Knowledge, Attitudes, Practices, and Acceptability of Medical Male Circumcision among Males in Traditionally Circumcising Rural Communities of Alfred Nzo District, Eastern Cape, South Africa

Abstract

Male circumcision (MC) reduces HIV transmission risk by up to 60% in heterosexual men. However, uptake of medical male circumcision (MMC) is low in traditionally circumcising communities of South Africa. We assessed knowledge, attitudes, and practices to identify factors predicting acceptability of MMC among males in the Alfred Nzo District. A cross-sectional study was conducted among males aged 15–49 years in this district. Logistic regression was used to identify factors predicting acceptability of MMC. We interviewed 343 males who had a median age of 19 years (interquartile range (IQR): 16–25 years). Of these, 77% (95% confidence interval (CI): 72–82) were circumcised: 77% (95% CI: 71–82) were circumcised in a traditional setting and 21% (95% CI: 16–26) in a medical setting. The median score of knowledge about the benefits of MMC was 62.5% (IQR: 37.5–75.0), with 59% (95% CI: 53–64) demonstrating a positive attitude towards MMC and 68% (95% CI: 63–73) accepting involvement of health workers in MC. Excellent knowledge (adjusted odds ratio (aOR): 3.07, 95% CI: 0.99–9.58, p = 0.053), awareness (aOR: 3.26, 95% CI: 1.08–9.86, p = 0.037), and positive attitude towards MMC (aOR: 2.35, 95% CI: 1.30–4.25, p = 0.005) were associated with acceptability of MMC. Participants demonstrated good knowledge and acceptance of the MMC programme. Knowledge, attitude, and awareness were significant predictors of MMC acceptability.