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Medical Male Circumcision and Associations Among Sexually Transmitted Infections Service Attendees

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Abstract

Medical male circumcision (MMC) is a proven intervention for preventing HIV acquisition among males. We describe the circumcision status, eligibility for MMC referral and associations with HIV positivity among symptomatic males attending sexually transmitted infections (STI) services. This study was a secondary analysis of cross-sectional data collected during sentinel surveillance for STI aetiologies. In the sentinel surveillance conducted at primary care facilities located in six South African provinces, an anonymous questionnaire was administered followed by collection of appropriate genital and blood specimens for laboratory testing including HIV, rapid plasma reagin (RPR) and HSV-2 serological testing. During analysis, multivariable logistic regression was used to determine association between prevalent HIV infection and male circumcision among males who were HSV-2 AND/OR RPR serology positive and among those who were negative. A total of 847 males were included the analysis, among whom the median age was 28 years (IQR 24–32 years) with 26.3% aged < 25 years. Of these, 166 (19.6%) were medically circumcised, 350 (41.4%) traditionally circumcised while 324 (39%) were not circumcised. The yield of assessment for MMC referral was 27.7%. Overall HIV positivity was 23.1%. Compared to no circumcision, MMC had a statistically insignificant 62% lower odds of being HIV positive –among males who were HSV-2 and RPR negative- adjusted odds ratio [aOR] 0.38 [95% confidence interval (CI) 0.12–1.18], p = 0.094. Among those HSV-2 AND/OR RPR positive, MMC had a statistically insignificant 26% lower odds of being HIV positive- aOR 0.74 (95% CI 0.41–1.36), p = 0.334. In both groups HIV positivity increased with age but was positively associated with condom use at last sexual encounter [aOR 3.41 (95% CI 1.43–8.15)] and previous treatment for an STI syndrome [aOR 3.81 (95% CI 1.60–9.05)] among those HSV-2 and RPR negative. High HIV positivity and high yield of eligibility for VMMC referral among males attending STI services points to the need for better integration of HIV prevention and treatment with STI care.

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References

  1. Reed JB, Patel RR, Baggaley R. Lessons from a decade of voluntary medical male circumcision implementation and their application to HIV pre-exposure prophylaxis scale up. Int J STD & AIDS. 2018;16:956462418787896.

    Google Scholar 

  2. Njeuhmeli E, Forsythe S, Reed J, Opuni M, Bollinger L, Heard N, et al. Voluntary medical male circumcision: modeling the impact and cost of expanding male circumcision for HIV prevention in eastern and southern Africa. PLoS Med. 2011;8(11):1567.

    Article  Google Scholar 

  3. Sharma SC, Raison N, Khan S, Shabbir M, Dasgupta P, Ahmed K. Male circumcision for the prevention of human immunodeficiency virus (HIV) acquisition: a meta-analysis. BJU Int. 2018;121(4):515–26.

    Article  Google Scholar 

  4. Rasheed Z. Male circumcision and human immunodeficiency virus infection: an update on randomized controlled trials and molecular evidences. Int J Health Sci. 2018;12(1):1–3.

    Google Scholar 

  5. Mills E, Cooper C, Anema A, Guyatt G. Male circumcision for the prevention of heterosexually acquired HIV infection: a meta-analysis of randomized trials involving 11,050 men. HIV Med. 2008;9(6):332–5.

    Article  CAS  Google Scholar 

  6. Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med. 2005;2(11):e298.

    Article  Google Scholar 

  7. Bailey RC, Moses S, Parker CB, Agot K, Maclean I, Krieger JN, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet. 2007;369(9562):643–56.

    Article  Google Scholar 

  8. Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S, Nalugoda F, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007;369(9562):657–66.

    Article  Google Scholar 

  9. Tobian AA, Serwadda D, Quinn TC, Kigozi G, Gravitt PE, Laeyendecker O, et al. Male circumcision for the prevention of HSV-2 and HPV infections and syphilis. N Engl J Med. 2009;360(13):1298–309.

    Article  CAS  Google Scholar 

  10. Pintye J, Baeten JM, Manhart LE, Celum C, Ronald A, Mugo N, et al. Association between male circumcision and incidence of syphilis in men and women: a prospective study in HIV-1 serodiscordant heterosexual African couples. Lancet Glob Health. 2014;2(11):e664–71.

