Attitudes, Beliefs and Predictors of Male Circumcision Promotion among Medical University Students in a Traditionally Non-Circumcising Region
Identifieur interne : 002538 ( Pmc/Corpus ); précédent : 002537; suivant : 002539Attitudes, Beliefs and Predictors of Male Circumcision Promotion among Medical University Students in a Traditionally Non-Circumcising Region
Auteurs : Maria Ganczak ; Marcin Korze ; Maciej OlszewskiSource :
- International Journal of Environmental Research and Public Health [ 1661-7827 ] ; 2017.
Abstract
Url:
DOI: 10.3390/ijerph14101097
PubMed: 28934174
PubMed Central: 5664598
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PMC:5664598Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Attitudes, Beliefs and Predictors of Male Circumcision Promotion among Medical University Students in a Traditionally Non-Circumcising Region</title><author><name sortKey="Ganczak, Maria" sort="Ganczak, Maria" uniqKey="Ganczak M" first="Maria" last="Ganczak">Maria Ganczak</name><affiliation><nlm:aff id="af1-ijerph-14-01097">Department of Epidemiology and Management, Faculty of Medical Sciences, Pomeranian Medical University, 71-210 Szczecin, Poland</nlm:aff></affiliation></author><author><name sortKey="Korze, Marcin" sort="Korze, Marcin" uniqKey="Korze M" first="Marcin" last="Korze">Marcin Korze</name><affiliation><nlm:aff id="af2-ijerph-14-01097">Department of Methods of Artificial Intelligence and Applied Mathematics, Faculty of Computer Science and Information Technology, West Pomeranian University of Technology, 71-210 Szczecin, Poland;<email>mkorzen@wi.zut.edu.pl</email></nlm:aff></affiliation></author><author><name sortKey="Olszewski, Maciej" sort="Olszewski, Maciej" uniqKey="Olszewski M" first="Maciej" last="Olszewski">Maciej Olszewski</name><affiliation><nlm:aff id="af3-ijerph-14-01097">Students’ Scientific Association, Pomeranian Medical University, 70-204 Szczecin, Poland;<email>olschevski@gmail.com</email></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28934174</idno><idno type="pmc">5664598</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664598</idno><idno type="RBID">PMC:5664598</idno><idno type="doi">10.3390/ijerph14101097</idno><date when="2017">2017</date><idno type="wicri:Area/Pmc/Corpus">002538</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002538</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Attitudes, Beliefs and Predictors of Male Circumcision Promotion among Medical University Students in a Traditionally Non-Circumcising Region</title><author><name sortKey="Ganczak, Maria" sort="Ganczak, Maria" uniqKey="Ganczak M" first="Maria" last="Ganczak">Maria Ganczak</name><affiliation><nlm:aff id="af1-ijerph-14-01097">Department of Epidemiology and Management, Faculty of Medical Sciences, Pomeranian Medical University, 71-210 Szczecin, Poland</nlm:aff></affiliation></author><author><name sortKey="Korze, Marcin" sort="Korze, Marcin" uniqKey="Korze M" first="Marcin" last="Korze">Marcin Korze</name><affiliation><nlm:aff id="af2-ijerph-14-01097">Department of Methods of Artificial Intelligence and Applied Mathematics, Faculty of Computer Science and Information Technology, West Pomeranian University of Technology, 71-210 Szczecin, Poland;<email>mkorzen@wi.zut.edu.pl</email></nlm:aff></affiliation></author><author><name sortKey="Olszewski, Maciej" sort="Olszewski, Maciej" uniqKey="Olszewski M" first="Maciej" last="Olszewski">Maciej Olszewski</name><affiliation><nlm:aff id="af3-ijerph-14-01097">Students’ Scientific Association, Pomeranian Medical University, 