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Hao Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment & Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, China
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Acceptability of Voluntary Medical Male Circumcision (VMMC) among Male Sexually Transmitted Diseases Patients (MSTDP) in China. PLoS One 2016; 11:e0149801. [PMID: 26905739 PMCID: PMC4764373 DOI: 10.1371/journal.pone.0149801] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 02/04/2016] [Indexed: 11/19/2022] Open
Abstract
Voluntary Medical Male circumcision (VMMC) is an evidence-based, yet under-utilized biomedical HIV intervention in China. No study has investigated acceptability of VMMC among male sexually transmitted diseases patients (MSTDP) who are at high risk of HIV transmission. A cross-sectional survey interviewed 350 HIV negative heterosexual MSTDP in Shenzhen, China; 12.0% (n = 42) of them were circumcised at the time of survey. When the uncircumcised participants (n = 308) were informed that VMMC could reduce the risk of HIV infection via heterosexual intercourse by 50%, the prevalence of acceptability of VMMC in the next six months was 46.1%. Adjusted for significant background variables, significant factors of acceptability of VMMC included: 1) emotional variables: the Emotional Representation Subscale (adjusted odds ratios, AOR = 1.13, 95%CI: 1.06–1.18), 2) cognitive variables derived from Health Belief Model (HBM): perceived some chance of having sex with HIV positive women in the next 12 months (AOR = 2.48, 95%CI: 1.15–5.33) (perceived susceptibility), perceived severity of STD infection (AOR = 1.06, 95%CI: 1.02–1.10), perceived benefit of VMMC in risk reduction (AOR = 1.29, 95%CI: 1.16–1.42) and sexual performance (AOR = 1.45, 95%CI: 1.26–1.71), perceived barriers against taking up VMMC (AOR = 0.88, 95%CI: 0.81–0.95), and perceived cue to action (AOR = 1.41, 95%CI: 1.23–1.61) and self-efficacy (AOR = 1.38, 95%CI: 1.26–1.35) related to taking up VMMC. The association between perceived severity of STD infection and acceptability was fully mediated by emotional representation of STD infection. The relatively low prevalence of circumcision and high acceptability suggested that the situation was favorable for implementing VMMC as a means of HIV intervention among MSTDP in China. HBM is a potential suitable framework to guide the design of future VMMC promotion. Future implementation programs should be conducted in STD clinic settings, taking the important findings of this study into account.
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Zeng M, Wang L, Chen C, Zeng F, Huang L, Xue R, Chen J, Gao B, Tang Z. Factors Associated with Knowledge of and Willingness for Adult Male Circumcision in Changsha, China. PLoS One 2016; 11:e0148832. [PMID: 26859292 PMCID: PMC4747502 DOI: 10.1371/journal.pone.0148832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 01/21/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Male circumcision (MC) has been shown to reduce the risk of male genital diseases. MC is not commonly practiced among Chinese males and little is known about the factors associated with their knowledge of and willingness for MC. This study was to explore the knowledge regarding the foreskin among Chinese males and to identify factors associated with their willingness to undergo circumcision. METHODS A total of 237 patients with redundant prepuce/phimosis were interviewed through face-to-face interviews. The items on the questionnaire included: demographics, an objective scale assessing knowledge about the foreskin, willingness to have MC, the attitudes of sexual partners and doctors toward redundant prepuce/phimosis, and the approaches that patients used to acquire knowledge regarding the prepuce. Univariate analysis and multiple logistic regression analysis were performed to identify factors that are associated with willingness to be circumcised (WTC). RESULTS A total of 212 patients completed the interview. Multivariable logistic regression showed that three factors were significantly associated with WTC: being married (OR = 0.43), perceiving redundant prepuce/phimosis as a disease (OR = 1.93), and if a patient's partner supported MC (OR = 1.39). 58% (n = 122) had received information about the foreskin from another party: 18% (n = 37) from school, 8% (n = 17) from family, 17% (n = 36) from friends, 27% (n = 57) from health care providers. About 4% (n = 8) believed that their partners disliked their redundant prepuce/phimosis. 20% (n = 42) had received doctors' advice to undergo circumcision. CONCLUSION Knowledge about the foreskin was low among Chinese males. Our study elucidates the factors associated with WTC and suggests that more education of the population about the foreskin can help improve the recognition of a correctible abnormality and help patients assess the potential role of MC in their health.
