Trends in age at male circumcision and its determinants in Rwanda

Area of Science:

• Public Health
• Epidemiology
• HIV Prevention

Background:

• Voluntary medical male circumcision (VMMC) is a proven HIV prevention method.
• Early circumcision (infancy or before sexual debut) maximizes protective benefits.
• Rwanda has expanded VMMC services, but understanding timing determinants is crucial for optimizing uptake.

Purpose of the Study:

• To analyze trends in the timing of voluntary medical male circumcision (VMMC) in Rwanda.
• To identify factors influencing the age at which men undergo circumcision.
• To inform strategies for enhancing VMMC uptake and HIV prevention.

Main Methods:

• Retrospective cross-sectional study using Rwanda Demographic and Health Surveys (2010, 2015, 2020).
• Analysis of 15,965 men aged 15-59.
• Kaplan-Meier curves, log-rank tests, and Cox regression models accounting for survey design.

Main Results:

• Male circumcision prevalence rose from 13.3% (2010) to 52.4% (2020).
• Higher education and frequent TV viewing were associated with earlier circumcision.
• Older age groups and rural residence showed delayed circumcision uptake.

Conclusions:

• Significant increase in VMMC uptake in Rwanda, especially among younger men.
• Health education, media campaigns, and targeted interventions for rural/older populations can improve early uptake.
• Optimizing VMMC timing is key to strengthening national HIV prevention programs.