Andersson Neil, Cockcroft Anne
Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico.
AIDS Care. 2012;24(3):301-9. doi: 10.1080/09540121.2011.608793. Epub 2011 Sep 21.
In efficacy trials male circumcision (MC) protected men against HIV infection. Planners need information relevant to MC programmes in practice. In 2008, we interviewed 2915 men and 4549 women aged 15-29 years in representative cluster samples in Botswana, Namibia and Swaziland, asking about socio-economic characteristics, knowledge and attitudes about HIV and MC and MC history. We tested finger prick blood samples for HIV. We calculated weighted frequencies of MC knowledge and attitudes, and MC history and HIV status. Multivariate analysis examined associations between MC and other variables and HIV status. In Botswana, 11% of young men reported MC, 28% in Namibia and 8% in Swaziland; mostly (75% in Botswana, 94% - mostly Herero - in Namibia and 68% in Swaziland) as infants or children. Overall, 6.5% were HIV positive (8.3% Botswana, 2.6% Namibia and 9.1% Swaziland). Taking other variables into account, circumcised men were as likely as uncircumcised men to be HIV positive. Nearly half of the uncircumcised young men planned to be circumcised; two-thirds of young men and women planned to have their sons circumcised. Some respondents had inaccurate beliefs and unhelpful views about MC and HIV, with variation between countries. Between 9 and 15% believed a circumcised man is fully protected against HIV; 20-26% believed men need not be tested for HIV before MC; 14-26% believed HIV-positive men who are circumcised cannot transmit the virus; and 8-34% thought it was "okay for a circumcised man to expect sex without a condom". Inaccurate perceptions about protection from MC could lead to risk compensation and reduce women's ability to negotiate safer sex. More efforts are needed to raise awareness about the limitations of MC protection, especially for women, and to study the interactions between MC roll out programmes and primary HIV prevention programmes.
在疗效试验中，男性包皮环切术可保护男性免受艾滋病毒感染。规划者需要与实际包皮环切术项目相关的信息。2008年，我们在博茨瓦纳、纳米比亚和斯威士兰具有代表性的整群样本中，对2915名年龄在15至29岁之间的男性和4549名女性进行了访谈，询问他们的社会经济特征、对艾滋病毒和包皮环切术的知识与态度以及包皮环切术史。我们对指尖采血样本进行了艾滋病毒检测。我们计算了包皮环切术知识与态度、包皮环切术史和艾滋病毒感染状况的加权频率。多变量分析研究了包皮环切术与其他变量以及艾滋病毒感染状况之间的关联。在博茨瓦纳，11%的年轻男性报告接受过包皮环切术，纳米比亚为28%，斯威士兰为8%；大多数（博茨瓦纳为75%，纳米比亚为94%——主要是赫雷罗人——斯威士兰为68%）是在婴儿期或儿童期接受的。总体而言，6.5%的人艾滋病毒呈阳性（博茨瓦纳为8.3%，纳米比亚为2.6%，斯威士兰为9.1%）。考虑到其他变量，接受包皮环切术的男性感染艾滋病毒的可能性与未接受包皮环切术的男性相同。近一半未接受包皮环切术的年轻男性计划接受包皮环切术；三分之二的年轻男性和女性计划让他们的儿子接受包皮环切术。一些受访者对包皮环切术和艾滋病毒存在不准确的认知和无益的看法，不同国家之间存在差异。9%至15%的人认为接受包皮环切术的男性可完全预防艾滋病毒；20%至26%的人认为男性在接受包皮环切术前无需进行艾滋病毒检测；14%至26%的人认为接受包皮环切术的艾滋病毒阳性男性不会传播病毒；8%至34%的人认为“接受包皮环切术的男性可以不使用避孕套进行性行为”。对包皮环切术防护作用的不准确认知可能导致风险补偿，并降低女性协商更安全性行为的能力。需要做出更多努力来提高人们对包皮环切术防护局限性的认识，尤其是对女性的认识，并研究包皮环切术推广项目与艾滋病毒初级预防项目之间的相互作用。