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Affiliation(s)
- Mingqiang Zeng
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ling Wang
- College of Public Health, Ohio State University, Columbus, Ohio, United States of America
| | - Caifang Chen
- Department of Geriatric Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fanchang Zeng
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Liang Huang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ruizhi Xue
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Junjie Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Benmin Gao
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhengyan Tang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Zhang Z, Yang B, Yu W, Han Y, Xu Z, Chen H, Chen Y, Dai Y. Application of a novel disposable suture device in circumcision: a prospective non-randomized controlled study. Int Urol Nephrol 2016; 48:465-73. [DOI: 10.1007/s11255-016-1213-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/04/2016] [Indexed: 12/19/2022]
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Yan WL, Wang CC, Huang YD, Yimiti D, Wang Q, Upur H. Parental factors affecting the circumcision of non-Muslim Chinese boys include education and family history. Acta Paediatr 2015. [PMID: 26215895 DOI: 10.1111/apa.13142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This study investigated the prevalence of circumcision among non-Muslim schoolboys in Urumqi, China, and how acceptable their parents found the practice. METHODS A convenient cluster sample of non-Muslim schoolboys (n = 3614) aged six to 15 years of age and 873 mothers and 927 fathers completed self-administered questionnaires. We compared the consistency of the circumcision status reported by students and their parents and analysed the factors that influenced the parents to have their child circumcised. RESULTS The mean age at circumcision was 8.3 years and the adjusted prevalence was 46.2%. Up to 45.4% of fathers and 66% of mothers with uncircumcised sons were willing to circumcise their sons after receiving further information on circumcision. Mothers were more likely to support circumcision if they had higher education levels and higher family income, were employed as government officials and had family members who had been circumcised, including their husband. Fathers were more likely to support circumcision if they were highly educated and had been circumcised themselves. CONCLUSION The prevalence and acceptability of circumcision were higher than expected in this traditional schoolboy population in Urumqi, China. Factors that increased parental support for circumcision included high education and the father being circumcised.
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Affiliation(s)
- Wei-Li Yan
- Department of Clinical Epidemiology; Children's Hospital of Fudan University; Shanghai China
| | - Chen-Chen Wang
- Department of Endemic Disease Control; Xinjinag Center of Disease Control and Prevention; Urumqi Xinjiang Uygur Autonomous Region China
| | - Yong-Di Huang
- Department of Endemic Disease Control; Xinjinag Center of Disease Control and Prevention; Urumqi Xinjiang Uygur Autonomous Region China
| | - Deliciati Yimiti
- College of Basic Medicine; Xinjiang Medical University; Urumqi Xinjiang Uygur Autonomous Region China
| | - Qian Wang
- Department of Epidemiology & Statistics; School of Public Health; Xinjiang Medical University; Urumqi Xinjiang Uygur Autonomous Region China
| | - Halmurat Upur
- Chinese Traditional Medical Hospital affiliated to Xinjiang Medical University; Urumqi Xinjiang Uygur Autonomous Region China
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Jiang J, Su J, Yang X, Huang M, Deng W, Huang J, Liang B, Qin B, Upur H, Zhong C, Wang Q, Wang Q, Ruan Y, Ye L, Liang H. Acceptability of Male Circumcision among College Students in Medical Universities in Western China: A Cross-Sectional Study. PLoS One 2015; 10:e0135706. [PMID: 26390212 PMCID: PMC4577094 DOI: 10.1371/journal.pone.0135706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 07/26/2015] [Indexed: 12/05/2022] Open
Abstract
Background Male circumcision (MC) has been shown to reduce the risk of female to male transmission of HIV. The goal of this survey was to explore MC’s acceptability and the factors associated with MC among college students in medical universities in western China. Methods A cross-sectional study was carried out in three provinces in western China (Guangxi, Chongqing and Xinjiang) to assess the acceptability of MC as well as to discover factors associated with the acceptability among college students in medical universities. A total of 1,790 uncircumcised male students from three medical universities were enrolled in this study. In addition, 150 students who had undergone MC were also enrolled in the survey, and they participated in in-depth interviews. Results Of all the uncircumcised participants (n = 1,790), 55.2% (n = 988) were willing to accept MC. Among those who accepted MC, 67.3% thought that MC could improve their sexual partners’ hygiene, 46.3% believed that HIV and sexually transmitted diseases (STDs) could be partially prevented by MC. The multivariable logistic regression indicates that MC’s acceptability was associated with three factors: the redundant foreskin (OR = 10.171, 95% CI = 7.629–13.559), knowing the hazard of having a redundant foreskin (OR = 1.597, 95% CI = 1.097–2.323), and enhancing sexual pleasure (OR = 1.628, 95% CI = 1.312–2.021). The in-depth interviews for subjects who had undergone MC showed that the major reason for having MC was the redundant foreskin (87.3%), followed by the benefits and the fewer complications of having MC done. In addition, most of these participants (65.3%) said that the MC could enhance sexual satisfaction. Conclusions MC’s acceptance among college students in medical universities is higher than it is among other populations in western China. An implementation of an MC programme among this population is feasible in the future.
