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Title: Male circumcision: a cancer prevention strategy?
Source: Lancet Oncology. 2009 May;10(5):431.
Abstract: Given that less than 20% of males are circumcised in many developing countries, and that male circumcision is relatively simple and reduces viral infection, might this practice be more widely used as a preventive measure against cancer? In developing countries, male circumcision could have a vital role in specific segments of the population depending on the answers to specific scientific and infrasturcture related questions. Discussions around male circumcision strategies should be encouraged within the context of cancer prevention, and these should include local communities alongside assessments of current capacities, measurable targets, cost analyses and modelling, and the development of practicable guidelines, so as to place male circumcision within the possible options available for disease prevention.
Language: English
Keywords:
UGANDA | SUMMARY REPORT | PREVALENCE | MEN | MALE CIRCUMCISION | CANCER | PREVENTION AND CONTROL | HIV PREVENTION | STANDARDS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Measurement | Research Methodology | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Neoplasms | Diseases | HIV Infections | Viral Diseases
Document Number: 341199

Title: Quick reference guide to family planning research.
Author: Family Health International [FHI]
Source: [Research Triangle Park, North Carolina], FHI, 2009 Jan. 51 p. (Research to Practice)
Abstract: This document is a summary of research and program findings that FHI believes could improve family planning and reproductive health services if they were more widely incorporated into policies and programs. The following topics are covered: Preventing Mother-to-Child Transmission of HIV through Family Planning; Integrating HIV Voluntary Testing and Counseling and Family Planning Services; Intrauterine Devices; Emergency Contraceptive Pills; Vasectomy; Male Condoms; Female Condoms; Standard Days Method; Eligibility Screening and Provider Checklists; Community-Based Services and Distribution; Youth (ages 10-24); Implants; Contraceptive Continuation; Male Circumcision and HIV; Contraceptive Counseling and Job Aids; Healthy Timing and Spacing of Pregnancies; Postpartum Family Planning.
Language: English
Keywords:
GLOBAL | CATALOG | RESEARCH ACTIVITIES | FAMILY PLANNING POLICY | CONTRACEPTIVE METHODS | HIV/FP INTEGRATION | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | EMERGENCY CONTRACEPTION | CONTRACEPTION CONTINUATION | MALE CIRCUMCISION | COMMUNITY-BASED DISTRIBUTION | COUNSELING | YOUTH PROGRAMS | POSTPARTUM PROGRAMS | Research Methodology | Population Policy | Social Policy | Policy | Political Factors | Sociocultural Factors | Family Planning | Contraception | Programs | Organization and Administration | Disease Transmission Control | Prevention and Control | Diseases | Contraceptive Usage | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Nonclinical Distribution | Distributional Activities | Program Activities | Clinic Activities | Family Planning Programs
Document Number: 331689

3.
Title: Counsellors are human [letter]
Author: Anand V
Source: Indian Journal of Medical Ethics. 2009 Jul-Sep;6(3):169-70.
Abstract: This letter touches on the subject of the medical knowledge of physicians in India. It first discusses male circumcision and then moves on to India not having an established system for sharing medical information and updates. It asks that better systems of regularly updating the medical knowledge of Indian physicians be developed.
Language: English
Keywords:
INDIA | CRITIQUE | PROVIDERS WITH CLIENTS | MALE CIRCUMCISION | KNOWLEDGE | INFORMED CONSENT | FEES | INFORMATION DISTRIBUTION | Asia, Southern | Asia | Developing Countries | Health Services | Delivery of Health Care | Health | Medical Procedures | Medicine | Sociocultural Factors | Financial Activities | Economic Factors | Communication
Document Number: 342876

Peer Reviewed

Title: Effect of male circumcision on the prevalence of high-risk human papillomavirus in young men: results of a randomized controlled trial conducted in orange farm, South Africa.
Author: Auvert B; Sobngwi-Tambekou J; Cutler E; Nieuwoudt M; Lissouba P; Puren A; Taljaard D
Source: Journal of Infectious Diseases. 2009 Jan 1;199(1):14-9.
Abstract: The authors used data from a male circumcision (MC) trial conducted in Orange Farm, South Africa among men aged 18-24 years to investigate the association between male circumcision (MC) and the prevalence of high-risk human papillomavirus (HR-HPV) among young men. Urethral swab samples were collected during a period of 262 consecutive days from participants in the intervention (circumcised) and control (uncircumcised) groups who were reporting for a scheduled follow-up visit. Swab samples were analyzed using polymerase chain reaction. HR-HPV prevalence rate ratios were assessed using univariate and multivariate log Poisson regression. In an intention-to-treat analysis, the prevalence of HR-HPV among the intervention group was 14.8% (94/637) and in the control group was 22.3% (140/627). Controlling for propensity score and confounders (ethnic group, age, education, sexual behavior [including condom use], marital status, and human immunodeficiency virus status) had no effect on the results. This is the first randomized controlled trial to show a reduction in the prevalence of urethral HR-HPV infection after MC. This finding explains why women with circumcised partners are at a lower risk of cervical cancer than other women.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | CLINICAL TRIALS | EPIDEMIOLOGIC METHODS | YOUTH | MULTIVARIATE ANALYSIS | MEN | MALE CIRCUMCISION | HPV | PREVALENCE | RISK FACTORS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Clinical Research | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Data Analysis | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Viral Diseases | Diseases | Measurement | Biology
Document Number: 328586

