Department of Defense HIV/AIDS Prevention Program, Naval Health Research Center, San Diego, California, United States of America.
PLoS One. 2011;6(11):e27561. doi: 10.1371/journal.pone.0027561. Epub 2011 Nov 29.
Overwhelming evidence, including three clinical trials, shows that male circumcision (MC) reduces the risk of HIV infection among men. However, data from recent Lesotho Demographic and Health Surveys do not demonstrate MC to be protective against HIV. These contradictory findings could partially be due to inaccurate self-reported MC status used to estimate MC prevalence. This study describes MC characteristics among men applying for Lesotho Defence Force recruitment and seeks to assess MC self-reported accuracy through comparison with physical-examination-based data.
During Lesotho Defence Force applicant screening in 2009, 241 (77%) of 312 men, aged 18-25 y, consented to a self-administered demographic and MC characteristic survey and physician-performed genital examination. The extent of foreskin removal was graded on a scale of 1 (no evidence of MC) to 4 (complete MC). MC was self-reported by 27% (n = 64/239) of participants. Of the 64 men self-reporting being circumcised, physical exam showed that 23% had no evidence of circumcision, 27% had partial circumcision, and 50% had complete circumcision. Of the MCs reportedly performed by a medical provider, 3% were Grade 1 and 73% were Grade 4. Of the MCs reportedly performed by traditional circumcisers, 41% were Grade 1, while 28% were Grade 4. Among participants self-reporting being circumcised, the odds of MC status misclassification were seven times higher among those reportedly circumcised by initiation school personnel (odds ratio = 7.22; 95% CI = 2.29-22.75).
Approximately 27% of participants self-reported being circumcised. However, only 50% of these men had complete MC as determined by a physical exam. Given this low MC self-report accuracy, countries scaling up voluntary medical MC (VMMC) should obtain physical-exam-based MC data to guide service delivery and cost estimates. HIV prevention messages promoting VMMC should provide comprehensive education regarding the definition of VMMC.
大量证据，包括三项临床试验，表明男性割礼（MC）可降低男性感染艾滋病毒的风险。然而，莱索托最近的人口与健康调查数据并未显示 MC 能预防艾滋病毒。这些相互矛盾的发现可能部分归因于用于估计 MC 流行率的不准确的自我报告的 MC 状态。本研究描述了申请莱索托国防军入伍的男性的 MC 特征，并试图通过与基于体检的数据比较来评估 MC 自我报告的准确性。
在 2009 年莱索托国防军应征者筛选期间，312 名年龄在 18-25 岁的男性中，有 241 名（77%）同意进行自我管理的人口和 MC 特征调查以及医生进行的生殖器检查。包皮切除的程度按 1（无 MC 证据）到 4（完全 MC）的等级评分。27%（n=64/239）的参与者自我报告接受了 MC。在 64 名自我报告接受割礼的男性中，体格检查显示，23%的人没有割礼证据，27%的人有部分割礼，50%的人有完全割礼。据报告由医疗服务提供者进行的 MC 中，3%为 1 级，73%为 4 级。据报告由传统割礼师进行的 MC 中，41%为 1 级，而 28%为 4 级。在自我报告接受割礼的参与者中，报告由入学人员进行割礼的人的 MC 状态分类错误的几率高出 7 倍（比值比=7.22；95%置信区间=2.29-22.75）。
大约 27%的参与者自我报告接受了割礼。然而，只有 50%的人在体格检查中确实接受了完全的 MC。鉴于这种低的 MC 自我报告准确性，正在扩大自愿医疗 MC（VMMC）的国家应该获得基于体检的 MC 数据，以指导服务提供和成本估计。促进 VMMC 的艾滋病毒预防信息应提供关于 VMMC 的全面教育。