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Affiliation(s)
- Junjun Jiang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Jinming Su
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Xiaobo Yang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Mingbo Huang
- Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, Georgia, 30310, United States of America
| | - Wei Deng
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Jiegang Huang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Bingyu Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Bo Qin
- The First Affiliated Hospital, Chongqing Medical University, Chongqing, 400016, China
| | - Halmurat Upur
- School of Public Health, Xinjiang Medical University, Xinjiang, 830011, China
| | - Chaohui Zhong
- School of Public Health, Chongqing Medical University, Chongqing, 400016, China
| | - Qianqiu Wang
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, 210042, China
| | - Qian Wang
- Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, Georgia, 30310, United States of America
| | - Yuhua Ruan
- State Key Laboratory for Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, 102206, China
| | - Li Ye
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China
- * E-mail: (HL); (LY)
| | - Hao Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China
- Guangxi Medical Research Center, Guangxi Medical University, Nanning, Guangxi, 530021, China
- * E-mail: (HL); (LY)
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Brito MO, Lerebours L, Volquez C, Basora E, Khosla S, Lantigua F, Flete R, Rosario R, Rodriguez LA, Fernandez M, Donastorg Y, Bailey RC. A Clinical Trial to Introduce Voluntary Medical Male Circumcision for HIV Prevention in Areas of High Prevalence in the Dominican Republic. PLoS One 2015; 10:e0137376. [PMID: 26367187 PMCID: PMC4569265 DOI: 10.1371/journal.pone.0137376] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 08/17/2015] [Indexed: 11/19/2022] Open
Abstract
Background Voluntary Medical Male Circumcision (VMMC) is an effective strategy to reduce the risk of HIV infection. Studies conducted in the Dominican Republic (DR) suggest that acceptability of VMMC among men may be as high as 67%. The goal of this clinical trial was to assess the acceptability, uptake and safety for VMMC services in two areas of high HIV prevalence in the country. Methods This was a single-arm, non-randomized, pragmatic clinical trial. Study personnel received background information about the risks and benefits of VMMC and practical training on the surgical technique. A native speaking research assistant administered a questionnaire of demographics, sexual practices and knowledge about VMMC. One week after the surgery, participants returned for wound inspection and to answer questions about their post-surgical experience. Results 539 men consented for the study. Fifty seven were excluded from participation for medical or anatomical reasons and 28 decided not to have the procedure after providing consent. A total of 454 men were circumcised using the Forceps Guided Method Under Local Anesthesia. The rate of adverse events (AE) was 4.4% (20% moderate, 80% mild). There were no serious AEs and all complications resolved promptly with treatment. Eighty eight percent of clients reported being “very satisfied” and 12% were “somewhat satisfied” with the outcome at the one-week postoperative visit. Conclusions Recruitment and uptake were satisfactory. Client satisfaction with VMMC was high and the rate of AEs was low. Roll out of VMMC in targeted areas of the DR is feasible and should be considered. Trial Registration ClinicalTrials.gov NCT02337179
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Affiliation(s)
- Maximo O. Brito
- University of Illinois at Chicago, Chicago, Illinois, United States of America
- * E-mail:
| | | | - Claudio Volquez
- HIV Vaccine Trials Unit, Instituto Dermatologico y Cirugia De Piel, Santo Domingo, Dominican Republic
| | | | - Shaveta Khosla
- University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Flavia Lantigua
- HIV Vaccine Trials Unit, Instituto Dermatologico y Cirugia De Piel, Santo Domingo, Dominican Republic
| | - Roberto Flete
- HIV Vaccine Trials Unit, Instituto Dermatologico y Cirugia De Piel, Santo Domingo, Dominican Republic
| | | | - Luis A. Rodriguez
- HIV Vaccine Trials Unit, Instituto Dermatologico y Cirugia De Piel, Santo Domingo, Dominican Republic
| | - Mathius Fernandez
- HIV Vaccine Trials Unit, Instituto Dermatologico y Cirugia De Piel, Santo Domingo, Dominican Republic
| | - Yeycy Donastorg
- HIV Vaccine Trials Unit, Instituto Dermatologico y Cirugia De Piel, Santo Domingo, Dominican Republic
| | - Robert C. Bailey
- University of Illinois at Chicago, Chicago, Illinois, United States of America
