Nyaga E M, Mbugua G G, Muthami L, Gikunju J K
East Afr Med J. 2014 Nov;91(11):407-13.
Voluntary Medical Male Circumcision (VMMC) is the surgical removal of all or part of the foreskin from the penis. It is done for medical reasons as it has been shown to reduce the risk of female to male transmission of HIV by up to 60%. It has also been associated with lower transmission of sexually transmitted infections. Voluntary Medical Male Circumcision services have been scaled up in countries with high prevalence, generalised heterosexual HIV epidemics and low rates of male circumcision. Kibera is inhabited by a multi-ethnic community with a sizeable number of un-circumcising ethnic groups.
To determine the uptake of voluntary medical male circumcision among men in Kibera Division and to identify factors associated with circumcision preference.
Descriptive cross-sectional study.
Kibera Division of Nairobi County.
Simple random sampling was used to enrol 387 participants. A 42-item questionnaire was administered to the participants for determining the uptake of VMMC. It had three sub-sections: demographic characteristics, general knowledge about VMMC and AIDS and acceptability of VMMC, which collected data on the main outcome measures. Data captured was entered into EpiInfo and converted to Stata13 for validation and analysis. Bivariate statistics were generated for all the variables in accordance to the study questions. Categorical variables were analysed using chi-square tests, while the qualitative variables were analysed using the t-test. Multivariate logistic regression analysis was performed to identify factors associated with the acceptability of male circumcision.
The study analysed data for a sample of 341 individuals whose mean age was 31 years (95% = 31 ± 9.1) and 62% were married. A total of 54% of the respondents had completed secondary and tertiary level of education. The level of understanding about VMMC was above average. Fifty nine percent of the respondents (95% CI = 0.54-0.64) knew about VMMC. Of these, 31% had obtained information about VMMC from TV and radio. The most frequently mentioned reason for undergoing VMMC was prevention of HIV and sexually transmitted infections. The level of uptake of VMMC was high at 75%. The study established that the prefered age group for circumcision was during adolescence. Using multivariate logistic regression, the factors associated with uptake of VMMC were education level, medical and hygiene reasons for VMMC. Barriers for uptake were cost, pain and long recovery period after the operation.
The uptake and acceptability of male circumcision is high among the general population in Kibera. Participant understanding of HIV and VMMC was also high. There is need for heightened awareness creation in educational institutes. This will specifically target young men before or shortly after their sexual debut when they may still be free of HIV and HSV-2 infections. Circumcision by medical providers should be increased in traditionally circumcising regions to reduce incidence of adverse events.
自愿男性医学包皮环切术（VMMC）是指通过手术切除阴茎的全部或部分包皮。出于医学原因开展此项手术，因为研究表明，该手术可将女性向男性传播艾滋病毒的风险降低多达60%。它还与较低的性传播感染率相关。在艾滋病毒高流行率、普遍存在异性传播艾滋病毒疫情且男性包皮环切率较低的国家，自愿男性医学包皮环切服务已得到推广。基贝拉居住着一个多民族社区，其中有相当数量的不进行包皮环切的族群。
确定基贝拉分区男性对自愿男性医学包皮环切术的接受情况，并确定与包皮环切偏好相关的因素。
描述性横断面研究。
内罗毕县基贝拉分区。
采用简单随机抽样方法招募了387名参与者。向参与者发放了一份包含42个条目的问卷，以确定他们对自愿男性医学包皮环切术的接受情况。问卷有三个子部分：人口统计学特征、关于自愿男性医学包皮环切术和艾滋病的一般知识以及对自愿男性医学包皮环切术的可接受性，收集了关于主要结局指标的数据。收集到的数据录入EpiInfo软件，并转换为Stata13软件进行验证和分析。根据研究问题对所有变量进行双变量统计分析。分类变量采用卡方检验进行分析，而定性变量采用t检验进行分析。进行多变量逻辑回归分析以确定与男性包皮环切术可接受性相关的因素。
该研究分析了341名个体的样本数据，这些个体的平均年龄为31岁（95%可信区间 = 31 ± 9.1），62%已婚。共有54%的受访者完成了中学和高等教育。对自愿男性医学包皮环切术的了解程度高于平均水平。59%的受访者（95%可信区间 = 0.54 - 0.64）了解自愿男性医学包皮环切术。其中，31%通过电视和广播获得了关于自愿男性医学包皮环切术的信息。接受自愿男性医学包皮环切术最常提到的原因是预防艾滋病毒和性传播感染。自愿男性医学包皮环切术的接受率很高，为75%。该研究确定，包皮环切术的首选年龄组是青春期。通过多变量逻辑回归分析，与接受自愿男性医学包皮环切术相关的因素是教育水平、自愿男性医学包皮环切术的医学和卫生原因。接受手术的障碍包括费用、疼痛和术后恢复时间长。
基贝拉普通人群中男性对包皮环切术的接受率和可接受性较高。参与者对艾滋病毒和自愿男性医学包皮环切术的了解程度也较高。需要在教育机构提高宣传力度。这将特别针对年轻男性在首次性行为之前或之后不久，此时他们可能仍未感染艾滋病毒和单纯疱疹病毒2型。在传统上进行包皮环切的地区，应由医疗服务提供者增加包皮环切手术，以降低不良事件的发生率。
