Weiss Helen A, Plummer Mary L, Changalucha John, Mshana Gerry, Shigongo Zachayo S, Todd Jim, Wight Daniel, Hayes Richard J, Ross David A
Infectious Disease Epidemiology Unit, London School of Hygiene & Tropical Medicine, London, UK.
Trop Med Int Health. 2008 Aug;13(8):1054-61. doi: 10.1111/j.1365-3156.2008.02107.x. Epub 2008 Jun 28.
Male circumcision reduces risk of HIV among heterosexual men by about 60%. Modelling the impact of circumcision on HIV transmission, and planning service expansion, relies on self-reported circumcision status. We investigated the validity of self-reported status.
Survey and in-depth interview (IDI) data from adolescents enrolled in a community randomized sexual health intervention trial in rural Mwanza, Tanzania were analysed.
The 5354 male school attenders (median age 15.5 years) were recruited in 1998 and followed for 3 years. At baseline, circumcision prevalence was 13.7% by self-report and 11.8% by clinical examination, rising to 17.3% by clinical examination at final survey. Only 61.5% of Muslim males were circumcised at the final survey. Of 506 participants who reported being circumcised at baseline, only 78.9% reported this at interim. Similarly, only 84.2% of participants clinically assessed as circumcised at baseline were also assessed as circumcised at interim. At both baseline and interim surveys, about 80% of participants who reported being circumcised were also found to be so at clinical examination. There was a high tolerance and respect for circumcision among male IDI respondents, with widespread belief that it was beneficial for penile hygiene and disease prevention. The majority of female IDI respondents said that they did not know what male circumcision was.
Attitudes to male circumcision were positive in this population despite its low prevalence. There were substantial inconsistencies in both self-reported and clinically assessed circumcision status. Methods are needed to improve self-report and training of clinicians in this setting.
男性包皮环切术可使异性恋男性感染艾滋病毒的风险降低约60%。对包皮环切术对艾滋病毒传播的影响进行建模以及规划服务扩展，依赖于自我报告的包皮环切状态。我们调查了自我报告状态的有效性。
对参与坦桑尼亚姆万扎农村社区随机性健康干预试验的青少年的调查和深入访谈（IDI）数据进行了分析。
1998年招募了5354名男学生（中位年龄15.5岁），并对其进行了3年的随访。基线时，自我报告的包皮环切患病率为13.7%，临床检查为11.8%，最终调查时临床检查升至17.3%。在最终调查中，只有61.5%的穆斯林男性接受了包皮环切术。在506名基线时报告接受过包皮环切术的参与者中，只有78.9%在中期报告了这一情况。同样，在基线时临床评估为包皮环切的参与者中，只有84.2%在中期也被评估为包皮环切。在基线和中期调查中，报告接受过包皮环切术的参与者中，约80%在临床检查中也被发现如此。男性IDI受访者对包皮环切术有很高的容忍度和尊重，普遍认为它有利于阴茎卫生和疾病预防。大多数女性IDI受访者表示，她们不知道男性包皮环切术是什么。
尽管该人群中男性包皮环切术的患病率较低，但对其态度是积极的。自我报告和临床评估的包皮环切状态都存在大量不一致之处。需要采取方法来改善自我报告，并对该环境中的临床医生进行培训。