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Chen Y, Shen Z, Morano JP, Khoshnood K, Wu Z, Lan G, Zhu Q, Zhou Y, Tang S, Liu W, Chen J, Tang Z. Bridging the epidemic: a comprehensive analysis of prevalence and correlates of HIV, hepatitis C, and syphilis, and infection among female sex workers in Guangxi Province, China. PLoS One 2015; 10:e0115311. [PMID: 25723548 PMCID: PMC4344209 DOI: 10.1371/journal.pone.0115311] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 11/21/2014] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Female sex workers (FSWs) are at highest risk for contracting HIV and facilitating the current heterosexual HIV epidemic in Guangxi, China, yet little is known of the impact of recent harm reduction campaigns in the province. We analyzed sentinel surveillance data collected between 2010 and 2012 in Guangxi to explore correlations between the prevalence of HIV, hepatitis C (HCV), and syphilis and risk behaviors of different categories of FSWs in Guangxi. METHODS The sentinel surveillance data for 5,1790 FSWs in all 14 prefectures and 64 city/county regions of Guangxi, China from 2010 to 2012 were collected. Differences between three categories of FSWs (grouped by venue) and disease trends (HIV, HCV, and syphilis) by year were analyzed using bivariate and multivariate logistic regression analyses as to evaluate risk factors correlated with HIV, HCV, or syphilis infection. RESULTS HIV and HCV prevalence remained constant across the three FSW categories; however, syphilis prevalence showed a significant increase from 5.7% to 7.3% for low-tier FSWs. Most cases with HIV, HCV, syphilis and intravenous drug use were seen in low-tier FSWs. Testing positive for HIV and syphilis were most correlated with being HCV positive (AOR 4.12 and AOR 4.36), only completing elementary school (AOR 3.71 and AOR 2.35), low tier venues (AOR 2.02 and AOR 2.00), and prior STI (AOR 1.40 and AOR 3.56), respectively. HCV infection was correlated with ever injecting drugs (AOR 60.65) and testing positive for syphilis (AOR 4.16) or HIV (AOR 3.74). CONCLUSIONS This study highlights that low tier FSWs with lower formal education levels are the most vulnerable population at risk for acquiring and transmitting HIV, HCV, and syphilis in Guangxi, China. Condom distribution with evolution to safer sex practices are the reasons to explain the non-increasing prevalence of HIV, HCV in Guangxi for 2010-2012.
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Affiliation(s)
- Yi Chen
- Guangxi Centers for Disease Control and Prevention, Nanning, China
| | - Zhiyong Shen
- Guangxi Centers for Disease Control and Prevention, Nanning, China
| | - Jamie P. Morano
- University of South Florida, Morsani College of Medicine, Division of Infectious Disease and International Medicine, and College of Public Health, Tampa, Florida, United States of America
| | - Kaveh Khoshnood
- Yale University School of Public Health, New Haven, Connecticut, United States of America
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, China Centers for Disease Control and Prevention, Beijing, China
| | - Guanghua Lan
- Guangxi Centers for Disease Control and Prevention, Nanning, China
| | - Qiuying Zhu
- Guangxi Centers for Disease Control and Prevention, Nanning, China
| | - Yuejiao Zhou
- Guangxi Centers for Disease Control and Prevention, Nanning, China
| | - Shuai Tang
- Guangxi Centers for Disease Control and Prevention, Nanning, China
| | - Wei Liu
- Guangxi Centers for Disease Control and Prevention, Nanning, China
| | - Jie Chen
- Health and Family Planning Commission of Guangxi, Zhuang Autonomous Region, Nanning, China
| | - Zhenzhu Tang
- Guangxi Centers for Disease Control and Prevention, Nanning, China
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Wamai RG, Morris BJ, Bailey RC, Klausner JD, Boedicker MN. Male circumcision for protection against HIV infection in sub-Saharan Africa: the evidence in favour justifies the implementation now in progress. Glob Public Health 2015; 10:639-66. [PMID: 25613581 PMCID: PMC6352987 DOI: 10.1080/17441692.2014.989532] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This article responds to a recent 'controversy study' in Global Public Health by de Camargo et al. directed at three randomised controlled trials (RCTs) of male circumcision (MC) for HIV prevention. These trials were conducted in three countries in sub-Saharan Africa (SSA) and published in 2005 and 2007. The RCTs confirmed observational data that had accumulated over the preceding two decades showing that MC reduces by 60% the risk of HIV infection in heterosexual men. Based on the RCT results, MC was adopted by global and national HIV policy-makers as an additional intervention for HIV prevention. Voluntary medical MC (VMMC) is now being implemented in 14 SSA countries. Thus referring to MC for HIV prevention as 'debate' and viewing MC through a lens of controversy seems mistaken. In their criticism, de Camargo et al. misrepresent and misinterpret current science supporting MC for HIV prevention, omit previous denunciations of arguments similar to theirs, and ignore evidence from ongoing scientific research. Here we point out the flaws in three areas de Camargo et al. find contentious. In doing so, we direct readers to growing evidence of MC as an efficacious, safe, acceptable, relatively low-cost one-off biomedical intervention for HIV prevention.
