Voluntary Medical Male Circumcision: A Cross-Sectional Study Comparing Circumcision Self-Report and Physical Examination Findings in Lesotho.

摘要

Overwhelming evidence including three clinical trials shows that medical male circumcision (MMC) reduces the risk of HIV infection among men. However, data from recent Lesotho Demographic and Health Surveys (LDHSs) do not demonstrate male circumcision (MC) to be protective against HIV. These contradictory findings could partially be due to inaccurate self-reported MC status used to estimate MC prevalence. This study describes MC characteristics among men applying for Lesotho Defence Force (LDF) recruitment and seeks to assess MC self-reported accuracy through comparison with physical examination-based data. Methods and Findings: During LDF applicant screening in 2009, 241 (77%) of 312 men, aged 18 - 25 years, consented to a self-administered demographic and MC characteristic survey and physician-performed genital examination. The extent of foreskin removal was graded on a scale of 1 (no evidence of MC) to 4 (complete MC). MC was self-reported by 27% (n = 64/239) of participants. Of the 64 men self-reporting MC, physical exam showed that 23% had no evidence of circumcision, 27% had partial, and 50% had complete circumcision. Of the MCs reportedly performed by a medical provider, 3% were Grade 1 and 73% were Grade 4. Of the MCs reportedly performed by traditional circumcisers, 41% were Grade 1, while 28% were Grade 4. Among participants self-reporting being circumcised, the odds of MC status misclassification were 7 times higher among those reportedly circumcised by initiation school personnel (odds ratio (OR) = 7.22; 95% confidence interval (CI) = 2.29-22.75). Conclusions: Approximately 27% of participants self-reported being circumcised. However, only 50% had complete MC as determined by a physical exam. Given this low MC self-report accuracy, countries scaling up MMC should obtain physical exam-based MC data to guide service delivery and cost estimates. HIV prevention messages promoting MMC should provide comprehensive education regarding the definition.