6.
Title: Circumcision's place in the vicious cycle involving herpes simplex virus type 2 and HIV [editorial]
Author: Bailey RC; Mehta SD
Source: Journal of Infectious Diseases. 2009 Apr 1;199(7):923-5.
Abstract: HSV-2 as a biological cofactor in HIV acquisition and transmission has likely contributed substantially to the HIV epidemic. Although it remains possible that HSV-2 suppressive therapy will be efficacious in reducing HIV transmission, it is not clear how and whether a twice daily regimen of acyclovir will be manageable and effective at a population level. Research is needed to develop and test a prophylactic vaccine that, even if only partially protective against HSV-2 acquisition, is likely to be effective in both concentrated epidemics and in generalized epidemics in which a large proportion of HIV transmission occurs in stable partnerships. (excerpt)
Language: English
Keywords:
AFRICA | EUROPE | SUMMARY REPORT | INCIDENCE | HERPES GENITALIS | HIV INFECTIONS | MALE CIRCUMCISION | SEX BEHAVIOR | HIV TESTING | LABORATORY PROCEDURES | Developing Countries | Developed Countries | Measurement | Research Methodology | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Viral Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Behavior | Laboratory Examinations and Diagnoses | Examinations and Diagnoses
Document Number: 341208

Peer Reviewed

Title: Behavioral mechanisms in HIV epidemiology and prevention: past, present, and future roles.
Author: Bingenheimer JB; Geronimus AT
Source: Studies in Family Planning. 2009 Sep;40(3):187-204.
Abstract: In the 1980�s behavioral variations across geographically and socially defined populations were the central focus of AIDS research, and behavior change was seen as the primary means of controlling HIV epidemics. Today, biological mechanisms-especially other sexually transmitted infections, antiretroviral therapy, and male circumcision-predominate in HIV epidemiology and prevention. We describe several reasons for this shift in emphasis. Although the shift is understandable, we argue for a sustained focus on behavioral mechanisms in HIV research in order to realize the theoretical promise of interventions targeting the biological aspects of HIV risk. We also provide evidence to suggest that large reductions in HIV prevalence may be accomplished by small changes in behavior. Moreover, we contend that behavioral mechanisms will find their proper place in HIV epidemiology and prevention only when investigators adopt a conceptual model that treats prevalence as a determinant as well as an outcome of behavior and that explicitly recognizes the dynamic interdependence between behavior and other epidemiological and demographic parameters.
Language: English
Keywords:
AFRICA, SUB SAHARAN | RESEARCH REPORT | CROSS-CULTURAL COMPARISONS | EPIDEMIOLOGY | BEHAVIOR CHANGE | HIV INFECTIONS | RISK REDUCTION BEHAVIOR | HIV PREVENTION | ANTIRETROVIRAL THERAPY | MALE CIRCUMCISION | Africa | Developing Countries | Comparative Studies | Studies | Research Methodology | Public Health | Health | Behavior | Viral Diseases | Diseases | HIV | Medical Procedures | Medicine | Health Services | Delivery of Health Care
Document Number: 339701

10.

Title: HIV / AIDs in Namibia: Behavioral and contextual factors driving the epidemic.
Author: de la Torre C; Khan S; Eckert E; Luna J; Koppenhaver T
Source: [Windhoek], Namibia, University of North Carolina at Chapel Hill, Carolina Population Center, MEASURE Evaluation, 2009 May. [98] p. (SR-09-53USAID Cooperative Agreement No. GPO-A-00-03-00003-00)
Abstract: This report identifies and describes what current evidence indicates are the main behavioral and contextual factors that are driving the HIV epidemic in Namibia. The report is intended to assist in the development of a national prevention strategy for combating the HIV / AIDS epidemic. Data from several sources are triangulated to assess which factors are most likely to contribute to the spread of HIV across the population. In the absence of a national seroprevalence survey, the following were examined to identify the main drivers of the Namibian HIV epidemic: 1. The prevalence, distribution, and trends over time of proximate determinants of HIV infection within Namibia (obtained from an analysis of the Namibia Demographic and Health Surveys [NDHS] and other local surveys); 2. Socio-demographic factors associated with HIV infection among clients who were tested for HIV in select New Start voluntary counseling and testing (VCT) facilities throughout Namibia (obtained from analysis of these data); 3. The findings and conclusions of other researchers who have investigated various aspects of HIV / AIDS vulnerability in Namibia; 4. Factors most associated with HIV infection in neighboring countries, and in other generalized epidemics for which representative HIV prevalence surveys exist. A number of factors are likely contributing to the high levels of HIV in Namibia. As described in this report, these various factors are often inter-related and operate in unison to create one of the worst HIV epidemics in the world. (Excerpt)
Language: English
Keywords:
NAMIBIA | TECHNICAL REPORT | HIV INFECTIONS | AIDS | EPIDEMICS | PREVALENCE | EPIDEMIOLOGY | VOLUNTARY COUNSELING AND TESTING | SEX BEHAVIOR | ALCOHOL USE AND ABUSE | MALE CIRCUMCISION | PERCEPTION | CONDOM USE | MIGRATION | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Viral Diseases | Diseases | Measurement | Research Methodology | Public Health | Health | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Behavior | Psychological Factors | Risk Reduction Behavior | Population Dynamics | Demographic Factors | Population
Document Number: 331841

11.

Peer Reviewed

Title: How to contain generalized HIV epidemics? A plea for better evidence to displace speculation.
Author: Gisselquist D; Potterat JJ; St Lawrence JS; Hogan M; Arora NK; Correa M; Dinsmore WW; Mehta G; Millogo J; Muth SQ; Okinyi M; Ounga T
Source: International Journal of STD and AIDS. 2009 Jul;20(7):443-6.
Abstract: In the worst generalized HIV epidemics in East and Southern Africa, from one-quarter to three-quarters of women aged 15 years can expect to be living with HIV or to have died with AIDS by age 40 years. This disaster continues in the face of massive HIV prevention programmes based on current inexact knowledge of HIV transmission pathways and risks. To stop this disaster, both the public and public health experts need better information about the specific factors that allow HIV to propagate so extensively in countries with generalized epidemics. This knowledge could be acquired by tracing HIV infections to their source - especially tracing HIV infections in women of all ages, and tracing unexplained HIV infections in children with HIV-negative mothers.
Language: English
Keywords:
AFRICA | CRITIQUE | EPIDEMIOLOGIC METHODS | HIV INFECTIONS | AIDS | EPIDEMICS | GOALS | NEEDLE PIERCING | BLOOD TRANSFUSION | HIV TRANSMISSION | HIV PREVENTION | MALE CIRCUMCISION | Developing Countries | Research Methodology | Viral Diseases | Diseases | Planning | Organization and Administration | Risk Behavior | Behavior | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342830

12.

