Background: WHO recommends a male circumcision (MC) prevalence higher than 80% to have a substantial impact on the HIV-AIDS epidemic in Eastern and Southern Africa. Orange Farm, a township in South Africa, has a voluntary medical male circumcision (VMMC) clinic that since 2008 offers free MC. The MC prevalence in 2008 was around 10%. Ongoing and past VMMC campaigns focused on youth with school talks, and adults at community level. The objectives were to assess among adults aged 18-49 years the change in MC prevalence in the past 5 years, the annual uptake rate of MC, and the characteristics of the uncircumcised men.
Methods: Cross-sectional surveys (ANRS-12126-12285) were conducted among random samples of 3182 and 522 adult men in 2010 and 2015 respectively. MC status and characteristics of participants were collected through a genital examination and face-to-face questionnaire. Multivariate Poisson regression allowed comparing circumcised men with uncircumcised men.
Results: MC prevalence among young adult men aged 18-19 years increased markedly from 61.2% (95%CI; 57.4% to 65.0%) in 2010 to 87.5% (76.0% to 94.6%) in 2015 (p< 0.001). In the same period, among men aged 18-49 years, MC prevalence varied little (p=0.60) from 55.4% (53.6% to 57.1%) to 56.7% (52.4% to 60.9%).
In 2015, 84.9% (79.2% to 89.5%) of uncircumcised adult men reported that they were willing to be circumcised. However, we estimated that only 4.6% (11/237; 2.5% to 7.9%) of the uncircumcised men became circumcised in 2015. In 2015, in comparison with circumcised men, uncircumcised men were younger, less educated, and more often lived in OF for less than 5 years. Most frequent reported reasons for not being circumcised were that MC was not cultural practice: 27.6% (21.5% to 34.3%) and fear of pain: 18.4% (13.3% to 24.4%).
Conclusions: In Orange Farm, VMMC campaigns were successful among the youth and led to a sufficiently high MC prevalence to have a substantial impact in the future on the HIV-AIDS epidemic. However, despite high acceptability and a free VMMC service, VMMC campaigns have failed to increase MC prevalence among adults above 80%. These campaigns should be revisited.