    Article  Google Scholar 

  11. Auvert B, Sobngwi-Tambekou J, Cutler E, Nieuwoudt M, Lissouba P, Puren A, et al. Effect of male circumcision on the prevalence of high-risk human papillomavirus in young men: results of a randomized controlled trial conducted in Orange Farm, South Africa. J Infect Dis. 2009;199(1):14–9.

    Article  Google Scholar 

  12. Larke N, Thomas SL, Dos Santos Silva I, Weiss HA. Male circumcision and human papillomavirus infection in men: a systematic review and meta-analysis. J Infect Dis. 2011;204(9):1375–90.

    Article  Google Scholar 

  13. Mehta SD, Moses S, Agot K, Maclean I, Odoyo-June E, Li H, et al. Medical male circumcision and herpes simplex virus 2 acquisition: posttrial surveillance in Kisumu, Kenya. J Infect Dis. 2013;208(11):1869–76.

    Article  Google Scholar 

  14. Mehta SD, Moses S, Parker CB, Agot K, Maclean I, Bailey RC. Circumcision status and incident herpes simplex virus type 2 infection, genital ulcer disease, and HIV infection. AIDS. 2012;26(9):1141–9.

    Article  Google Scholar 

  15. Davis S, Toledo C, Lewis L, Maughan-Brown B, Ayalew K, Kharsany ABM. Does voluntary medical male circumcision protect against sexually transmitted infections among men and women in real-world scale-up settings? Findings of a household survey in KwaZulu-Natal, South Africa. BMJ Glob Health. 2019;4(3):e001389.

    Article  Google Scholar 

  16. Pintye J, Baeten JM, Manhart LE, Celum C, Ronald A, Mugo N, et al. Association between male circumcision and incidence of syphilis in men and women: a prospective study in HIV-1 serodiscordant heterosexual African couples. Lancet Glob Health. 2014;2(11):e664–71.

    Article  Google Scholar 

  17. Grund JM, Bryant TS, Jackson I, Curran K, Bock N, Toledo C, et al. Association between male circumcision and women’s biomedical health outcomes: a systematic review. Lancet Glob Health. 2017;5(11):e1113–22.

    Article  Google Scholar 

  18. Tobian AAR, Gaydos C, Gray RH, Kigozi G, Serwadda D, Quinn N, et al. Male circumcision and Mycoplasma genitalium infection in female partners: a randomised trial in Rakai, Uganda. Sex Transm Infect. 2014;90(2):150–4.

    Article  Google Scholar 

  19. Morris BJ, Hankins CA, Tobian AA, Krieger JN, Klausner JD. Does male circumcision protect against sexually transmitted infections? Arguments and meta-analyses to the contrary fail to withstand scrutiny. ISRN Urol. 2014;13(2014):684706.

    Google Scholar 

  20. Davis SM, Hines JZ, Habel M, Grund JM, Ridzon R, Baack B, et al. Progress in voluntary medical male circumcision for HIV prevention supported by the US President’s Emergency Plan for AIDS Relief through 2017: longitudinal and recent cross-sectional programme data. BMJ Open. 2018;8(8):e021835.

    Article  Google Scholar 

  21. UNAIDS. Joint strategic action framework to accelerate the scale-up of voluntary medical male circumcision for HIV prevention in Eastern and Southern Africa, 2012–2016. Geneva: WHO; 2012.

    Google Scholar 

  22. World Health Organisation. A framework for voluntary medical male circumcision: effective HIV prevention and a gateway to improved adolescent boys’ & men’s health in Eastern and Southern Africa by 2021. Geneva: WHO; 2016.

    Google Scholar 

  23. South African National AIDS Council. Enhanced progress report: National Strategic Plan on HIV, STIs and TB (2011–2016). Hatfield: South African National AIDS Council; 2012.

    Google Scholar 

  24. Marshall E, Rain-Taljaard R, Tsepe M, Monkwe C, Hlatswayo F, Tshabalala S, et al. Sequential cross-sectional surveys in orange farm, a township of South Africa, revealed a constant low voluntary medical male circumcision uptake among adults despite demand creation campaigns and high acceptability. PLoS ONE. 2016;11(7):e0158675.