Title: Circumcision and sexual behavior: factors independently associated with human papillomavirus detection among men in the HIM study.
Author: Giuliano AR; Lazcano E; Villa LL; Flores R; Salmeron J; Lee JH; Papenfuss M; Abrahamsen M; Baggio ML; Silva R; Quiterio M
Source: International Journal of Cancer. 2009 Mar 15;124(6):1251-7.
Abstract: There is growing interest in understanding human papillomavirus (HPV) infection and related disease among men. To date there have been numerous studies reporting HPV DNA prevalence among men from several different countries, however, few have incorporated multivariable analyses to determine factors independently associated with male HPV detection. The purpose of this study was to assess the factors independently associated with HPV detection in men ages 18-70 years residing in Brazil (n = 343), Mexico (n = 312), and the United States (US) (n = 333). In samples combined from the coronal sulcus, glans penis, shaft, and scrotum, we evaluated factors associated with any, oncogenic, and nononcogenic HPV infections. In multivariable analyses, detection of any HPV infection was significantly associated with reported race of Asian/Pacific Islander, lifetime and recent number of sexual partners, and having sex in the past 3 months. Oncogenic HPV detection was independently associated with lifetime and recent number of sexual partners, and having sex in the past 3 months. NonOncogenic HPV infection was independently associated with lifetime number of sexual partners. Circumcision, assessed by clinical examination, was associated with reduced risk of HPV detection across all categories of HPV evaluated. HPV detection in men in the current study was strongly related to sexual behavior and circumcision status. Interventions such as circumcision may provide a low-cost method to reduce HPV infection.
Language: English
Keywords:
LATIN AMERICA | UNITED STATES OF AMERICA | RESEARCH REPORT | KAP SURVEYS | MULTIVARIATE ANALYSIS | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | MEN | ASIANS | MALE CIRCUMCISION | SEX BEHAVIOR | PREVALENCE | RISK BEHAVIOR | RISK FACTORS | HPV | Americas | Developing Countries | Developed Countries | North America | Surveys | Sampling Studies | Studies | Research Methodology | Data Analysis | Demographic Factors | Population | Ethnic Groups | Cultural Background | Population Characteristics | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Behavior | Measurement | Biology | Viral Diseases | Diseases
Document Number: 330377

13.

Title: The number of procedures required to achieve optimal competency with male circumcision: findings from a randomized trial in Rakai, Uganda.
Author: Kiggundu V; Watya S; Kigozi G; Serwadda D; Nalugoda F; Buwembo D; Settuba A; Anyokorit M; Nkale J; Kighoma N; Ssempijja V; Wawer M; Gray RH
Source: BJU International. 2009 Aug;104(4):529-32.
Abstract: OBJECTIVE: To assess the number of procedures required to achieve optimal competency (time required for surgery with minimal adverse events) in Rakai, Uganda, and thus facilitate the development of guidelines for training providers, as male circumcision reduces the acquisition of human immunodeficiency virus (HIV) in men and is recommended for HIV prevention. PATIENTS AND METHODS: In a randomized trial, 3011 men were circumcised, using the sleeve method, by six physicians who had completed training, which included 15-20 supervised procedures. The duration of surgery from local anaesthesia to wound closure, moderate or severe surgery-related adverse events (AEs), and wound healing were assessed in relation to the number of procedures done by each physician. RESULTS: The median age of the patients was 24 years. The number of procedures per surgeon was 20-981. The mean time required to complete surgery was approximately 40 min for the first 100 procedures and declined to 25 min for the subsequent 100 circumcisions. After controlling for the number of procedures there was no significant difference in duration of the surgery by patient HIV status or age. The rate of moderate and severe AEs was 8.8% (10/114) for the first 19 unsupervised procedures after training, 4.0% for the next 20-99 (13/328) and 2.0% for the last 100 (P for trend, 0.003). All AEs resolved with management. CONCLUSION: The completion of more than 100 circumcisions was required before newly trained physicians achieved the optimum duration of surgery. AEs were higher immediately after training and additional supervision is needed for at least the first 20 procedures after completing training.
Language: English
Keywords:
UGANDA | RESEARCH REPORT | CLINICAL TRIALS | PHYSICIANS | HIV PREVENTION | MALE CIRCUMCISION | COMPLICATIONS | TRAINING PROGRAMS | SUPERVISION | ANESTHESIA | STANDARDS | TIME FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Clinical Research | Research Methodology | Health Personnel | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Education | Management | Organization and Administration | Treatment | Population Dynamics | Demographic Factors | Population
Document Number: 342642

14.

Title: Global epidemiology of HIV.
Author: Kilmarx PH
Source: Current Opinion In HIV and AIDS. 2009 Jul;4(4):240-6.
Abstract: PURPOSE OF REVIEW: To provide an update on the epidemiology of HIV worldwide and by region, along with an overview of recent HIV epidemiological research. RECENT FINDINGS: The global prevalence of HIV-1 has stabilized at 0.8%, with 33 million people living with HIV/AIDS, 2.7 million new infections, and 2.0 million AIDS deaths in 2007. Heterosexual spread in the general population is the main mode of transmission in sub-Saharan Africa, which remains the most heavily affected region, with 67% of the global burden. Male-male sex, injection drug use, and sex work are the predominant risk factors in most other regions. Infection rates are declining in some regions, including some of the most heavily affected countries in Africa, but climbing elsewhere such as in eastern Europe and central Asia. Recent HIV epidemiologic research findings include new insights into the role of HIV viral load, co-infection with sexually transmitted infections, male circumcision, antiretroviral treatment, serosorting, and superinfection in HIV transmission and prevention. SUMMARY: The global prevalence of HIV has stabilized in this decade, but with important regional differences in trends and modes of transmission. Prevention and treatment programs have an expanding impact in preventing HIV infection and AIDS deaths.
Language: English
Keywords:
GLOBAL | LITERATURE REVIEW | EPIDEMIOLOGY | HIV INFECTIONS | AIDS | PREVALENCE | MORTALITY | HIV TRANSMISSION | INCIDENCE | ANTIRETROVIRAL THERAPY | SEXUALLY TRANSMITTED DISEASES | HIV PREVENTION | MALE CIRCUMCISION | Public Health | Health | Viral Diseases | Diseases | Measurement | Research Methodology | Population Dynamics | Demographic Factors | Population | HIV | Reproductive Tract Infections | Infections | Medical Procedures | Medicine | Health Services | Delivery of Health Care
Document Number: 342343