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Affiliation(s)
- Richard G. Wamai
- Department of African-American Studies, Northeastern University, Boston, Massachusetts, USA
| | - Brian J. Morris
- School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Robert C. Bailey
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jeffrey D. Klausner
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, California, USA
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Peltzer K, Onoya D, Makonko E, Simbayi L. Prevalence and acceptability of male circumcision in South Africa. AFRICAN JOURNAL OF TRADITIONAL, COMPLEMENTARY, AND ALTERNATIVE MEDICINES 2014; 11:126-30. [PMID: 25392591 DOI: 10.4314/ajtcam.v11i4.19] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The objectives of the current national study were to determine the rates of self-reported circumcision among South African men and, more importantly, evaluate the acceptability of male circumcision in South Africa by uncircumcised adult men and all adult women. MATERIALS AND METHODS The study based on a population-based survey included a nationally representative subgroup of 6654 men aged 15 years and older who where included in the analysis on male circumcision prevalence, and a subgroup of 6796 women aged 15 to 49 years who were included in the analysis on male circumcision acceptance. RESULTS An overall prevalence of self-reported male circumcision of 42.8% was found. Among the Black African population group the prevalence of male circumcision was 48.2%, 32.1% were traditionally and 13.4% were medically circumcised. Among males not circumcised 45.7% of 15-24 years olds indicated that they would consider being circumcised compared to 28.3% among 25-49 years olds. In multivariate analysis among non-circumcised men Black African and Coloured population groups and having heard of the HIV protective effect of male circumcision were significant predictors for male circumcision acceptability, and among women with a non-circumcised sexual partner, Black African and Coloured population groups and higher education were predictors for male circumcision acceptability. CONCLUSION The study found high rates and high acceptability of male circumcision. Findings associated with the acceptability of male circumcision can be used to increase awareness of the benefits of male circumcision for HIV prevention.
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Affiliation(s)
- Karl Peltzer
- HIV/AIDS/STI and TB Research Programme, Human Sciences Research Council, Cape Town, South Africa ; Department of Psychology, University of Limpopo, Turloop, South Africa ; ASEAN Institute for Health Development, Mahidol University, Salaya, Thailand
| | - Dorina Onoya
- HIV/AIDS/STI and TB Research Programme, Human Sciences Research Council, Cape Town, South Africa
| | - Elias Makonko
- HIV/AIDS/STI and TB Research Programme, Human Sciences Research Council, Cape Town, South Africa
| | - Leickness Simbayi
- HIV/AIDS/STI and TB Research Programme, Human Sciences Research Council, Cape Town, South Africa
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Wang J, Zhou Y, Xia S, Zhu Z, Jia L, Liu Y, Jiang M. Safety and efficacy of a novel disposable circumcision device: a pilot randomized controlled clinical trial at 2 centers. Med Sci Monit 2014; 20:454-62. [PMID: 24647226 PMCID: PMC3965290 DOI: 10.12659/msm.889722] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background We evaluated the safety and efficacy of a novel disposable male circumcision (MC) device developed by Jiangxi-Yuansheng-Langhe Medical Instrument Co., Ltd. Material/Methods Adult male patients (n=120; mean age, 26.6 years) with redundant foreskin and/or phimosis were included in a randomized, multicenter pilot clinical trial from October 2011 to February 2012. Patients were divided into 2 groups and subjected to MC with a novel disposable device (Device Group) (n=60) or to conventional dissection technique (CDT) (Control Group) (n=60). Intraoperative bleeding, surgery duration, pain, healing, and satisfaction with penis appearance were assessed. Adverse events (AEs) were noted. Results Intraoperative bleeding volume [3.5±2.7 (15–35) ml vs. 13.1±6.1 (4–25) ml] and mean surgical time [7.6±4.5 (2–23) min vs. 23.6±4.4 (15–35) min] in the Device Group were significantly less than in the Control Group (P<0.01). No AEs were observed in either group. There were no significant differences in postoperative pain, healing, or satisfaction with penis appearance between groups (P>0.05). Conclusions This novel disposable circumcision device produced satisfactory preliminary adult MC results compared with CDT treatments. This device may be broadly used in men, such as those with phimosis, who are ineligible for CDT.
