The protection circumcision provides against HIV will be a
major motivation for South Africans to seek the procedure, a study published in Health Policy and Planning
suggests. Study participants
were generally “repulsed” by the suggestion that circumcision would provide an
alternative to consistent condom use. However, individuals of white race found
this suggestion attractive.
“Our study…shows that demand for circumcision is largely
determined by the perceived benefits of reduced HIV/STI transmission,” comment
the investigators. They add, “condom avoidance is not perceived as a benefit of
Three randomised controlled trials have shown that
circumcised men have a low risk of infection with HIV than uncircumcised men.
The World Health Organization (WHO) recommends that male circumcision
programmes should form part of comprehensive HIV prevention strategies in high
Kenya has rolled out a national circumcision programme.
However, despite having a high HIV incidence, South Africa has yet to adopt a
policy of promoting male circumcision. This is partly because of concern that
the promotion of circumcision could undermine other HIV prevention efforts,
especially consistent condom use.
A team of investigators from South Africa and the US wanted
to see which factors would motivate individuals to seek circumcision, and if
there was a perception that circumcision would mean that men would not need to
The study was conducted in Johannesburg and involved
individuals from the main racial groups: black, coloured and white.
Its population included “decision makers” about
circumcision: 403 mothers and fathers. It also included 237 sons aged between
14 and 30 who were uncircumcised. Of the 201 fathers who completed the study,
94 were circumcised. This included 40% of black participants, 33% of coloured
fathers and 21% of whites.
Participants were interviewed to see what would motivate
them to seek circumcision, and if circumcision would lead to condom avoidance.
Factors that would motivate individuals to seek circumcision
Reduced risk of infection with HIV (p<
Reduced risk of sexually transmitted infections
(p < 0.001)
Hygiene (p < 0.05)
Improved sexual performance (p < 0.05).
Significant racial differences were apparent. Coloured
participants were the only group who identified a reduced risk of cervical
cancer in sex partners as a motivation for circumcision. Black participants
were the only group who focused on the reduced risk of sexually transmitted
In addition, the reasons why fathers would be motivated to
seek circumcision for their sons varied according to their own circumcision
status. Circumcised fathers would
seek circumcision for their sons because they believed it would provide
protection against sexually transmitted infections (p = 0.02) and HIV (p <
0.001). Uncircumcised fathers did not have these motivations.
Similarly, circumcised fathers would be motivated to have
their sons circumcised because of its perceived hygienic benefits (p = 0.05),
but uncircumcised fathers did not find this an attractive benefit of the
Overall, the suggestion that circumcision would reduce the
need for condoms was rejected.
But racial differences were apparent. Black and coloured
participants were strongly repulsed (p < 0.001) by this suggestion. However,
white respondents found it attractive (p = 0.04).
Sons aged under 18 found the suggestion that circumcision
reduced the need to use condoms somewhat attractive, but not significantly so
(p = 0.15).
“We conclude that the implementation of a national male
circumcision programme in South Africa should not be delayed over concerns
about its potential impact on condom avoidance,” write the researchers.
However, they stress that any such programme must “take into
account that whites may value circumcision as a means to avoid subsequent