15.
Peer Reviewed

Title: High rate of adverse events following circumcision of young male adults with the Tara KLamp technique: a randomised trial in South Africa.
Author: Lagarde E; Taljaard D; Puren A; Auvert B
Source: South African Medical Journal. 2009 Mar;99(3):163-9.
Abstract: BACKGROUND: The Tara KLamp (TK) device has been claimed to enable circumcisions to be performed safely and easily in medical and non-medical environments. Published evaluation studies have been conducted among young children only. METHODS: Following a randomised controlled trial (RCT) on 3 274 participants on the impact of male circumcision on HIV transmission, 69 control group members participated in this male circumcision methods trial and were randomised to a forceps-guided (FG) group and a TK group, and circumcised. RESULTS: Of the 166 men asked to participate, 97 declined, most (94) refusing circumcision by the TK technique; 34 men were randomised to the FG group and 35 to the TK group, and 32 and 24 patients were circumcised by the FG and TK methods respectively, of whom 29 and 19 respectively attended the post-circumcision visit. All 12 adverse event sheets corresponded to the TK group (p<0.001) and circumcisions by the TK method. Less favourable outcomes were associated with the TK method, including any sign of an adverse event (37% v. 3%; p=0.004), delayed wound healing (21% v. 3%; p=0.004) and problems with penis appearance (31% v. 3%; p=0.001). Participants randomised to the TK method were significantly more likely to report bleeding (21% v. 0%; p=0.02), injury to the penis (21% v. 0%; p=0.02), infection (32% v. 0%; p=0.002), swelling (83%/ v. 0%; p<0.001), and problems with urinating (16% v. 0%; p=0.056). The mean score of self-estimated pain was 9.5 for participants circumcised by TK compared with 6.1 for other participants (adjusted p=0.003). CONCLUSION: This study provides compelling evidence that strongly cautions against use of the TK method on young adults.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | CHILD, MALE | YOUTH | MALE CIRCUMCISION | PAIN | SURGERY | RISK FACTORS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Child | Age Factors | Population Characteristics | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Signs and Symptoms | Diseases | Treatment
Document Number: 342688

17.
Title: [The need for high-quality training and surgical standards for adult male circumcision in China]
Author: Li PS; Lu NQ; Cheng Y; Peng YF; Tian L; Liu YD; Ben KL; Xu JC; Lee R; Kim H; Sokal DC
Source: Zhonghua Nan Ke Xue. 2009 May;15(5):390-4.
Abstract: Although HIV is a significant problem in Africa, HIV infection rates are rising rapidly in other regions such as Asia and South America. International health organizations have recognized the need to develop effective strategies to check the worldwide transmission of HIV. Studies have demonstrated the significant reduction of HIV, HPV, HSV-2 and other STD infection rates with male circumcision (MC). Although numerous MC techniques are available, there are no standardized protocols and surgical training programs. Studies have shown that the standardization of MC techniques coupled with training programs can significantly reduce complication rates. High complication rates have been a primary obstacle to the implementation of MC services. We recommend the establishment of surgical standards and training protocols prior to the promotion of MC services in China.
Language: Chinese
Keywords:
CHINA | RESEARCH REPORT | PREVALENCE | CLIENTS | MEN | MALE CIRCUMCISION | HIV INFECTIONS | TRAINING PROGRAMS | QUALITY OF HEALTH CARE | STANDARDS | HEALTH SERVICES | SURGERY | Asia, Eastern | Asia | Developing Countries | Measurement | Research Methodology | Program Activities | Programs | Organization and Administration | Demographic Factors | Population | Medical Procedures | Medicine | Delivery of Health Care | Health | Viral Diseases | Diseases | Education | Health Services Evaluation | Program Evaluation | Treatment
Document Number: 342636

18.
Title: Doesn't the public have the right to know that male circumcision protects against HIV? [editorial]
Author: Madhivanan P; Krupp K
Source: Indian Journal of Medical Ethics. 2009 Jan-Mar;6(1):5-6.
Abstract: This editorial examines the issue of male circumcision (MC) in India and discusses doctor's challenges' with the question,"Doesn't the public have the right to know that male circumcision protects against HIV?" It describes the reluctance of the Government of India to disclose this information due to the controversy that may erupt between conservative Hindus and the Muslims in the country in which male circumcision is a marker of religious identity.
Language: English
Keywords:
INDIA | CRITIQUE | PUBLIC OPINION | HUMAN RIGHTS | MALE CIRCUMCISION | INFORMATION DISTRIBUTION | HIV PREVENTION | Asia, Southern | Asia | Developing Countries | Attitudes | Psychological Factors | Behavior | Political Factors | Sociocultural Factors | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Communication | HIV Infections | Viral Diseases | Diseases
Document Number: 330900

