A REVIEW OF MALE MEDICAL CIRCUMCISION RECORDS IN KWA-ZULU NATAL PROGRESS REPORT for period ending 31 December 2010 Draft: 6 January 2011 Address all enquiries or correspondence to: Dr Irwin Friedman; Study Coordinator and Principal Investigator (Community study) The SEED Trust Tel: 031 765 1494 Cell: 083 601 8235 Email: Dr Andre Rose, Co-Principal Investigator (Community Study) Health Systems Trust Tel: (011) 312-4524 /4523 Fax: (011) 312-4545 Email: Dr Joseph Mokete Titus, Co-Principal Investigator (Institutional study) University of Kwa-Zulu Tel: (033) 897 3292 Cell: 082 492 4785 Email: Trial
young warriors away from their military duties in his army. Circumcision has therefore hitherto been unusual among Zulu men. Interestingly, as a major shift in the circumcision paradigm in contemporary Zulu society, His Majesty, King Zwelithini has been prepared to end nearly two centuries of tradition in the interest of reducing the risk of young men acquiring HIV, saving lives, and avoiding unnecessary deaths. Without in anyway denigrating the value of cultural traditions, in contrast to the TMC approach elsewhere, the KZN strategy has adopted an MMC approach aimed at ensuring the practice of safe medical circumcisions by health personnel qualified to perform the procedure while acknowledging the value of traditional culture. Since the 1980s, over 30 observational studies have suggested a protective effect of male medical circumcision on HIV acquisition in heterosexual men. In 2002, three randomised controlled trials to assess the efficacy of male circumcision for preventing HIV acquisition in men commenced in Africa. A Cochrane Review published in September 2008 evaluated the results of these trials, ANRS 1265, Bailey 2007 and Gray 2007. The meta-analysis specifically considered the effectiveness and safety of male circumcision for preventing the acquisition of HIV in heterosexual men. There was strong evidence that medical male circumcision reduced the transmission of HIV to heterosexual men by between 38% and 66% over 24 months. Circumcision was performed using commonly used surgical techniques, the forceps-guided technique or sleeve resection under local anaesthesia. Incidence of adverse events was very low, indicating that male circumcision, when conducted under these conditions, was a safe procedure. Inclusion of male circumcision into current HIV prevention measures guidelines was therefore warranted. Further research was needed to assess the feasibility, desirability, and of implementing the procedure within local contexts. Meta-analysis of the secondary outcomes measuring sexual behaviour for the Kenyan and Ugandan trials between circumcised and uncircumcised men found no significant differences. For the South African the mean number of sexual contacts at the 12-month visit was 5.9 in the circumcision group versus 5 in the control group, which was a statistically significant difference (p < 0.001). This difference remained statistically significant at the 21-month visit (7.5 versus 6.4; p = 0.0015). No other significant differences were observed.
and lost consciousness as a result of the pain and not blood loss, have experienced level 10. 5.5 Study setting The study setting has been observing the Provincial MCC Outreach team based at Northdale Hospital and with them visiting community (circumcision camp) based sites for the implementation of MMC (n=10 sites) across KZN province. This has included hospitals, community centres and prisons. 5.6 Study population The population of interest has been all males who have participated in the MMC roll-out in KZN within the selected health facilities and mass circumcision camps. Inclusion criteria: All post-pubertal males who had MMC procedures in health institutions or who participated in mass circumcision campaigns in KZN. Table 6 : Total targetted number of participants in the study Central Institutional setting Health Institutions No of circumcised boys/men: TCD No of circumcised boys/men: FG Northdale Hospital, Edendale Hospital and Imbalenhle CHC 200 176 Community setting Mass Circumcision Campaign sites No of circumcised boys/men: TCD No of circumcised boys/men: FG Retrospective Review Plessislaer, Ladysmith Ngwelezana , Clairwood, Appelsbosch, Edendale, Vryheid, Nongoma Hospitals and Bruntville CHC 1,855 374 Concurrent Review Appelsbosch, Greytown, Richmond and Benedictine Hospitals plus Sevontein & Medium B Prisons 700+ 100+