Acceptability of Male Circumcision for the Prevention of HIV/AIDS in the Dominican Republic

By PLoS ONE • on October 31, 2009

Background

Male circumcision (MC) is an effective strategy to prevent HIV infection in heterosexual men. To our knowledge, there are no studies of the acceptability of this procedure in the Dominican Republic (DR). The main objective of this study was to assess the acceptability of MC to prevent HIV transmission among men ages 18 to 50 years in the Altagracia Province in the Dominican Republic. Because differences in culture and beliefs between Haitians and Dominicans could potentially influence their acceptability of MC, we conducted a comparative analysis based on national origin.

Methods

A survey was administered to a convenience sample of 368 men. The questionnaire was divided in 3 sections: 1) Background demographics (including national origin), 2) Male circumcision and 3) Sexual health. Stratified and logistic multivariate regression analyses were performed to identify factors associated with the acceptability of MC.

Results

The sample consisted of 238 (65%) Dominicans and 130 (35%) Haitian immigrants. Almost all participants were uncircumcised (95%) and about half (52%) were single. The overall acceptability of MC was 29%. The number of men willing to be circumcised increased to 67% after an information session explaining the benefits of the procedure. 74% of men reported that they would be willing to circumcise their sons after hearing that information. In multivariate analysis, Haitian nationality (OR = 1.86, 95% CI 1.01–3.41), knowing that circumcision improves hygiene (OR = 2.78, 95% CI 1.29–6.0) and not believing that circumcision decreases sexual pleasure (OR = 2.18, 95% CI 1.20–3.94) were associated with a higher acceptability of the procedure. Although age was not significantly associated with the willingness to be circumcised in the multivariate analysis, stratified analysis based on national origin suggested that younger Dominicans (<30 years of age) are more likely to accept the procedure when compared to their older counterparts (OR = 2.17, 95% CI 1.14–4.12).

Conclusions

An important number of sexually active men in the DR may be willing to be circumcised if educational resources detailing the benefits of the procedure are made available. These educational activities would constitute a great opportunity to teach about sexual health and reinforce safe sex practices.

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Acceptability of Male Circumcision for the Prevention of HIV/AIDS in the Dominican Republic
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  • ml66uk
    How about an "information session" explaining the *drawbacks* of the procedure?

    Male circumcision (MC) is NOT an effective strategy to prevent HIV infection in heterosexual men. In Europe, almost no-one circumcises unless they're Muslim or Jewish, and they have significantly lower rates than the USA of almost all STI's including HIV.

    Even in Africa, there are six countries where men are more likely to be HIV+ if they've been circumcised: Cameroon, Ghana, Lesotho, Malawi, Rwanda, and Swaziland. Eg in Malawi, the HIV rate is 13.2% among circumcised men, but only 9.5% among intact men. In Rwanda, the HIV rate is 3.5% among circumcised men, but only 2.1% among intact men. If circumcision really worked against AIDS, this just wouldn't happen. We now have people calling circumcision a "vaccine" or "invisible condom", and viewing circumcision as an alternative to condoms.

    The one study into male-to-female transmission showed a 50% higher rate in the group where the men had been circumcised btw.

    ABC (Abstinence, Being faithful, Condoms) is the way forward. Promoting genital surgery will cost lives, not save them.
  • The whole basis of the claim that "Male circumcision (MC) is an effective strategy to prevent HIV infection in heterosexual men" is clinical trials in three African countries where the HIV rate is higher in circumcised men. 5,400 volunteers were circumcised and a similar number, randomly chosen, left intact. After less than two years, 64 of the circumcised men had HIV and 137 of the control group. That difference - 73 men who might not have got HIV if they had been circumcised - is all there is. Meanwhile 327 of the circumcised men dropped out of the trails, their HIV status unknown. The trial was not double-blinded or placebo controlled, and there have been no field trials. It is, to say the least, premature to start proposing mass circumcision in the Dominican Republic when you don't even know the HIV rate among circumcised and intact men. It could make matters worse, not better.

    "These educational activities would constitute a great opportunity to teach about sexual health and reinforce safe sex practices." And if the HIV rate falls, circumcision will get the credit, but it may be the education and safe sex that does it.
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