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Affiliation(s)
- Jingen Wang
- Department of Urology, Jiangxi Provincial People's Hospital, Nanchang, China (mainland)
| | - Yongfei Zhou
- Yongfeng Traditional Chinese Medicine Hospital, Yongfeng, China (mainland)
| | - Shuxia Xia
- Department of Urology, Affiliated Hospital of Jiangxi College of Traditional Chinese Medicine, Nanchang, China (mainland)
| | - Zunwei Zhu
- Department of Urology, Jiangxi Provincial People's Hospital, Nanchang, China (mainland)
| | - Linghua Jia
- Department of Urology, Jiangxi Provincial People's Hospital, Nanchang, China (mainland)
| | - Yong Liu
- Yongfeng Traditional Chinese Medicine Hospital, Yongfeng, China (mainland)
| | - Min Jiang
- Institution of Clinical Trial, Jiangxi Provincial People's Hospital, Nanchang, China (mainland)
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Jiang J, Huang J, Yang X, Ye L, Wei B, Deng W, Wei S, Qin B, Upur H, Zhong C, Wang Q, Wang Q, Ruan Y, Wei F, Xu N, Xie P, Liang H. Acceptance of male circumcision among male rural-to-urban migrants in western China. AIDS Res Hum Retroviruses 2013; 29:1582-8. [PMID: 23931654 DOI: 10.1089/aid.2013.0156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To describe the acceptability of male circumcision (MC) and explore potential factors associated with MC acceptability among male rural-to-urban migrants in western China, a cross-sectional survey of MC acceptability was conducted with 1,904 subjects in three western provinces with high HIV prevalence (Guangxi, Chongqing, and Xinjiang) in China between June 2009 and November 2009. Through face-to-face interviews, the participants completed a self-administered questionnaire about demographics, MC knowledge, willingness and reasons to accept or refuse MC, sexual behaviors, and other psychosocial variables. Factors associated with acceptability of MC were identified by multiple logistic regression analysis. Of the participants (n=1,904), 710 men were willing to accept MC (37.3%); the reasons included promotion of the partners' genital hygiene (54.9%), redundant prepuce or phimosis (43.1%), enhancement of sexual pleasure (40.6%), prevention of penile inflammation or cancer (35.5%), and protection against HIV and sexual transmitted diseases (STDs)(31.1%). A multivariable logistic regression showed that four factors were associated with acceptability of MC, including education level (OR=1.286, 95% CI=1.025~1.614), redundant prepuce or phimosis (OR=13.751, 95% CI=10.087~18.745), having one or more circumcised friends (OR=2.468, 95% CI=1.953~3.119), and having sexual intercourse with a temporary partner in the past year (OR=1.543, 95% CI=1.101~2.162). Compared with previously published data among the general population in China or worldwide, the acceptability of MC (37.3%) was low among the male rural-to-urban migrants in western China. Nevertheless, appropriate education could greatly improve the acceptability of MC. More public campaigns and health education on MC are needed to increase the rate of MC in China.
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Affiliation(s)
- Junjun Jiang
- School of Public Health, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, China
| | - Jiegang Huang
- School of Public Health, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, China
| | - Xiaobo Yang
- School of Public Health, Guangxi Medical University, Nanning, China
| | - Li Ye
- School of Public Health, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, China
| | - Bo Wei
- School of Public Health, Guangxi Medical University, Nanning, China
| | - Wei Deng
- School of Public Health, Guangxi Medical University, Nanning, China
| | - Suosu Wei
- School of Public Health, Guangxi Medical University, Nanning, China
| | - Bo Qin
- The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Halmurat Upur
- School of Public Health, Xinjiang Medical University, Xinjiang, China
| | - Chaohui Zhong
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Qianqiu Wang
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, China
| | - Qian Wang
- School of Public Health, Xinjiang Medical University, Xinjiang, China
| | - Yuhua Ruan
- State Key Laboratory for Infectious Disease Prevention and Control and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fumei Wei
- School of Public Health, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, China
| | - Na Xu
- School of Public Health, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, China
| | - Peiyan Xie
- School of Public Health, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, China
| | - Hao Liang
- School of Public Health, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, China
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Ning C, Jiang J, Ye L, Yang X, Wei B, Deng W, Wei S, Huang J, Qin B, Upur H, Zhong C, Wang Q, Wang Q, Ruan Y, Wei F, Xu N, Xie P, Hsi JH, Shao Y, Liang H. Comparison of three intervention models for promoting circumcision among migrant workers in western China to reduce local sexual transmission of HIV. PLoS One 2013; 8:e76107. [PMID: 24098770 PMCID: PMC3786908 DOI: 10.1371/journal.pone.0076107] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 08/20/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Three models for promoting male circumcision (MC) as a preventative intervention against HIV infection were compared among migrant worker populations in western China. METHODS A cohort study was performed after an initial cross-sectional survey among migrant workers in three provincial level districts with high HIV prevalence in western China. A total of 1,670 HIV seronegative male migrants were cluster-randomized into three intervention models, in which the dissemination of promotional materials and expert- and volunteer-led discussions are conducted in one, two, and three stage interventions. Changes in knowledge of MC, acceptability of MC, MC surgery uptake, and the costs of implementation were analyzed at 6-month and 9-month follow-up visits. RESULTS All three models significantly increased the participants' knowledge about MC. The three-stage model significantly increased the acceptability of MC among participants and led to greatest increase in MC uptake. At the end of follow-up, 9.2% (153/1,670) of participants underwent MC surgery; uptake among the one-, two-, and three-stage models were 4.9%, 9.3%, and 14.6%, respectively. Multivariable Cox regression analysis showed that three-stage model was the most effective method to scale up MC, with RR = 2.0 (95% CI, 1.3-3.1, P=0.002) compared to the on-site session model. The two-stage intervention model showed no significant difference with either the on-site session model (RR=1.5, 95% CI, 0.92-2.4, P=0.12) or three-stage model (P=0.10). CONCLUSIONS A three-stage intervention with gradual introduction of knowledge led to the significantly increase in MC uptake among migrant workers in western China, and was also the most cost-effective method among the three models.