19.
Peer Reviewed

Title: Transmission probabilities of HIV and herpes simplex virus type 2, effect of male circumcision and interaction: a longitudinal study in a township of South Africa.
Author: Mahiane SG; Legeai C; Taljaard D; Latouche A; Puren A; Peillon A; Bretagnolle J; Lissouba P; Nguema EP; Gassiat E; Auvert B
Source: AIDS. 2009 Jan 28;23(3):377-383.
Abstract: OBJECTIVES: A synergy between HIV and herpes simplex virus type 2 (HSV-2) infections has been reported in observational studies. The objectives of this study were to estimate the per-sex-act female-to-male transmission probabilities (FtoMTPs) of HIV and HSV-2, the effect of each infection on the FtoMTP of the other and the effect of male circumcision on these FtoMTPs. DESIGN: We used longitudinal data collected during the male circumcision trial conducted in Orange Farm (South Africa). METHODS: Results were obtained by specific mathematical modeling of HIV and HSV-2 statuses of the men as functions of their sexual behavior and male circumcision status. The model took into account an estimation of the HIV and HSV-2 statuses of each of their female partners. Confidence intervals (CI) were estimated using a bootstrap resampling method. RESULTS: The HIV and HSV-2 FtoMTPs, during an unprotected sexual contact for an uncircumcised male in the absence of the other virus in both partners, were 0.0047 (95% CI: 0.0014-0.017) and 0.0067 (95% CI: 0.0028-0.014), respectively. HSV-2 in either partner increased HIV FtoMTP with a relative risk (RR) of 3.0 (95% CI: 1.01-7.3). Conversely, HIV in either partner increased HSV-2 FtoMTP (RR= 2.5; 95% CI: 1.1- 6.3). Male circumcision significantly decreased these probabilities with RRs of 0.24 (95% CI: 0.11-0.44) and 0.59 (95% CI: 0.36-0.91), respectively. CONCLUSION: This study gave the first estimates of HSV-2 per-sex-act FtoMTPs in Africa. It demonstrated a synergy between HIV and HSV-2 infections and a protective effect of male circumcision on HSV-2 acquisition by males.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | LONGITUDINAL STUDIES | MEN | HETEROSEXUALS | MALE CIRCUMCISION | HERPES GENITALIS | MATHEMATICAL MODEL | HIV INFECTIONS | HIV TRANSMISSION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Demographic Factors | Population | Sex Behavior | Behavior | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Theoretical Models | Viral Diseases
Document Number: 330895

20.

Title: Pioneering HIV prevention strategies in rural Kenya: a case study of Marie Stopes International's male circumcision outreach project.
Author: Nelson E; Quinn H
Source: London, United Kingdom, Marie Stopes International, 2009 Jul. 4 p. (MSI Innovations)
Abstract: The HIV epidemic continues to grow, in spite of global efforts to prevent the disease. Millions of people die each year of preventable HIV infections. It is projected that 60 million new HIV infections will occur by 2015, if current rates are not reversed. In 2006, new research confirmed for the first time that male circumcision could reduce the risk of HIV infection for heterosexual men by up to 60%. Marie Stopes International (MSI) responded quickly to these significant findings by pioneering a new outreach model for male circumcision (MC) provision in Western Kenya and the Nyanza Province, a region with the lowest MC rates and the highest HIV infection rates in the country. MSI was the one of the first organisations to deliver this critical HIV prevention service directly to Kenyans living in remote and rural areas. Responding to evidence that MC could potentially avert up to three million deaths in 20 years if all sexually active men in sub-Saharan Africa were circumcised, MSI now plans to bring this innovative outreach model to Malawi, Zambia and Swaziland.
Language: English
Keywords:
KENYA | ZAMBIA | SWAZILAND | MALAWI | SUMMARY REPORT | HETEROSEXUALS | MEN | MALE CIRCUMCISION | HIV PREVENTION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Africa, Southern | Sex Behavior | Behavior | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases
Document Number: 331471

21.

Peer Reviewed

Title: Medical circumcision and manhood initiation rituals in the Eastern Cape, South Africa: a post intervention evaluation.
Author: Peltzer K; Kanta X
Source: Culture, Health and Sexuality. 2009 Jan;11(1):83-97.
Abstract: The objectives of this study were first, to report the adverse events reported following male circumcision performed by medical professionals after a one-day training workshop; second, to report on the attitudes towards, beliefs surrounding and experiences regarding circumcision and initiation; and third, to assess the HIV-risk behaviour of young men attending initiation schools post medical circumcision. Initiates who had been medically circumcised by trained healthcare providers were examined and interviewed on the seventh day after circumcision and, in addition, focus-group discussions were conducted with initiates. Results indicate that of the 78 initiates physically examined on the seventh day after circumcision by a trained clinical nurse, seven (9%) adverse events (complications) were found. Initiates reported mixed attitudes towards combining medical circumcision with traditional initiation. The majority of the initiates (70%) felt that they could be stigmatized as a result of choosing medical rather than traditional circumcision and 20% thought that the relationship between medical and traditionally circumcised men was hostile. Prior to circumcision, most initiates (92%) had been sexually active and had engaged in HIV-risk behaviour. Focus-group discussions revealed that sexually active initiates, when asked about sex after circumcision, indicated they wished to abstain for a short period before resuming sexual activities with intended condom use being high. Findings are promising for efforts to up-scale integrated medical circumcision alongside traditional initiation into manhood.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | SAMPLING STUDIES | YOUTH | MALE CIRCUMCISION | TRADITIONAL CEREMONIES | ATTITUDES | BELIEFS | COMPLICATIONS | SEX BEHAVIOR | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Culture | Sociocultural Factors | Psychological Factors | Behavior | Diseases
Document Number: 341436

22.

