Gasasira et al. BMC Public Health 2012, 12:134 http://www.biomedcentral.com/1471-2458/12/134 being a non-traditionally circumcising society, circumci- sion is most commonly viewed as a Muslim practice [9]. Rwanda has a generalized HIV epidemic, with 3% HIV prevalence in the general population, yet prevalence of MC among men aged 15-59 years was estimated at 9% in 2005 and 12% in 2008 [9,10]. Unlike Muslims who practice MC (with MC prevalence of 82.4%) [9] as part of religious ritual, the majority of Rwandan who are Christian (93%) does not traditionally practice MC (the prevalence is 9.7% in Catholics, 11.4% in protestants and 12% in Adventists) [9]. In late 2007, the government of Rwanda endorsed MC as an additional preventive method as part of the national strategy to halving the incidence of HIV in the general population by 2012 [11]. Yet, there is knowledge gap with regard to the per- ception and willingness to undergo male circumcision among Rwandan non circumcised adults and their male children. This study aimed at filling this gap, and findings will contribute to the development of evidence-based policy and strategies for implementing MC for HIV prevention in Rwanda. The analysis focused on how uncircumcised young men perceived MC compared to older men and the factors influencing their willingness to go for circumcision. Methods The analysis used data from a nationwide survey on knowledge, attitudes and practices regarding MC in gen- eral population (MC-KAP) conducted in Rwanda between January and March 2010 by the Center for Treatment and Research on AIDS, Malaria, Tuberculosis and other Epi- demics (TRAC Plus)/Rwanda Ministry of Health. The MC-KAP survey included both men and women aged 15- 59 for men and 15-49 for women. The main objective of MC KAP survey was to serve as a situational analysis, and guide medium and long term strategic program planning using MC as a preventive method for HIV. Sampling The MC KAP surveyed a nationally representative sam- ple of 1452 households selected through a two-stage cluster. The sample was first stratified in order to ensure a good representation of all 5 provinces (City of Kigali, Southern, Western, Northern and Eastern Provinces) and all 30 districts of the country. The primary sampling units (PSUs) were the villages called “imidugudu” and the second stage included the households. The selection of PSUs was based on the existing list of villages and households, which was constructed based on the updated list of enumeration areas covered in 2002 Gen- eral Population and Housing Census (RGPH) prepared by the National Institute of Statistics of Rwanda (NISR) [12] (Figure 1). Page 2 of 8 A systematic probability proportional to size (PPS) sampling method was used to select the PSU in each district. Due to the sampling oversight, the district of Nyanza was not selected, bringing the number of dis- tricts covered by the survey to 29. In total, 279 PSUs were selected for the data collection (18% in urban area and 82% in rural area). Within each selected village, households were selected with a probability proportional to the size of the village from the existing list of house- holds used during the malaria indicator survey carried out in 2007 and 2008 in Rwanda along with the interim demographic health survey [9]. Within each selected household, all males aged 15-59 years who consented and had spent the last night in the household were eligi- ble for the study. Assuming that each household had at least one eligible adult male, the estimated number of participants was estimated at 1,452. Data collection and data entry The study questionnaire was developed in English and then translated into Kinyarwanda, (the national language in Rwanda) and pre-tested. Study interviewers were selected and trained during one day on questionnaire administration and other study procedures. All partici- pants were asked to provide signed informed consent prior to interview. All data were double entered in the statistical package Epi Info™ Version 6.04 and comparison was done and any discrepancies verified. Data analysis The analysis focused on the subset of male who partici- pated in the MC KAP survey, to measure the rate of MC in the Rwandan male population who do not tradi- tionally practice MC. The three main outcome variables were: 1) Circumcision status (“Are you circumcised yourself?”); 2) Willingness to be circumcised ("Would you consider being circumcised?”), and 3) Willingness to have one’s son circumcised (“If you have a son, would you circumcise him?”). Univariate analysis and multiple logistic regressions were performed using SAS version 9.2. For logistic regression, the factors that were found to be significant in the univari- ate analysis were first included into the full model with all potentially important co-variates to adjust for confound- ing. A step wise regression model was conducted. Vari- ables with no effect in the adjusted model were removed one by one to obtain more robust results [13]. Ethical considerations The ethical approval was obtained from Rwanda National Ethics Committee (RNEC) functioning under the Ministry of Health, Rwanda. A written informed