70-204 Szczecin, Poland;<email>olschevski@gmail.com</email></nlm:aff></affiliation></author></analytic><series><title level="j">International Journal of Environmental Research and Public Health</title><idno type="ISSN">1661-7827</idno><idno type="eISSN">1660-4601</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><italic>Objective</italic>: To evaluate the beliefs of medical university students regarding male circumcision (MC), as well as attitudes and the predictors of its promotion in the case of adults at risk of HIV. <italic>Methods</italic>: A cross-sectional survey was conducted between 2013–2016 at the Medical University in Szczecin, Poland, among final year Polish/foreign students from Northern Europe, using a standardized questionnaire. <italic>Results</italic>: There were 539 participants, median age 25 years, 40.8% males, and 66.8% were Polish nationals. The MC rate was 16.7%. Regarding HIV/AIDS knowledge, 66.6% of the students scored more than 75%; and, 34.2% knew that MC reduces the risk of HIV infection. One in eleven respondents (9.1%) believed that circumcised men felt more intense sexual pleasure. More than half of the respondents (54.8%) declared that they would recommend MC to adult patients at risk for HIV. The belief that circumcised men felt more intense sexual pleasure, and knowledge on MC regarding HIV risk reduction was associated with greater odds of recommending adult MC (OR = 3.35 and OR = 2.13, respectively). <italic>Conclusions</italic>: Poor knowledge of its benefits and a low willingness to promote the procedure—strongly dependent on personal beliefs—suggest that medical students may need additional training to help them to discuss MC more openly with adult men at risk for HIV infection. Knowledge may be an effective tool when making decisions regarding MC promotion.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Friedman, B" uniqKey="Friedman B">B. Friedman</name></author><author><name sortKey="Khoury, J" uniqKey="Khoury J">J. Khoury</name></author><author><name sortKey="Petersiel, N" uniqKey="Petersiel N">N. Petersiel</name></author><author><name sortKey="Yahalomi, T" uniqKey="Yahalomi T">T. Yahalomi</name></author><author><name sortKey="Paul, M" uniqKey="Paul M">M. Paul</name></author><author><name sortKey="Neuberger, A" uniqKey="Neuberger A">A. Neuberger</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Weiss, H A" uniqKey="Weiss H">H.A. Weiss</name></author><author><name sortKey="Thomas, S L" uniqKey="Thomas S">S.L. Thomas</name></author><author><name sortKey="Munabi, S K" uniqKey="Munabi S">S.K. Munabi</name></author><author><name sortKey="Hayes, R J" uniqKey="Hayes R">R.J. Hayes</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zhu, Y P" uniqKey="Zhu Y">Y.P. Zhu</name></author><author><name sortKey="Jia, Z W" uniqKey="Jia Z">Z.W. Jia</name></author><author><name sortKey="Dai, B" uniqKey="Dai B">B. Dai</name></author><author><name sortKey="Ye, D W" uniqKey="Ye D">D.W. Ye</name></author><author><name sortKey="Kong, Y Y" uniqKey="Kong Y">Y.Y. Kong</name></author><author><name sortKey="Chang, K" uniqKey="Chang K">K. Chang</name></author><author><name sortKey="Wang, Y" uniqKey="Wang Y">Y. Wang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kilmarx, P H" uniqKey="Kilmarx P">P.H. Kilmarx</name></author><author><name sortKey="Kretsinger, K" uniqKey="Kretsinger K">K. Kretsinger</name></author><author><name sortKey="Millett, G A" uniqKey="Millett G">G.A. Millett</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kim, H H" uniqKey="Kim