23.
Title: [Is male circumcision an effective method of controlling HIV spread worldwide?] Czy obrzezanie mezczyzn jest dobrym sposobem na zahamowanie rozprzestrzeniania
Author: Rogowska-Szadkowska D; Chlabicz S
Source: Przeglad Epidemiologiczny. 2009;63(1):49-54.
Abstract: After early ending of controlled randomized studies in three African countries, where it has been shown that male circumcision diminishes the risk of their HIV infection even by 60%, campaigns recommending such procedures were undertaken in many countries. However circumcision does not provide to males absolute protection against HIV and it is necessary to apply other strategies diminishing the risk of infection, like delaying sexual initiation, reducing the number of sexual partners and consistent and proper use of condoms. It has not been unequivocally clarified so far how male circumcision affects the risk of infection of their female sexual partner. There are very few studies concerning the influence of hygiene of sexual organs on the risk of acquiring sexual transmitted diseases, including HIV. It would be advisable to explore those issues before recommending male circumcision, particularly in those countries where HIV infected women outnumber HIV-infected men.
Language: Polish
Keywords:
GLOBAL | AFRICA | RESEARCH REPORT | MEN | PERSONS LIVING WITH HIV/AIDS | HIV PREVENTION | MALE CIRCUMCISION | HIV INFECTIONS | HYGIENE | Developing Countries | Demographic Factors | Population | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Public Health
Document Number: 341921

24.

Title: Willingness to be circumcised for preventing HIV among Chinese men who have sex with men.
Author: Ruan Y; Qian HZ; Li D; Shi W; Li Q; Liang H; Yang Y; Luo F; Vermund SH; Shao Y
Source: AIDS Patient Care and STDs. 2009 May;23(5):315-21.
Abstract: Male circumcision can reduce the risk of HIV acquisition among heterosexual men, but its effectiveness is uncertain in men who have sex with men (MSM). Additionally, its acceptability among Chinese men is unknown given a lack of history and cultural norms endorsing neonatal and adult circumcision. This study evaluated the willingness to participate in a clinical trial of circumcision among 328 Chinese MSM. Some 11.6% respondents reported having been circumcised, most of them due to a tight foreskin. Of 284 uncircumcised MSM, 16.9% said they were absolutely willing to participate, 26.4% were probably, 28.9% were probably not, and 27.8% were absolutely not; 81% said male circumcision would help maintain genital hygiene. The major motivators for willingness to participate included contribution to AIDS scientific research and getting free medical service. Men also had concerns about ineffectiveness of circumcision in reducing HIV/sexually transmitted infection (STI) risks and side effects of the surgery. Those who did not have a Beijing resident card (adjusted odds ratio [AOR], 1.99; 95% confidence interval [CI], 1.17-3.38), did not find sexual partners through the Internet (AOR, 2.13; 95% CI, 1.21-3.75), and were not concerned about the effectiveness of circumcision (AOR, 2.37; 95% CI, 1.34-4.19) were more likely to be willing to participate in a trial. The study suggests that circumcision is uncommon among Chinese MSM. Considerable community education will be needed in circumcision advocacy among MSM in China. A clinical trial for efficacy among MSM should be considered.
Language: English
Keywords:
CHINA | RESEARCH REPORT | CLINICAL TRIALS | COHORT ANALYSIS | MEN HAVING SEX WITH MEN | HIV PREVENTION | MALE CIRCUMCISION | PREVALENCE | PERCEPTION | INTERVIEWS | PARTICIPATION | Asia, Eastern | Asia | Developing Countries | Clinical Research | Research Methodology | Sex Behavior | Behavior | HIV Infections | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Measurement | Psychological Factors | Data Collection | Social Behavior
Document Number: 342179

25.

Title: Male circumcision for prevention of heterosexual acquisition of HIV in men.
Author: Siegfried N; Muller M; Deeks JJ; Volmink J
Source: Cochrane Database of Systematic Reviews. 2009;(2):CD003362.
Abstract: BACKGROUND: Male circumcision is defined as the surgical removal of all or part of the foreskin of the penis and may be practiced as part of a religious ritual, as a medical procedure, or as part of a traditional ritual performed as an initiation into manhood. Since the 1980s, over 30 observational studies have suggested a protective effect of male circumcision on HIV acquisition in heterosexual men. In 2002, three randomised controlled trials to assess the efficacy of male circumcision for preventing HIV acquisition in men commenced in Africa. This review evaluates the results of these trials, which analysed the effectiveness and safety of male circumcision for preventing acquisition of HIV in heterosexual men. OBJECTIVES: To assess the evidence of an interventional effect of male circumcision for preventing acquisition of HIV-1 and HIV-2 by men through heterosexual intercourse SEARCH STRATEGY: We formulated a comprehensive and exhaustive search strategy in an attempt to identify all relevant studies regardless of language or publication status (published, unpublished, in press, and in progress). In June 2007 we searched the following electronic journal and trial databases: MEDLINE, EMBASE, and CENTRAL. We also searched the electronic conference databases NLM Gateway and AIDSearch and the trials registers ClinicalTrials.gov and Current Controlled Trials. We contacted researchers and relevant organizations and checked reference lists of all included studies. SELECTION CRITERIA: Randomised controlled trials of male circumcision versus no circumcision in HIV-negative heterosexual men with HIV incidence as the primary outcome. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility, extracted data, and graded methodological quality. Data extraction and methodological quality were checked by a third author who resolved differences when these arose. Data were considered clinically homogeneous and meta-analyses and sensitivity analyses were performed. MAIN RESULTS: Three large RCTs of men from the general population were conducted in South Africa (N = 3 274), Uganda (N = 4 996) and Kenya (N = 2 784) between 2002 and 2006. All three trials were stopped early due to significant findings at interim analyses. We combined the survival estimates for all three trials at 12 months and also at 21 or 24 months in a meta-analysis using available case analyses using the random effects model. The resultant incidence risk ratio (IRR) was 0.50 at 12 months with a 95% confidence interval (CI) of 0.34 to 0.72; and 0.46 at 21 or 24 months (95% CI: 0.34 to 0.62). These IRRs can be interpreted as a relative risk reduction of acquiring HIV of 50% at 12 months and 54% at 21 or 24 months following circumcision. There was little statistical heterogeneity between the trial results (chi(2) = 0.60; df = 2; p = 0.74 and chi(2) = 0.31; df = 2; p = 0.86) with the degree of heterogeneity quantified by the I(2) at 0% in both analyses. We investigated the sensitivity of the calculated IRRs and conducted meta-analyses of the reported IRRs, the reported per protocol IRRs, and reported full intention-to-treat analysis. The results obtained did not differ markedly from the available case meta-analysis, with circumcision displaying significant protective effects across all analyses.We conducted a meta-analysis of the secondary outcomes measuring sexual behaviour for the Kenyan and Ugandan trials and found no significant differences between circumcised and uncircumcised men. For the South African trial the mean number of sexual contacts at the 12-month visit was 5.9 in the circumcision group versus 5 in the control group, which was a statistically significant difference (p < 0.001). This difference remained statistically significant at the 21-month visit (7.5 versus 6.4; p = 0.0015). No other significant differences were observed.Incidence of adverse events following the surgical circumcision procedure was low in all three trials.Reporting of methodological quality was variable across the three trials, but overall, the potential for significant biases affecting the trial results was judged to be low to moderate given the large sample sizes of the trials, the balance of possible confounding variables across randomised groups at baseline in all three trials, and the employment of acceptable statistical early stopping rules. AUTHORS' CONCLUSIONS: There is strong evidence that medical male circumcision reduces the acquisition of HIV by heterosexual men by between 38% and 66% over 24 months. Incidence of adverse events is very low, indicating that male circumcision, when conducted under these conditions, is a safe procedure. Inclusion of male circumcision into current HIV prevention measures guidelines is warranted, with further research required to assess the feasibility, desirability, and cost-effectiveness of implementing the procedure within local contexts.
Language: English
Keywords:
SOUTH AFRICA | UGANDA | KENYA | RESEARCH REPORT | CONTROL GROUPS | DATA ANALYSIS | HETEROSEXUALS | MEN | MALE CIRCUMCISION | HIV PREVENTION | INCIDENCE | SEX BEHAVIOR | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Africa, Eastern | Research Methodology | Behavior | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Measurement
Document Number: 341773

