Acceptability of Male Circumcision for the Prevention of HIV Among High-Risk Heterosexual Men in Thailand

Tieu, Hong-Van; Phanuphak, Nittaya; Ananworanich, Jintanat; Vatanparast, Rana; Jadwattanakul, Tanate; Pharachetsakul, Nutthasun; Mingkwanrungrueng, Pravit; Buajoom, Raksakul; Teeratakulpisarn, Somsong; Teeratakulpisarn, Nipat; Methajittiphun, Pornpen; Hammer, Scott M.; Chiasson, Mary Ann; Phanuphak, Praphan

doi:10.1097/olq.0b013e3181c9963a

Cited by 26 publications

(22 citation statements)

References 7 publications

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“…However, on the basis of the RCTs and the Cochrane review, researchers are now raising the possibility of incorporating male circumcision into HIV prevention initiatives in regions such as Papua New Guinea (Hill et al, 2012;Kelly et al, 2012), the Dominican Republic (Brito, Caso, Balbuena, & Bailey, 2009), the Caribbean (Duncan, 2010) and Thailand (Tieu et al, 2010). Although the rise of EBM enabled the 'male circumcision effect' to be taken as given, can we assume that the operation would have the same effect globally?…”

Section: Debating the Evidencementioning

confidence: 98%

HIV prevention: Making male circumcision the ‘right’ tool for the job

Bell

2014

Global Public Health

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In recent years, HIV/AIDS programming has been transformed by an ostensibly 'new' procedure: male circumcision. This article examines the rise of male circumcision as the 'right' HIV prevention tool. Treating this controversial topic as a 'matter of concern' rather than a 'matter of fact', I examine the reasons why male circumcision came to be seen as a partial solution to the problem of HIV transmission in the twenty-first century and to what effect. Grounded in a close reading of the primary literature, I suggest that the embrace of male circumcision in HIV prevention must be understood in relation to three factors: (1) the rise of evidence-based medicine as the dominant paradigm for conceptualising medical knowledge, (2) the fraught politics of HIV/AIDS research and funding, which made the possibility of a biomedical intervention attractive and (3) underlying assumptions about the nature of African 'culture' and 'sexuality'. I conclude by stressing the need to expand the parameters of the debate beyond the current polarised landscape, which presents us with a problematic either/or scenario regarding the efficacy of male circumcision.

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Section: Debating the Evidencementioning

confidence: 98%

HIV prevention: Making male circumcision the ‘right’ tool for the job

Bell

2014

Global Public Health

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“…While the prevalence of MC worldwide is almost 30%, only 5% of Chinese males are circumcised [12]. While the acceptability of MC has been studied in men and women in sub-Saharan Africa [13], [14], the United States [15], and Thailand [16], no population-level studies, with large sample size, prior to ours have been conducted in China, especially targeting general population. An earlier study assessed MC acceptability among MSM [17], which reported very low level of MC acceptability (16.9% would absolutely willing to participate and 26.4% would probably participate).…”

Section: Introductionmentioning

confidence: 99%

Factors Influencing Chinese Male's Willingness to Undergo Circumcision: A Cross-Sectional Study in Western China

et al. 2012

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BackgroundMale circumcision (MC) has been shown to reduce the risk of female to male transmission of HIV. The goal of this survey was to explore the acceptability of MC among the Chinese and to identify factors associated with circumcision preference.MethodsA cross-sectional survey was conducted between September 2009 and December 2010. We interviewed 2,219 male community participants, from three high HIV prevalence provinces in western China. A structured questionnaire was used to collect data on MC knowledge, willingness to accept MC, reasons to accept or refuse MC, and sexual behaviors and health. For those who refused MC, a health education intervention providing information on the benefits of circumcision was conducted. We used multiple logistic regression models to identify factors associated with the acceptability of MC.ResultsOf the respondents (n = 2,219), 44.6% (989/2,219) reported they would accept MC for the following reasons: promotion of female partners' hygiene (60.3%), redundant foreskin (59.4%), prevention of penile cancer (50.2%), enhanced sexual pleasure (41.4%), and protection against HIV and STDs (34.2%). The multivariable logistic regression showed that five factors were associated with MC willingness: long foreskin (OR = 15.98), residing in Xinjiang province (OR = 3.69), being younger than 25 (OR = 1.60), knowing hazards of redundant foreskin (OR = 1.78), and having a friend who underwent circumcision (OR = 1.36).ConclusionThe acceptability of male circumcision was high among the general population in China. Our study elucidates the factors associated with circumcision preference and suggests that more health education campaigns about positive health effects are necessary to increase the MC rate in China.

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“…182,183 Although a recent study in India suggests that circumcised MSM who predominantly take the receptive role in anal intercourse may be at a lower risk of HIV infection, 184 evidence that circumcision reduces HIV among MSM remains weak and inconsistent. 185,186 Despite the willingness to undergo circumcision among MSM populations, 187,188 male circumcision is not promoted as a priority in Asian countries with concentrated epidemics and has not been recommended for MSM unless they also engage in vaginal sex. 148 It is therefore unlikely that male circumcision will significantly contribute to reducing the HIV incidence among MSM populations.…”

Section: Implications For Hiv Prevention Trialsmentioning

confidence: 99%

HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials

Phanuphak

Shao³

et al. 2015

AIDS Research and Human Retroviruses

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An overall decrease of HIV prevalence is now observed in several key Asian countries due to effective prevention programs. The decrease in HIV prevalence and incidence may further improve with the scale-up of combination prevention interventions. The implementation of future prevention trials then faces important challenges. The opportunity to identify heterosexual populations at high risk such as female sex workers may rapidly wane. With unabating HIV epidemics among men who have sex with men (MSM) and transgender (TG) populations, an effective vaccine would likely be the only option to turn the epidemic. It is more likely that efficacy trials will occur among MSM and TG because their higher HIV incidence permits smaller and less costly trials. The constantly evolving patterns of HIV-1 diversity in the region suggest close monitoring of the molecular HIV epidemic in potential target populations for HIV vaccine efficacy trials. CRF01_AE remains predominant in southeast Asian countries and MSM populations in China. This relatively steady pattern is conducive to regional efficacy trials, and as efficacy warrants, to regional licensure. While vaccines inducing nonneutralizing antibodies have promise against HIV acquisition, vaccines designed to induce broadly neutralizing antibodies and cell-mediated immune responses of greater breadth and depth in the mucosal compartments should be considered for testing in MSM and TG. The rationale and design of efficacy trials of combination prevention modalities such as HIV vaccine and preexposure prophylaxis (PrEP) remain hypothetical, require high adherence to PrEP, are more costly, and present new regulatory challenges. The prioritization of prevention interventions should be driven by the HIV epidemic and decided by the country-specific health and regulatory authorities. Modeling the impact and cost-benefit may help this decision process.

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Acceptability of Male Circumcision for the Prevention of HIV Among High-Risk Heterosexual Men in Thailand

Cited by 26 publications

References 7 publications

HIV prevention: Making male circumcision the ‘right’ tool for the job

HIV prevention: Making male circumcision the ‘right’ tool for the job

Factors Influencing Chinese Male's Willingness to Undergo Circumcision: A Cross-Sectional Study in Western China

HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials

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