H">H.H. Kim</name></author><author><name sortKey="Li, P S" uniqKey="Li P">P.S. Li</name></author><author><name sortKey="Goldstein, M" uniqKey="Goldstein M">M. Goldstein</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Morris, B J" uniqKey="Morris B">B.J. Morris</name></author><author><name sortKey="Kennedy, S E" uniqKey="Kennedy S">S.E. Kennedy</name></author><author><name sortKey="Wodak, A D" uniqKey="Wodak A">A.D. Wodak</name></author><author><name sortKey="Mindel, A" uniqKey="Mindel A">A. Mindel</name></author><author><name sortKey="Golovsky, D" uniqKey="Golovsky D">D. Golovsky</name></author><author><name sortKey="Schrieber, L" uniqKey="Schrieber L">L. Schrieber</name></author><author><name sortKey="Lumbers, E R" uniqKey="Lumbers E">E.R. Lumbers</name></author><author><name sortKey="Handelsman, D J" uniqKey="Handelsman D">D.J. Handelsman</name></author><author><name sortKey="Ziegler, J B" uniqKey="Ziegler J">J.B. Ziegler</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tobian, A A" uniqKey="Tobian A">A.A. Tobian</name></author><author><name sortKey="Kacker, S" uniqKey="Kacker S">S. Kacker</name></author><author><name sortKey="Quinn, T C" uniqKey="Quinn T">T.C. Quinn</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rogowska Szadkowska, D" uniqKey="Rogowska Szadkowska D">D. Rogowska-Szadkowska</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Nied Wiedzka Stadnik, M" uniqKey="Nied Wiedzka Stadnik M">M. Niedźwiedzka-Stadnik</name></author><author><name sortKey="Pielacha, M" uniqKey="Pielacha M">M. Pielacha</name></author><author><name sortKey="Rosi Ska, M" uniqKey="Rosi Ska M">M. Rosińska</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Xu, X" uniqKey="Xu X">X. Xu</name></author><author><name sortKey="Patel, D A" uniqKey="Patel D">D.A. Patel</name></author><author><name sortKey="Dalton, V K" uniqKey="Dalton V">V.K. Dalton</name></author><author><name sortKey="Pearlman, M D" uniqKey="Pearlman M">M.D. Pearlman</name></author><author><name sortKey="Johnson, T R" uniqKey="Johnson T">T.R. Johnson</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Westercamp, M" uniqKey="Westercamp M">M. Westercamp</name></author><author><name sortKey="Agot, K E" uniqKey="Agot K">K.E. Agot</name></author><author><name sortKey="Ndinya Achola, J" uniqKey="Ndinya Achola J">J. Ndinya-Achola</name></author><author><name sortKey="Bailey, R C" uniqKey="Bailey R">R.C. Bailey</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Venables, W N" uniqKey="Venables W">W.N. Venables</name></author><author><name sortKey="Ripley, B D" uniqKey="Ripley B">B.D. Ripley</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Morris, B J" uniqKey="Morris B">B.J. Morris</name></author><author><name sortKey="Wamai, R G" uniqKey="Wamai R">R.G. Wamai</name></author><author><name sortKey="Henebeng, E B" uniqKey="Henebeng E">E.B. Henebeng</name></author><author><name sortKey="Tobian, A A" uniqKey="Tobian A">A.A. Tobian</name></author><author><name sortKey="Klausner, J D" uniqKey="Klausner J">J.D. Klausner</name></author><author><name sortKey="Banerjee, J" uniqKey="Banerjee J">J. Banerjee</name></author><author><name sortKey="Hankins, C A" uniqKey="Hankins C">C.A. Hankins</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Frisch, M" uniqKey="Frisch M">M. Frisch</name></author><author><name sortKey="Lindholm, M" uniqKey="Lindholm M">M. Lindholm</name></author><author><name sortKey="Gr Nbeck, M" uniqKey="Gr Nbeck M">M. Grønbeck</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Carbery, B" uniqKey="Carbery