26.

Peer Reviewed

Title: Male circumcision and Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis: observations after a randomised controlled trial for HIV prevention.
Author: Sobngwi-Tambekou J; Taljaard D; Nieuwoudt M; Lissouba P; Puren A; Auvert B
Source: Sexually Transmitted Infections. 2009 Apr;85(2):116-20.
Abstract: OBJECTIVE: To assess the association between male circumcision and Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis using data from a male circumcision randomised controlled trial. METHODS: We used data collected during the male circumcision trial conducted in Orange Farm (South Africa) among men aged 18-24 years. Altogether, 1767 urine samples collected during the final follow-up visit were analysed using PCR. Prevalence of N gonorrhoeae, C trachomatis and T vaginalis was assessed as a function of male circumcision using odds ratios (OR) given by univariate and multivariate logistic regression. RESULTS: In an intention-to-treat analysis, prevalence of N gonorrhoeae, C trachomatis and T vaginalis among intervention and control groups were 10.0% versus 10.3% (OR 0.97; p = 0.84), 2.1% versus 3.6% (OR 0.58; p = 0.065) and 1.7% versus 3.1% (OR 0.54; p = 0.062), respectively. The association between T vaginalis and male circumcision remained borderline when controlling for age, ethnic group, number of lifetime partners, marital status, condom use and HIV status (AOR 0.48; p = 0.069). In the as-treated analysis, this association became significant (OR 0.49, p = 0.030; AOR 0.41, p = 0.030). CONCLUSIONS: This study demonstrates for the first time that male circumcision reduces T vaginalis infection among men. This finding explains why women with circumcised partners are less at risk for T vaginalis infection than other women. The protective effect on T vaginalis is an additional argument to recommend male circumcision in Africa where it is acceptable.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | CONTROL GROUPS | MEN | MALE CIRCUMCISION | GONORRHEA | CHLAMYDIA | TRICHOMONIASIS | PREVALENCE | LABORATORY PROCEDURES | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Measurement | Laboratory Examinations and Diagnoses | Examinations and Diagnoses
Document Number: 341848

27.

Title: HIV-prevention science at a crossroads: advances in reducing sexual risk.
Author: Vermund SH; Allen KL; Karim QA
Source: Current Opinion In HIV and AIDS. 2009 Jul;4(4):266-73.
Abstract: PURPOSE OF REVIEW: We review the current state of evidence-based prevention strategies for reducing sexual transmission of HIV. The combined programmatic and scientific efforts through 2008 to reduce sexual transmission of HIV have failed to reduce substantially the global pandemic. RECENT FINDINGS: Prevention interventions to reduce HIV infection target behavioral, biomedical, and structural risk factors. Some of these prevention strategies have been evaluated in randomized clinical trials (RCTs) with HIV seroincidence endpoints. When RCTs are not feasible, a variety of observational and quasiexperimental research approaches can provide insight as to program effectiveness of specific strategies. Only five RCTs have demonstrated a notable decrease in sexually acquired HIV incidence. These include the Mwanza study of syndromic management of sexually transmitted diseases and three male circumcision trials in East Africa; a microbicide trial reported in 2009 shows substantial promise for the efficacy of PRO 2000 (0.5% gel). SUMMARY: The combined programmatic and scientific efforts to reduce sexual transmission of HIV have made incremental progress. New prevention tools are needed to stem the continued spread of HIV, though microbicides and vaccines will take many more years to develop, test, and deploy. Combination strategies of existing modalities should be tested to evaluate the potential for more proximate prevention benefits.
Language: English
Keywords:
GLOBAL | LITERATURE REVIEW | CLINICAL TRIALS | EPIDEMICS | HIV PREVENTION | SEX BEHAVIOR | SEXUALLY TRANSMITTED DISEASES | PREVENTION AND CONTROL | MICROBICIDES | MALE CIRCUMCISION | ANTIRETROVIRAL THERAPY | VACCINES | BEHAVIOR CHANGE | Clinical Research | Research Methodology | Diseases | HIV Infections | Viral Diseases | Behavior | Reproductive Tract Infections | Infections | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV
Document Number: 342340

28.

