In Tanzania, Educating Religious Leaders Increases Uptake of Male Circumcision

Educating religious leaders about male circumcision may improve uptake of the procedure in Sub-Saharan African countries. (1) In a cluster randomized trial conducted in rural Tanzania, men had an elevated likelihood of undergoing circumcision during a government campaign if their village's religious leaders had attended a day-long educational seminar about circumcision (odds ratio, 3.2). Among men who had a circumcision, the proportion who attributed their decision to having heard about the procedure in church was substantially higher in intervention villages than in control villages (31% vs. 1%). Although randomized trials in Sub-Saharan Africa have shown that circumcision reduces the risk of HIV infection, uptake of the procedure has fallen short of goals in many countries. In Tanzania, one impediment has been religious objection, notably from Christians who view the practice as appropriate only for Muslims and sexually promiscuous individuals. Given that religion plays an important role in the lives of most Tanzanians, researchers designed a study to examine whether uptake of circumcision would increase if local religious leaders received education about the procedure. The study was conducted in 2014-2015 in rural northwest Tanzania in conjunction with a regional circumcision campaign administered by the Ministry of Health, in which circumcision and voluntary HIV testing and counseling were offered free of charge to all males aged 10 or older. Although the baseline prevalence of circumcision in the area was not known, it was thought to be low because most residents are Christian and belong to an ethnic group that traditionally does not circumcise youth. The researchers selected 16 villages, from which they formed eight pairs of villages that were within 60 kilometers of one another and would be targeted by the campaign at the same time; contact between each village and its counterpart was minimal because of poor infrastructure. One village in each pair was randomly chosen to receive the intervention, in which Christian church leaders (ideally at least one male and one female from each church) were invited to attend a day-long seminar that discussed the medical, historical, social and religious aspects of circumcision. Participants were encouraged to share the information they had received with their congregations. At about the same time, a team from the circumcision campaign began offering circumcisions and related outreach programs in both the intervention and the control villages, and documented the number of boys and men in each village who underwent the procedure. Information was collected on clients' demographic characteristics and reasons for circumcision. The researchers used client records and data from the 2012 census to estimate the proportion of males in each village who had been circumcised during the campaign. They used logistic regression models to identify differences between the intervention and control groups in circumcision levels and in the reasons men gave for wanting to be circumcised. …