Abstract
BACKGROUND: New cases of HIV are increasing among young adults in Zambia; yet voluntary medical male circumcision (VMMC) coverage as an HIV prevention measure remains low. Despite having the highest HIV burden in the province, Ndola district had a VMMC coverage of 23% in 2015 compared to the national target of 80% among high-risk groups. OBJECTIVES: To determine predictive factors associated with circumcision status among male students in Ndola district. METHODS: We conducted a cross-sectional study in May 2016 among students aged 18-35 years enrolled in five conveniently sampled colleges. We administered a structured questionnaire to assess the knowledge, attitudes and perceptions about VMMC. We used multivariable logistic regression to determine factors associated with male circumcision (MC) status. RESULTS: Of 136 students interviewed, 63% were circumcised, and of those, 96% were medically circumcised. Half of all students were aged 21-24 years. Those who perceived the circumcision procedure to be 'safe' (adjusted odds ratio [aOR] = 5.13; 95% CI: 2.09-14.82), and knew that it reduced female to male HIV transmission risk (aOR = 3.65; 95% CI: 3.12-11.67), were more likely to be circumcised. The perception that MC promotes 'promiscuous behaviour' (aOR = 0.20; 95% CI: 0.07-0.61), and that sexual sensitivity is the 'same' regardless of circumcision status, were associated with not being circumcised (aOR = 0.13; 95% CI: 0.02-0.80). CONCLUSION: Students had adequate knowledge about the safety of medical circumcision, and the subsequent risk reduction of HIV infection. Interventions aimed at addressing negative sexual perceptions about circumcision may increase VMMC coverage among college students.