To cut or not to cut: Willingness to change the Maasai male circumcision procedure

Background: In 2007 WHO announced that medical male circumcision is an efficacious intervention and that it is an important HIV prevention tool for heterosexual men. The Maasai tribe in Tanzania and Kenya practice traditional circumcision termed the "button-hole” procedure. This technique pulls the glans of the penis through an incision in the foreskin, leaving a portion of foreskin hanging as a permanent appendage. This circumcision may not provide the same protective benefits as medical circumcision and may entail other health risks.

Methods: This study is a cluster-randomized survey of 370 Maasai participants. Items within the survey instrument were developed based on prior circumcision willingness questionnaires, qualitative interviews and cognitive interviewing. When finalized, the instrument was translated and backtranslated from English to Maa.

Results: The proportion of parents willing to medically circumcise their child given information that it could prevent HIV was 28%. The strongest factor to increase willingness was traditional leader support, which resulted in a three-fold increase in willingness (84%). Parents were supportive of using medically sanitized tools (88%) and anesthesia (67%) for children's circumcision procedures. Few male adults were willing to be re-circumcised (12%). When guarantees of anesthesia and support of tribal elders were included, nearly half agreed to recircumcision (48%).

Conclusions: Future programs should work collaboratively with traditional leaders to promote sterile blades and other medical supplies for disease prevention. If circumcision is to be scaled as an intervention, future epidemiological research should be conducted to determine protection afforded by different circumcision techniques.