Peer Reviewed

Title: Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial.
Author: Wawer MJ; Makumbi F; Kigozi G; Serwadda D; Watya S; Nalugoda F; Buwembo D; Ssempijja V; Kiwanuka N; Moulton LH; Sewankambo NK; Reynolds SJ; Quinn TC; Opendi P; Iga B; Ridzon R; Laeyendecker O; Gray RH
Source: Lancet. 2009 Jul 18;374(9685):229-37.
Abstract: BACKGROUND: Observational studies have reported an association between male circumcision and reduced risk of HIV infection in female partners. We assessed whether circumcision in HIV-infected men would reduce transmission of the virus to female sexual partners. METHODS: 922 uncircumcised, HIV-infected, asymptomatic men aged 15-49 years with CD4-cell counts 350 cells per microL or more were enrolled in this unblinded, randomised controlled trial in Rakai District, Uganda. Men were randomly assigned by computer-generated randomisation sequence to receive immediate circumcision (intervention; n=474) or circumcision delayed for 24 months (control; n=448). HIV-uninfected female partners of the randomised men were concurrently enrolled (intervention, n=93; control, n=70) and followed up at 6, 12, and 24 months, to assess HIV acquisition by male treatment assignment (primary outcome). A modified intention-to-treat (ITT) analysis, which included all concurrently enrolled couples in which the female partner had at least one follow-up visit over 24 months, assessed female HIV acquisition by use of survival analysis and Cox proportional hazards modelling. This trial is registered with ClinicalTrials.gov, number NCT00124878. FINDINGS: The trial was stopped early because of futility. 92 couples in the intervention group and 67 couples in the control group were included in the modified ITT analysis. 17 (18%) women in the intervention group and eight (12%) women in the control group acquired HIV during follow-up (p=0.36). Cumulative probabilities of female HIV infection at 24 months were 21.7% (95% CI 12.7-33.4) in the intervention group and 13.4% (6.7-25.8) in the control group (adjusted hazard ratio 1.49, 95% CI 0.62-3.57; p=0.368). INTERPRETATION: Circumcision of HIV-infected men did not reduce HIV transmission to female partners over 24 months; longer-term effects could not be assessed. Condom use after male circumcision is essential for HIV prevention. FUNDING: Bill & Melinda Gates Foundation with additional laboratory and training support from the National Institutes of Health and the Fogarty International Center.
Language: English
Keywords:
UGANDA | RESEARCH REPORT | CLINICAL TRIALS | CONTROL GROUPS | PERSONS LIVING WITH HIV/AIDS | MEN | SEXUAL PARTNERS | MALE CIRCUMCISION | HIV TRANSMISSION | HIV PREVENTION | SEXUALLY TRANSMITTED DISEASE PREVENTION | VOLUNTARY COUNSELING AND TESTING | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Clinical Research | Research Methodology | HIV Infections | Viral Diseases | Diseases | Demographic Factors | Population | Sex Behavior | Behavior | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses
Document Number: 342223

29.

Title: Can routine neonatal circumcision help prevent human immunodeficiency virus transmission in the United States?
Author: Xu X; Patel DA; Dalton VK; Pearlman MD; Johnson TR
Source: American Journal of Men's Health. 2009 Mar;3(1):79-84.
Abstract: Primary prevention of human immunodeficiency virus (HIV) continues to pose an important challenge in the United States. Recent clinical trials conducted in Kenya, South Africa, and Uganda have demonstrated considerable benefit of male circumcision in reducing HIV seroincidence in males. These results have ignited debate over the appropriateness of implementing routine provision of neonatal circumcision in the United States for HIV prevention. This article discusses major contextual differences between the United States and the three African countries where the clinical trials were conducted, and cautions that the applicability of the scientific data from Africa to this country must be carefully considered before rational policy recommendations regarding routine neonatal circumcision can be made as a strategy to prevent the spread of HIV in the United States.
Language: English
Keywords:
UNITED STATES OF AMERICA | KENYA | SOUTH AFRICA | UGANDA | RESEARCH REPORT | CLINICAL TRIALS | INFANT | MALE CIRCUMCISION | HIV PREVENTION | HIV INFECTIONS | HIV TRANSMISSION | PROGRAM EVALUATION | Developed Countries | North America | Americas | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Africa, Southern | Clinical Research | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Viral Diseases | Diseases | Programs | Organization and Administration
Document Number: 342910

30.

Title: Novel way to 'cut' the risk of HIV transmission.
Source: Expert Review of Medical Devices. 2008 Sep;5(5):549.
Abstract: Adult male circumcision has recently been endorsed as a strategy for HIV prevention and an innovative device is being considered for this purpose. HIV/AIDS continues to spread in sub-Saharan Africa at an epidemic rate and previous studies into the benefit of circumcision within that area were halted when the NIH considered it unethical to withhold the procedure from the men acting as controls. Some communities in Africa link circumcision, or the lack of it, to rites of passage and religious and tribal identity. However, the recent recommendation by the WHO has been accompanied by an increase in men voluntarily seeking the procedure. The current 'free-hand' technique used in Africa takes approximately 20-30 min and requires suturing. Recently, attention has been drawn to a device currently only available in China that may provide a faster and safer alternative. (excerpt)
Language: English
Keywords:
AFRICA, SUB SAHARAN | CRITIQUE | RECOMMENDATIONS | PILOT PROJECTS | MEN | MALE CIRCUMCISION | HIV PREVENTION | TIME FACTORS | PROCEDURES | SURGICAL EQUIPMENT | APPROPRIATE TECHNOLOGY | Africa | Developing Countries | Studies | Research Methodology | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Population Dynamics | Organization and Administration | Equipment and Supplies | Technology | Economic Factors
Document Number: 328821


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