The acceptability of male circumcision (MC) as a measure to prevent HIV infection among men who have sex with men (MSM) in Thailand

Published: July 18, 2010

The acceptability of male circumcision (MC) as a measure to prevent HIV infection among men who have sex with men (MSM) in Thailand

T. Chemnasiri1,2, R. Chuachoowong2, S. Chaikummao1,2, P. Oungprasertgul1, A. Varangrat1, F. van Griensven1,2,3

1Thailand Ministry of Public Health – U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand, 2Silom Community Clinic, Bangkok, Thailand, 3Centers for Diease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, United States

Background: Clinical trials have shown a protective effect of MC against the acquisition of HIV infection in heterosexual men. Current data do not support a protective effect of MC in MSM. The general prevalence of MC in Thailand is unknown, but it is thought to be low. This study investigated the acceptability of MC as a potential measure to prevent HIV infection among MSM in Thailand.

Methods: Six focus group discussions were conducted between November 2007 and February 2008. Socio-demographic and behavioral data were collected using a short questionnaire. Discussions were tape-recorded and transcribed. Atlas.ti was used in data analysis.

Results: All 41 participants were Thai, MSM and ≥18 years. Focus groups included circumcised and uncircumcised men and men who were predominantly insertive or receptive in anal intercourse. Issues discussed in relation to acceptability of MC were concerns about the efficacy of MC for HIV prevention for MSM in general and for receptive MSM in particular; preventive benefits not outweighing post-surgical pain, fears about loss of sexual sensitivity and concerns about a misshaped penis post-circumcision. Participants considered MC more as minor surgery for people with phimosis, frenulum-breve, as a religious rite, or for personal hygiene. Men were not aware of the existence of different surgical circumcision styles (placement and shape of the circumcision scar line and amount of foreskin left) with different esthetical outcomes. Participants felt there were other and better ways than MC to protect themselves from HIV infection.

Conclusions: MSM had appropriate concerns about the efficacy of MC to prevent male-to-male HIV transmission and preferred other HIV prevention methods. Participants expressed misconceptions about side-effects and surgical outcomes of MC, and were not aware of different MC styles. Should MC be proven as a measure to protect MSM from HIV infection, additional education about MC will be necessary.

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