    Article  Google Scholar 

  25. Marshall E, Rain-Taljaard R, Tsepe M, Monkwe C, Taljaard D, Hlatswayo F, et al. Obtaining a male circumcision prevalence rate of 80% among adults in a short time: an observational prospective intervention study in the orange farm township of South Africa. Medicine. 2017;96(4):e5328.

    Article  Google Scholar 

  26. Ortblad KF, Barnighausen T, Chimbindi N, Masters SH, Salomon JA, Harling G. Predictors of male circumcision incidence in a traditionally non-circumcising South African population-based cohort. PLoS ONE. 2018;13(12):e0209172.

    Article  Google Scholar 

  27. World Health Organization. Republic of South Africa. National Department of Health. Sexually transmitted infections management guidelines. Geneva: WHO; 2015.

    Google Scholar 

  28. Kohler PK, Marumo E, Jed SL, Mema G, Galagan S, Tapia K, et al. A national evaluation using standardised patient actors to assess STI services in public sector clinical sentinel surveillance facilities in South Africa. Sex Transm Infect. 2017;93(4):247–52.

    Article  Google Scholar 

  29. Sobngwi-Tambekou J, Taljaard D, Lissouba P, Zarca K, Puren A, Lagarde E, et al. Effect of HSV-2 serostatus on acquisition of HIV by young men: results of a longitudinal study in Orange Farm, South Africa. J Infect Dis. 2009;199(7):958–64.

    Article  Google Scholar 

  30. Gray RH, Serwadda D, Tobian AA, Chen MZ, Makumbi F, Suntoke T, et al. Effects of genital ulcer disease and herpes simplex virus type 2 on the efficacy of male circumcision for HIV prevention: Analyses from the Rakai trials. PLoS Med. 2009;6(11):e1000187.

    Article  Google Scholar 

  31. Kufa T, Maseko VD, Nhlapo D, Radebe F, Puren A, Kularatne RS. Knowledge of HIV status and antiretroviral therapy use among sexually transmitted infections service attendees and the case for improving the integration of services in South Africa: a cross sectional study. Medicine. 2018;97(39):e12575.

    Article  Google Scholar 

  32. Human Sciences Research Council (2018) The fifth South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, 2017- HIV Impact Assessment Summary. Pretoria

  33. Kularatne RS, Muller EE, Maseko DV, Kufa-Chakezha T, Lewis DA. Trends in the relative prevalence of genital ulcer disease pathogens and association with HIV infection in Johannesburg, South Africa, 2007–2015. PLoS ONE. 2018;13(4):e0194125.

    Article  Google Scholar 

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Acknowledgements

The authors would like to acknowledge Dr Vanessa Quan and Dr Linda Erasmus from the NICD GERMS team for operational support during fieldwork, surveillance officers Ms. Valencia Kekana, Mr. Alex Vezi, Ms. Thembisa Makaleng, Ms. Bulele Makaleni, Ms. Badikazi Matiwane and Ms. Khasi Mawasha for data collection, Ms Thabitha Mathega and Ms. Gloria De Gita for data entry and management.

Funding

The surveillance activities during which the data were collected and the secondary data analysis described in the manuscript were funded by the National Department of Health in South Africa through core funding to National Institute for Communicable Diseases (NICD). The funder had no role in the design of the study, data collection, data analysis or interpretation. All authors have no conflict of interests to declare.

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Authors and Affiliations

  1. Centre for HIV and STIs, National Institute for Communicable Diseases, 1 Modderfontein Road, Sandringham, Johannesburg, South Africa

    Tendesayi Kufa, Frans Radebe, Venessa Maseko, Adrian Puren & Ranmini Kularatne

  2. School of Public Health, University of the Witwatersrand, Johannesburg, South Africa

    Tendesayi Kufa

  3. Department of Virology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Adrian Puren

  4. Department of Clinical Microbiology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Ranmini Kularatne

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  1. Tendesayi Kufa
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Correspondence to Tendesayi Kufa.

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Kufa, T., Radebe, F., Maseko, V. et al. Medical Male Circumcision and Associations Among Sexually Transmitted Infections Service Attendees. AIDS Behav 24, 1422–1431 (2020). https://doi.org/10.1007/s10461-019-02729-9

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