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Complications after male circumcision for HIV prevention, Kenya.

Male circumcision services are now being introduced in selected populations in sub-Saharan Africa. This prospective study identified, using a two-stage cluster sampling method, young men intending to undergo traditional or clinical circumcision in Bungoma district, Kenya, where male circumcision is universally practised. During the July-August 2004 circumcision season, 1,007 men were interviewed 1-3 months post-circumcision, 24 men were directly observed during the procedure and 3, 8, 30 and 90 days post-circumcision, and 298 underwent clinical examination 45-89 days post-procedure. 21 traditional and 20 clinical practitioners were interviewed, and inventories of health facilities were taken to assess the condition of instruments and supplies.

The prevalence of adverse events observed was of an order of magnitude higher than clinical circumcision performed on infants in developed countries and much higher than the 1.7% rate in the randomised trial of male circumcision in Kisumu, Kenya. Of 443 men circumcised traditionally, 156 (35.2%) experienced an adverse event compared with 99 of 559 (17.7%) circumcised clinically (OR 2.53; 95% CI, 1.89-3.38). Bleeding and infection were the most common adverse effects, with excessive pain, lacerations, torsion and erectile dysfunction also observed. Participants were aged 5-21 years and half were sexually active before circumcision. Practitioners lacked knowledge and training. Proper instruments and supplies were lacking at most health facilities. Extensive training and resources will be necessary in sub-Saharan Africa before male circumcision can be aggressively promoted for HIV prevention. Two-thirds of African men are circumcised, most by traditional or unqualified practitioners. Safety of circumcision in communities where it is already widely practised must not be ignored. (1)

(1.) Bailey RC, Egesah O, Rosenberg S. Male circumcision for HIV prevention: a prospective study of complications in clinical and traditional settings in Bungoma, Kenya. Bulletin of World Health Organization 2008;86(9):669-77.

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Title Annotation:ROUND UP: HIV/AIDS
Publication:Reproductive Health Matters
Article Type:Report
Geographic Code:60SUB
Date:Nov 1, 2009
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