B">B. Carbery</name></author><author><name sortKey="Zhu, J" uniqKey="Zhu J">J. Zhu</name></author><author><name sortKey="Gust, D A" uniqKey="Gust D">D.A. Gust</name></author><author><name sortKey="Chen, R T" uniqKey="Chen R">R.T. Chen</name></author><author><name sortKey="Kretsinger, K" uniqKey="Kretsinger K">K. Kretsinger</name></author><author><name sortKey="Kilmarx, P H" uniqKey="Kilmarx P">P.H. Kilmarx</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Castro, J G" uniqKey="Castro J">J.G. Castro</name></author><author><name sortKey="Jones, D L" uniqKey="Jones D">D.L. Jones</name></author><author><name sortKey="Lopez, M" uniqKey="Lopez M">M. Lopez</name></author><author><name sortKey="Barradas, I" uniqKey="Barradas I">I. Barradas</name></author><author><name sortKey="Weiss, S M" uniqKey="Weiss S">S.M. Weiss</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Devieux, J G" uniqKey="Devieux J">J.G. Dévieux</name></author><author><name sortKey="Saxena, A" uniqKey="Saxena A">A. Saxena</name></author><author><name sortKey="Rosenberg, R" uniqKey="Rosenberg R">R. Rosenberg</name></author><author><name sortKey="Klausner, J D" uniqKey="Klausner J">J.D. Klausner</name></author><author><name sortKey="Jean Gilles, M" uniqKey="Jean Gilles M">M. Jean-Gilles</name></author><author><name sortKey="Madhivanan, P" uniqKey="Madhivanan P">P. Madhivanan</name></author><author><name sortKey="Gaston, S" uniqKey="Gaston S">S. Gaston</name></author><author><name sortKey="Rubens, M" uniqKey="Rubens M">M. Rubens</name></author><author><name sortKey="Theodore, H" uniqKey="Theodore H">H. Theodore</name></author><author><name sortKey="Deschamps, M M" uniqKey="Deschamps M">M.M. Deschamps</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Morris, B J" uniqKey="Morris B">B.J. Morris</name></author><author><name sortKey="Krieger, J N" uniqKey="Krieger J">J.N. Krieger</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cox, G" uniqKey="Cox G">G. Cox</name></author><author><name sortKey="Krieger, J N" uniqKey="Krieger J">J.N. Krieger</name></author><author><name sortKey="Morris, B J" uniqKey="Morris B">B.J. Morris</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Shabanzadeh, D M" uniqKey="Shabanzadeh D">D.M. Shabanzadeh</name></author><author><name sortKey="During, S" uniqKey="During S">S. Düring</name></author><author><name sortKey="Frimodt M Ller, C" uniqKey="Frimodt M Ller C">C. Frimodt-Møller</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Glanz, K" uniqKey="Glanz K">K. Glanz</name></author><author><name sortKey="Rimer, B K" uniqKey="Rimer B">B.K. Rimer</name></author><author><name sortKey="Viswanath, K" uniqKey="Viswanath K">K. Viswanath</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sahay, S" uniqKey="Sahay S">S. Sahay</name></author><author><name sortKey="Nagarajan, K" uniqKey="Nagarajan K">K. Nagarajan</name></author><author><name sortKey="Mehendale, S" uniqKey="Mehendale S">S. Mehendale</name></author><author><name sortKey="Deb, S" uniqKey="Deb S">S. Deb</name></author><author><name sortKey="Gupta, A" uniqKey="Gupta A">A. Gupta</name></author><author><name sortKey="Bharat, S" uniqKey="Bharat S">S. Bharat</name></author><author><name sortKey="Kumar, A B" uniqKey="Kumar A">A.B. Kumar</name></author><author><name sortKey="Kanthe, V" uniqKey="Kanthe V">V. Kanthe</name></author><author><name sortKey="Sinha, A" uniqKey="Sinha A">A. Sinha</name></author><author><name sortKey="Chandhiok, N" uniqKey="Chandhiok N">N. Chandhiok</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Slosar, J P" uniqKey="Slosar