Population Council Research that makes a difference

XVIII International AIDS Conference (AIDS 2010)
18–23 July 2010

Abstract

"Assessing reporting of male circumcision in sub-Saharan Africa" (PDF)
Barbara Mensch, Kelvin Munjile, Louis Apicella, Nicole Haberland, and Paul C. Hewett

Background
As male circumcision (MC) programs are scaled up for HIV prevention, measurement of MC prevalence in household-based surveys will be critical. Given that verification of circumcision status through physical examination is unlikely to be acceptable, there is a need to assess the reliability of self- and partner-reported MC status. This study sought to determine whether illustrations and/or interview methods improve accuracy of reporting.

Methods
The study was conducted in Lusaka, Zambia, and Mbabane and Matsapha, Swaziland, among men aged 18–50, their female partners, and adolescent boys aged 13–17. Over 400 males and females in each country were recruited in and around health clinics. Participants were randomized into one of three arms: (1) a control arm that provided a detailed verbal description of MC in a face-to-face interview; (2) an arm that provided an illustration of a circumcised and uncircumcised penis during a face-to-face interview; and (3) an arm that provided the same illustration within the context of a computerized self-interview. Male respondents were requested to undergo a visual examination conducted by a trained clinician to verify their circumcision status.

Results
In Zambia and in Swaziland, preliminary findings show that between 5 percent and 9 percent of males reported they were circumcised when they were not. All but three circumcised men accurately reported their status. Female misreporting was higher (7 percent to 19 percent), with the error in reporting occurring in both directions. Although the illustration tended to lower misreporting, particularly for those who had low levels of literacy, the differences were not consistently statistically significant.

Conclusions
Misreporting of circumcision status by uncircumcised men occurs in both countries, but at levels lower than reported elsewhere. The illustration tended to lower misreporting, particularly for study participants who were not able to read. Misreporting by women is significantly higher than in men and is only marginally improved with an illustration.

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