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Key points for decision makers
* Male circumcision (MC) is efficacious in preventing the transmission of HIV among heterosexual men. The widespread implementation of MC will require the design of specific services
* Given that MC will have to be applied to boys and young men of different ages, the design of services will need to accommodate the wishes of fathers, mothers, and sons
* We utilized conjoint analysis to explore the preferences for the design of MC services among fathers, mothers, and sons in Johannesburg, South Africa
* Having a follow-up visit, a lower infection rate, less pain, and a private waiting room were seen as most important across the family, but having the risks and benefits of MC explained was valued higher by sons, and sons did not value requiring a HIV test
Introduction
Male circumcision (MC) has a proven efficacy in reducing the risk of HIV acquisition in heterosexual males. Three recent clinical trials[1-3] confirmed numerous observational studies. The World Health Organization subsequently recommended that medical MC be made available by governments in areas of hyper-endemic HIV, where HIV prevalence exceeds 15% in the general population.[4,5] Several Sub-Saharan African countries are implementing mass scale-up of medical MC strategies. South Africa, a country with a seroprevalence of 30% among pregnant women,[6] would benefit from such public health measures. At the time of writing, however, South Africa was still preparing its national MC program.
While more is written about the influence of the parent in risk-taking behavior and sexual initiation,[7] the role of parents in HIV prevention has received some attention.[8,9] Yet the literature on decision making for MC is relatively sparse. An American study aimed at reducing MC found no impact of a MC educational program on the decision to circumcise, concluding that neonatal MC was more a factor of parents' beliefs and education.[10] In a comprehensive review of the literature on the acceptability of MC, Westercamp and Bailey[11] found that,
"acceptance of MC by men and by parents of males in traditionally non-circumcising communities will be crucial to the success of a[n] MC intervention for reducing HIV prevalence."
Madhivanan et al.[12] focused specifically on determining the primary decision makers in MC, finding that father, mother, and both parents were primarily involved...