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Affiliation(s)
- Chuanyi Ning
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, China
| | - Junjun Jiang
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, China
| | - Li Ye
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, China
| | - Xiaobo Yang
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, China
| | - Bo Wei
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Wei Deng
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Suosu Wei
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Jiegang Huang
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, China
| | - Bo Qin
- The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Halmurat Upur
- School of Public Health, Xinjiang Medical University, Urumchi, Xinjiang, China
| | - Chaohui Zhong
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Qianqiu Wang
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, China
| | - Qian Wang
- School of Public Health, Xinjiang Medical University, Urumchi, Xinjiang, China
| | - Yuhua Ruan
- State Key Laboratory for Infectious Disease Prevention and Control and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fumei Wei
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, China
| | - Na Xu
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, China
| | - Peiyan Xie
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, China
| | - Jenny H. Hsi
- State Key Laboratory for Infectious Disease Prevention and Control and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yiming Shao
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- State Key Laboratory for Infectious Disease Prevention and Control and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail: (YS); (HL)
| | - Hao Liang
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, China
- * E-mail: (YS); (HL)
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15
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Muhamadi L, Ibrahim M, Wabwire-Mangen F, Peterson S, Reynolds SJ. Perceived medical benefit, peer/partner influence and safety and cost to access the service: client motivators for voluntary seeking of medical male circumcision in Iganga district eastern Uganda, a qualitative study. Pan Afr Med J 2013; 15:117. [PMID: 24255723 PMCID: PMC3830467 DOI: 10.11604/pamj.2013.15.117.2540] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 06/25/2013] [Indexed: 11/15/2022] Open
Abstract
Introduction Although voluntary medical male circumcision (VMMC) in Iganga district was launched in 2010 as part of the Uganda national strategy to prevent new HIV infections with a target of having 129,896 eligible males circumcised by 2012, only 35,000 (27%) of the anticipated target had been circumcised by mid 2012. There was paucity of information on why uptake of VMMC was low in this setting where HIV awareness is presumably high. This study sought to understand motivators for uptake of VMMC from the perspective of the clients themselves in order to advocate for feasible approaches to expanding uptake of VMMC in Iganga district and similar settings. Methods In Iganga district, we conducted seven key informant interviews with staff who work in the VMMC clinics and twenty in-depth interviews with clients who had accepted and undergone VMMC. Ten focus-group discussions including a total of 112 participants were also conducted with clients who had undergone VMMC. Results Motivators for uptake of VMMC in the perspective of the circumcised clients and the health care staff included: perceived medical benefit to those circumcised such as protection against acquiring HIV and other sexually transmitted diseases, peer/partner influence, sexual satisfaction and safety and cost to access the service. Conclusion Since perceived medical benefit was a motivator for seeking VMMC, it can be used to strengthen campaigns for increasing uptake of VMMC. Peer influence could also be used in advocacy campaigns for VMMC expansion, especially using peers who have already undergone VMMC. There is need to ensure that safety and cost to access the service is affordable especially to rural poor as it was mentioned as a motivator for seeking VMMC.
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Affiliation(s)
- Lubega Muhamadi
- District Health Office, Iganga District Administration, PO Box 358, Iganga, Uganda ; Division of Global Health, IHCAR, Department of Public Health Sciences, Karolinsika Institutet, Stockholm, Sweden ; Department of Epidemiology and Biostatistics, Makerere University School of Public Health, PO Box 7072, Kampala, Uganda ; School of Graduate Studies and Research Busoga University, PO BOX 154, Iganga Uganda
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Huang J, Jiang J, Abdullah AS, Yang X, Wei B, Deng W, Qin B, Upur H, Zhong C, Wang Q, Wang Q, Ruan Y, Zou Y, Ye L, Xie P, Wei F, Xu N, Liang H. Factors associated with acceptability of circumcision among male drug users in western China: a cross-sectional study. Int J STD AIDS 2013; 24:541-7. [PMID: 23970769 DOI: 10.1177/0956462412473893] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study is aimed to investigate whether male circumcision (MC) is feasible among IDUs in China. 1304 drug users who attended methadone maintenance therapy clinics in Guangxi, Chongqing and Xinjiang were selected for participation by using convenience sampling, and completed a self-administered questionnaire. The factors associated with the acceptability of MC were examined via multiple logistic regression models. 45.2% (589/1304) of the participants reported an acceptance of MC. Many of the participants who were initially not willing to accept MC (715/1304) had changed their mind when they were informed that MC would reduce the risk of HIV and STDs (43.4%; 310/715), that MC is associated with few surgery-related complications (23.1%; 165/715), that the surgical procedure could be arranged free of charge (20.1%, 144/715). In the multivariate analysis, higher acceptability of MC was associated with knowledge of the hazards of phimosis (OR=2.22), the presence of phimosis (OR=14.87), and knowledge that MC can prevent AIDS and STDs (OR=1.49); while lower acceptability was associated with residing in Chongqing province (OR=0.41) and an educational level of junior (OR=0.64) and senior high (OR=0.63) school. The MC policy targeting IDUs in China should take into account these factors associated with MC acceptability.
