Male circumcision for HIV prevention: a prospective study of complications in clinical and traditional settings in Bungoma, Kenya
- 1 September 2008
- journal article
- Published by WHO Press
- Vol. 86 (9), 669-677
- https://doi.org/10.2471/blt.08.051482
Abstract
Male circumcision reduces the risk of HIV acquisition by approximately 60%. Male circumcision services are now being introduced in selected populations in sub-Saharan Africa and further interventions are being planned. A serious concern is whether male circumcision can be provided safely to large numbers of adult males in developing countries. This prospective study was conducted in the Bungoma district, Kenya, where male circumcision is universally practised. Young males intending to undergo traditional or clinical circumcision were identified by a two-stage cluster sampling method. During the July-August 2004 circumcision season, 1007 males were interviewed 30-89 days post- circumcision. Twenty-four men were directly observed during and 3, 8, 30 and 90 days post-circumcision, and 298 men underwent clinical exams 45-89 days post-procedure. Twenty-one traditional and 20 clinical practitioners were interviewed to assess their experience and training. Inventories of health facilities were taken to assess the condition of instruments and supplies necessary for performing safe circumcisions. Of 443 males circumcised traditionally, 156 (35.2%) experienced an adverse event compared with 99 of 559 (17.7%) circumcised clinically (odds ratio: 2.53; 95% confidence interval: 1.89-3.38). Bleeding and infection were the most common adverse effects, with excessive pain, lacerations, torsion and erectile dysfunction also observed. Participants were aged 5 to 21 years and half were sexually active before circumcision. Practitioners lacked knowledge and training. Proper instruments and supplies were lacking at most health facilities. Extensive training and resources will be necessary in sub-Saharan Africa before male circumcision can be aggressively promoted for HIV prevention. Two-thirds of African men are circumcised, most by traditional or unqualified practitioners in informal settings. Safety of circumcision in communities where it is already widely practised must not be ignored.Keywords
This publication has 24 references indexed in Scilit:
- Potential HIV-1 target cells in the human penisAIDS, 2006
- HIV-1 target cells in foreskins of African men with varying histories of sexually transmitted infections.2006
- Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 TrialPLoS Medicine, 2005
- Adult male circumcision: results of a standardized procedure in Kisumu District, KenyaBJU International, 2005
- Newborn circumcision using the Plastibell device: an audit of practice.2004
- A review on male circumcision procedures among South African blacks.1997
- Significantly increased complication risks with mass circumcisionsBritish Journal of Urology, 1997
- Botched circumcisions lead to arrest for murderBMJ, 1996
- Ritual Circumcision (Umkhwetha) amongst the Xhosa of the CiskeiBritish Journal of Urology, 1990
- Circumcision: Its nature and practice among some ethnic groups in Southern NigeriaSocial Science & Medicine, 1985