RESUMEN
BACKGROUND: Male circumcision is known to reduce the risk of acquiring HIV, but few studies have been performed to assess its acceptability among either children or adults in sub-Saharan Africa. METHODS: We conducted a cross sectional survey in nine geographically representative locations in Botswana to determine the acceptability of male circumcision in the country, as well as the preferred age and setting for male circumcision. Interviews were conducted using standardised questionnaires both before and after an informational session outlining the risks and benefits of male circumcision. RESULTS: Among 605 people surveyed, the median age was 29 years (range 18-74 years), 52% were male, and >15 ethnicities were represented. Before the informational session, 408 (68%) responded that they would definitely or probably circumcise a male child if circumcision was offered free of charge in a hospital setting; this number increased to 542 (89%) after the informational session. Among 238 uncircumcised men, 145 (61%) stated that they would definitely or probably get circumcised themselves if it were offered free of charge in a hospital setting; this increased to 192 (81%) after the informational session. In a multivariate analysis of all participants, people with children were more likely to favour circumcision than people without children (adjusted odds ratio 1.8, 95% CI 1.0 to 3.4). Most participants (55%) felt that the ideal age for circumcision is before 6 years, and 90% of participants felt that circumcision should be performed in the hospital setting. CONCLUSIONS: Male circumcision appears to be highly acceptable in Botswana. The option for safe circumcision should be made available to parents in Botswana for their male children. Circumcision might also be an acceptable option for adults and adolescents, if its efficacy as an HIV prevention strategy among sexually active people is supported by clinical trials.
Asunto(s)
Circuncisión Masculina , Infecciones por VIH/prevención & control , Adolescente , Adulto , Anciano , Botswana/epidemiología , Control de Enfermedades Transmisibles/organización & administración , Estudios Transversales , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Salud Rural , Salud UrbanaRESUMEN
PIP: The high rate of human immunodeficiency virus (HIV) infection among young women in Botswana reflects, in part, Setswanese cultural norms that permit older men to have sex with young girls or virgins. There is a belief that sex with a preadolescent girl will cleanse or rejuvenate an older man. Young girls, raised to respect and never question their elders, have little power to refuse these advances or insist on condom use. As a result of this practice, females in Botswana are becoming infected with HIV at a significantly younger age than men. Other factors contributing to female HIV infection include men's involvement with multiple sex partners and the large number of female-headed households created by abandonment of pregnant women. To provide for their children, many of these women engage in sex for money, and the rate of pay is higher when condoms are not required. To reduce women's vulnerability to HIV, efforts are being made to encourage parents to discuss sexuality with their children and to amend the marriage law to protect wives who do not want to have sex with husbands known to have engaged in high-risk extramarital behaviors.^ieng