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Affiliation(s)
- J Huang
- School of Public Health, Guangxi Medical University, Nanning, China
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Xu HL, Jia MH, Min XD, Zhang RZ, Yu CJ, Wang J, Li YF, Wang L, Pan SF, Lu L. Factors influencing HIV infection in men who have sex with men in China. Asian J Androl 2013; 15:545-9. [PMID: 23708455 DOI: 10.1038/aja.2013.51] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 02/25/2013] [Accepted: 03/30/2013] [Indexed: 11/09/2022] Open
Abstract
To identify risk factors for HIV infection among men who have sex with men (MSM) and to provide a theoretical basis for prevention interventions. Between December 2011 and August 2012, a case-control study was conducted among MSM who underwent voluntary counselling and testing for HIV. Confirmed HIV-positive MSM were included in the case group, and HIV-negative MSM were included in the control group. Information on possible risk factors was collected by a survey questionnaire and a qualitative interview. The results of a conditional logistic regression showed that the following were influencing factors for HIV infection: average monthly income between 2001 and 3000 Yuan (odds ratio (OR)=6.341, 95% CI: 1.714-12.544), only sometimes using condoms when having anal sex with men in the last 6 months (OR=7.601, 95% CI: 1.359-23.083), having HIV-positive sex partners (OR=5.273, 95% CI: 1.572-17.691), rectal trauma with bleeding in the last 6 months (OR=2.947, 95% CI: 1.308-6.638), not using condoms at last sexual encounter (OR=1.278, 95% CI: 1.012-5.595), engaging in commercial sex (OR=5.925, 95% CI: 1.923-13.890) and having more than 16 sex partners in the last 6 months (OR=1.175, 95% CI: 1.021-1.353). These seven factors were the risk factors of HIV infection (OR>1). However, having anal sex less than 10 times in the previous 1 month (OR=0.002, 95% CI: 0.000-0.287) was a protective factor against HIV infection among MSM (OR<1), and insertive (OR=0.116, 95% CI: 0.000-0.236) (OR<1) anal intercourse influenced HIV infection. Interventions should be targeted at MSM whose average monthly income is between 2001 and 3000 Yuan, and who engage in commercial sex. In addition, the importance of using condoms at every sexual encounter should be emphasised in health education, as should the treatment of rectal trauma with bleeding. Finally, MSM should decrease the number of sex partners and frequency of anal sex to decrease the rate of HIV infection.
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Affiliation(s)
- Hong-Lv Xu
- Kunming Medical University, Kunming, Yunnan 650500, China
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18
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Chen XS, Liang GJ, Wang QQ, Yin YP, Jiang N, Zhou YJ, Yang LG, Liu Q, Wang HC, Wang B. HIV prevalence varies between female sex workers from different types of venues in southern China. Sex Transm Dis 2013; 39:868-70. [PMID: 23064536 DOI: 10.1097/olq.0b013e318264c3ba] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We conducted a cross-sectional study on prevalence of human immunodeficiency virus (HIV) and syphilis among female sex workers (FSWs) recruited from different types of venues in 6 cities in China. Among 5322 FSWs (1379 were from high-tier venues, 2482 from middle-tier venues, and 1461 from low-tier venues, respectively), overall HIV prevalence was 0.54% (95% confidence interval [CI], 0.37%- 0.76%). By typology of venues where FSWs solicited clients, the prevalence was 1.37% (95% CI, 0.89%-2.11%) in low-tier venues, 0.28% (95% CI, 0.14%- 0.58%) in middle-tier venues, and 0.07% (95% CI, 0.01%-0.41%) in high-tier venues. The final logistic regression model showed an association of having had HIV infection with working in low-tier venues (adjusted odds ratio 2.73; 95% CI, 1.12-6.67) and coming from Guangxi Province (adjusted odds ratio, 7.89; 95% CI, 1.65-37.64). It can be concluded that FSWs working in low-tier venues (on the streets or public outdoor places) had higher risk of HIV infection than other venues. Such subgroup of FSWs should be efficiently covered by the current HIV/STD surveillance and intervention programs in China.
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Affiliation(s)
- Xiang-Sheng Chen
- National Center for STD Control, Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Dermatology, Nanjing, China.
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