Male Circumcision Promotion Study Among Immigrant Workers In Western China

Objective(1) To evaluate the effect of three modes to promote male circumcision for AIDS prevention for proposing the best mode among immigrant workers in western China with high HIV prevalence.(2) To explore the effect of male circumcision on preventing HIV or syphilis infection;(3) To evaluate the effect on sexual behavior and the safety of male circumcision.Methods(1) A series of media materials including traditional handbook, display panels, Flash animation and scenario educational films were designed in this study. Combining with on-site mission of university student volunteers by their own surgery experience, three intervention modes to promote circumcision for AIDS prevention were established. (2) Immigrant workers were recruited in Guangxi、Chongqing and Xinjiang. Them were divided into three groups in cluster randomization, and were intervened with three modes of male circumcision protected against HIV prevention, respectively. The intervention effect of the modes was assessed through the changing of willingness and circumcision rate. (3) After intervention, the subjects who were willing to accept surgery were circumcised. The subjects were divided into surgery group and the non-surgery group, and were followed up at sixth months and ninth months after baseline, respectively.Results(1) Willingness to circumcision among immigrant workers was 38.1%. The proportion who felt themselves suffering from redundant prepuce or phimosis was 19.2%, and they willingness was 86.6%. (2) 1670 immigrant workers who met the inclusion criteria were recruited. After the intervention, the effects of the three modes were evaluated. It was found that the knowledge of male circumcision were greatly improved (P<0.05). The willingness and operation rate of male circumcision were improved among the three modes. Through comparing with the three modes, there was no significant difference within the willingness of circumcision, but the difference of operation rate was statistically significance(P<0.05), the operation rate of mode 1 was 14.6%, the mode 2 was 9.3%, the mode 3 was 4.9%. (3) Cox proportional hazard regression model analysis found that the mode 1 was better than the mode 3 to improve the operation rate of male circumcision,(RR=2.021,95%Cl:1.303-3.134). But compared the mode 2 with the other two modes have no statistically significance (P>0.05). (4) the intervention cost of mode 1 was the lowest to improve operation rate by cost-effectiveness, and the cost was 753 yuan for each person. (5) The serious complications was low, the rate is less than 5%. The changes of sexual characteristics were little (P>0.05). (6)The HIV incidence were 0/100 person-years and 0.21/100 person-years respectively in the surgery group and the non-surgery group. The syphilis incidence were 0/100 person-years and 0.21/100 person-years respectively in the surgery group and the non-surgery group. There was no significant difference in HIV and syphilis incidence between the two groups.Conclusions(1) In this study, the promotional materials and three kinds of intervention modes to improve the awareness rate of the reasons for male circumcision were developed. Though the cost-effectiveness analysis, The mode 1 costed lowest to intervence one person to perform surgery, and it also was more for improving the rate of circumcision. So the mode 1 was the best mode to promote male circumcision among immigrant workers; (2) Through assessing the standard operating procedures (SOP) of the surgery, the male circumcision is secure. The male circumcision has no significant effect on sexual behavior. (3) The effect of male circumcision on preventing HIV or syphilis infection still need further confirmation among immigrant workers.