Gasasira et al. BMC Public Health 2012, 12:134 http://www.biomedcentral.com/1471-2458/12/134 R E S E A R C H A R T I C L E Open Access Determinants of circumcision and willingness to be circumcised by Rwandan men, 2010 Rwego A Gasasira1*†, Malabika Sarker1†, Landry Tsague2, Sabin Nsanzimana3, Aimée Gwiza3, Jennifer Mbabazi3, Corine Karema3, Anita Asiimwe3 and Placidie Mugwaneza3 Abstract Background: Male Circumcision (MC) has been recommended as one of the preventive measures against sexual HIV transmission by the World Health Organization (WHO). Rwanda has adopted MC as recommended but the country is a non-traditionally circumcising society. The objective was to explore knowledge and perception of Rwandan men on Male Circumcision (MC) and to determine the factors associated with the willingness to be circumcised and to circumcise their sons. Methods: This cross sectional study was conducted in 29 districts of Rwanda between January and March 2010. Data were collected using a structured questionnaire among men aged 15-59 years. The rate of MC was measured and its perception from respondents, and then the factors associated with the willingness to go for MC were analysed using multiple logistic regressions. Results: A total of 1098 men were interviewed. Among respondents 17% (95% CI 14-19%) reported being circumcised. About three-quarter (72%) could define MC, but 37% of adolescent could not. Half of the participants were willing to get circumcised and 79% of men would accept circumcision for their sons. The main motivators for MC were its benefits in HIV/STI prevention (69%) and improving hygiene (49%). Being too old was the main reason (32%) reported by men reluctant to undergo MC and younger men were afraid of pain in particular those less than 19 years old (42%). The willingness to circumcise was significantly associated with younger age, living in the Eastern Province, marital status, and the knowledge of the preventive role of circumcision. Conclusions: Adolescents and young adults were more willing to be circumcised. It is critical to ensure the availability of pain free services in order to satisfy the increasing demand for the scale up of MC in Rwanda. Keywords: Male Circumcision, HIV/AIDS, HIV Prevention, Rwanda Background Male Circumcision (MC) has been recommended as one of the preventive measures against sexual HIV transmis- sion in 2007 by the World Health Organization (WHO) and UNAIDS [1]. Three Randomized Controlled Trials (RCT) conducted in South Africa, Uganda and Kenya, strongly supported the efficacy of MC at reducing the risk of HIV transmission from infected women to cir- cumcised men, by approximately 60% [2-5]. Studies also reported a substantially reduced risk of other Sexually Transmitted Infections (STIs) such as syphilis, chancroid, * Correspondence: rwegoa@gmail.com † Contributed equally 1Institute of Public Health, University of Heidelberg, Heidelberg, Germany Full list of author information is available at the end of the article and Herpes Simplex-2 (HSV) in circumcised men [6]. The MC procedure is cost effective particularly in adoles- cent and infant MC [7]. WHO has advocated countries with a generalized HIV epidemic and with a male cir- cumcision rate below 20% to adopting extensively MC for the benefit of the whole population [1]. A recent review from 13 African countries reported that on average 65% of uncircumcised men were willing to get circumcised and 71% were willing to have a son circumcised, although MC was not a common practice in these communities [8]. Higher odds of being circum- cised among adults were associated with improved hygiene and a reduced risk of STIs. Male circumcision is associated with four major determinants classified as: Religious, Cultural, Social and Medical [1]. Rwanda © 2012 Gasasira et al; BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.