Gasasira et al. BMC Public Health 2012, 12:134 http://www.biomedcentral.com/1471-2458/12/134 styles of circumcision practiced in the community. Several authors in Africa reported three categories of circumcision: “not circumcised: foreskin completely cov- ered the glans of penis; partially circumcised: foreskin partly covered the glans; completely circumcised: fore- skin did not cover the glans at all” [17,18]. Presence of these categories raises concern over two major issues: the training of Health Care providers to perform effec- tive circumcision and the role of the remaining foreskin to increase or to reduce the risk of HIV transmission from female to male. Higher education was significantly associated with being circumcised. This corroborates with other African countries like Kenya, Ethiopia, Tanzania and Uganda [1]. Knowledge on STI/HIV prevention had a significant positive effect not only in men who were circumcised but also in UCM. The prevention of STI and improved hygiene is similar to the findings of other studies as fac- tors associated with the acceptability of MC [8]; [19]. In Zambia, most of the participants reported that if MC is proven to reduce risk for HIV and STIs, they would seek circumcision for themselves or their sons [20]. In South Africa, more than 70% of UCM report that they would want to be circumcised if MC were effective to protect against STIs [21]. The half of the participants (50.2%) in this study was willing to circumcise and 78.5% considered their son/s to be circumcised. These findings are similar to those found in other African communities where circumcision was not practiced traditionally. A review of studies car- ried out in Botswana, Kenya, Malawi, South Africa, Swa- ziland, Uganda, Tanzania, Zambia and Zimbabwe, showed that the median proportion of men willing to circumcise was 65% with a range between 29% in Uganda and 87% in Swaziland. In addition, 71% sup- ported the circumcision of their male child/children [8]. In another study in Dominican Republic, 29% of men were willing to go for circumcision [19]. Those who are young (below 25 years) are more willing to circumcise than the older ones. Similar findings were reported in Dominican Republic and in some African studies where older men are more agreeable to the procedure for their children rather than themselves [8]; [19]. Challenges remain in expanding access to circumci- sion and addressing cultural concerns about the accept- ability of the intervention [22]. The promising fact of this study was that overall willingness for self circumci- sion and son/s to be circumcised was high. Young peo- ple in this study were willing to go for circumcision but fear of pain was found to be a major concern. In other African studies, the major barriers to the acceptability of MC were the fear of pain, concerns for safety and the cost of the procedure [8]. A recent report from Rwanda argued that while adolescent MC is highly cost effective, Page 7 of 8 adult MC is neither cost-saving nor highly cost effective when only the direct benefit for the circumcised man is considered [7]. World Health Organisation recommends that setting with high prevalence, generalized or hyper endemic het- erosexual HIV epidemics and low circumcision rates should consider increasing access to circumcision as an additional HIV prevention strategy [23]. On the other hand, concerns have been expressed over inflated sense of STI/HIV protection of circumcised men which can promote high risk behavior [3,24-27]. Nevertheless, ade- quate counseling on risk reduction can inhibit the adverse behavioral pattern. Similarly engaging in sex during healing period after circumcision may cause increased exposure to infection but appropriate counsel- ing on the abstinence period could potentially reduce such behavior [28]. The study has several strengths. In this nationwide survey participants were nationally distributed, all five provinces and 29 out of 30 districts were covered. The high participation rate (75.6%) and bigger sample size is an indicator for national representation and thus results can be generalized. On the other hand, few limitations are needed to be acknowledged. Firstly self reported cir- cumcision status because the validity of self reported answer without direct observation was questionable. Secondly the quantitative nature of the study didn’t allow in depth exploration of knowledge and percep- tions as well as attitudes of participants towards circumcision. Conclusions The results showed that adolescents and young adults were more willing to be circumcised. Education, access to information on role of MC on STI/HIV prevention, and elimination of fear associated with circumcision are pivotal to increase the acceptability and uptake of MC among men in Rwanda. In this study, 9.4% of circumci- sions were performed by traditional practitioner. It is critical to ensure the availability of services in health facilities and trained providers, in order to satisfy the possible increasing demand of MC. However setting up a system for routinely offering circumcision with safe procedure is a formidable challenge as health system requires both skilled resources and funding [22]. In countries with low prevalence of MC, strategies should include the use of a variety of communication tools to improve knowledge about MC to a wide audience, train- ings of providers on safe circumcision and adopt a vari- ety of culturally appropriate options including scaling up neonatal MC, to increase the coverage. Finally, it may take years before the necessary human trial of an effec- tive treatment against HIV is possible [29]. Therefore synergies between preventive and biological intervention