Voluntary Medical Male Circumcision
1. Programs must continue to promote protective behavior such as condom use in addition to male circumcision. Studies found that male circumcision is only partially effective, making protective behavior such as partner reduction and condom use, in addition to circumcision, essential. Men who have been circumcised can still transmit HIV to women if they are HIV-positive. Until healing is complete following circumcision, men are more likely to transmit HIV. A post hoc analysis found the HIV-1 acquisition rate among partners of men who remained uncircumcised was 7.9% during the first 6 months after enrollment compared with 27.8% for partners of men who were circumcised and then resumed sexual activity prior to documented healing of the surgical wound, a substantially increased risk.
Gap noted, for example, in Uganda (Wawer et al., 2009); sub-Saharan Africa (Hallett et al., 2008a); Kenya (Agot et al., 2007); South Africa (Taljaard et al., 2008); Uganda and Zimbabwe (Matovu et al., 2007); Kenya, Rwanda, South Africa, and Zambia (Baeten et al., 2010).
2. Programs for male circumcision need to provide women, as well as men, with detailed factual knowledge of the benefits and risks of voluntary medical male circumcision. Surveys found that women lacked detailed factual knowledge of the benefits and risks of voluntary medical male circumcision and believed that if their male partner was circumcised (whether medically or traditionally) that condom use was unnecessary to protect them from acquiring HIV. Both women and men needed knowledge that abstinence is necessary during wound-healing. Women also need to know that female genital cutting does NOT protect against HIV acquisition or transmission. Women reported that circumcised men adopted risky sexual behaviors. Women feared that medical male circumcision would reduce their ability to negotiate for safer sex and would increase violence. A study of women who acquired HIV found that a large proportion of women reported not knowing whether their partner was circumcised.
Gap noted, for example, in Kenya, Namibia, South Africa, Swaziland and Uganda (AVAC et al., 2010); and South Africa and Zimbabwe (Mavedzenge et al., 2011b).