J">J.P. Slosar</name></author><author><name sortKey="O Rien, D" uniqKey="O Rien D">D. O’Brien</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hankins, C" uniqKey="Hankins C">C. Hankins</name></author><author><name sortKey="Warren, M" uniqKey="Warren M">M. Warren</name></author><author><name sortKey="Njeuhmel, E" uniqKey="Njeuhmel E">E. Njeuhmel</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Morris, B J" uniqKey="Morris B">B.J. Morris</name></author><author><name sortKey="Klausner, J D" uniqKey="Klausner J">J.D. Klausner</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Siegfied, N" uniqKey="Siegfied N">N. Siegfied</name></author><author><name sortKey="Muller, M" uniqKey="Muller M">M. Muller</name></author><author><name sortKey="Deeks, J J" uniqKey="Deeks J">J.J. Deeks</name></author><author><name sortKey="Volmink, J" uniqKey="Volmink J">J. Volmink</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Auvert, B" uniqKey="Auvert B">B. Auvert</name></author><author><name sortKey="Taljaard, D" uniqKey="Taljaard D">D. Taljaard</name></author><author><name sortKey="Rech, D" uniqKey="Rech D">D. Rech</name></author><author><name sortKey="Lissouba, P" uniqKey="Lissouba P">P. Lissouba</name></author><author><name sortKey="Singh, B" uniqKey="Singh B">B. Singh</name></author><author><name sortKey="Bouscaillou, J" uniqKey="Bouscaillou J">J. Bouscaillou</name></author><author><name sortKey="Peytavin, G" uniqKey="Peytavin G">G. Peytavin</name></author><author><name sortKey="Mahiane, S G" uniqKey="Mahiane S">S.G. Mahiane</name></author><author><name sortKey="Sitta, R" uniqKey="Sitta R">R. Sitta</name></author><author><name sortKey="Puren, A" uniqKey="Puren A">A. Puren</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Morris, B J" uniqKey="Morris B">B.J. Morris</name></author><author><name sortKey="Wamai, R G" uniqKey="Wamai R">R.G. Wamai</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Warner, L" uniqKey="Warner L">L. Warner</name></author><author><name sortKey="Ghanem, K G" uniqKey="Ghanem K">K.G. Ghanem</name></author><author><name sortKey="Newman, D R" uniqKey="Newman D">D.R. Newman</name></author><author><name sortKey="Macaluso, M" uniqKey="Macaluso M">M. Macaluso</name></author><author><name sortKey="Sullivan, P S" uniqKey="Sullivan P">P.S. Sullivan</name></author><author><name sortKey="Erbelding, E J" uniqKey="Erbelding E">E.J. Erbelding</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chemtob, D" uniqKey="Chemtob D">D. Chemtob</name></author><author><name sortKey="Op De Coul, E" uniqKey="Op De Coul E">E. Op de Coul</name></author><author><name sortKey="Van Sighem, A" uniqKey="Van Sighem A">A. van Sighem</name></author><author><name sortKey="Mor, Z" uniqKey="Mor Z">Z. Mor</name></author><author><name sortKey="Cazein, F" uniqKey="Cazein F">F. Cazein</name></author><author><name sortKey="Semaille, C" uniqKey="Semaille C">C. Semaille</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Marrazzo, J M" uniqKey="Marrazzo J">J.M. Marrazzo</name></author><author><name sortKey="Del Rio, C" uniqKey="Del Rio C">C. del Rio</name></author><author><name sortKey="Holtgrave, D R" uniqKey="Holtgrave D">D.R. Holtgrave</name></author><author><name sortKey="Cohen, M S" uniqKey="Cohen M">M.S. Cohen</name></author><author><name sortKey="Kalichman, S C" uniqKey="Kalichman S">S.C. Kalichman</name></author><author><name sortKey="Mayer, K H" uniqKey="Mayer K">K.H. Mayer</name></author><author><name sortKey="Montaner, J S" uniqKey="Montaner J">J.S. Montaner</name></author><author><name sortKey="Wheeler, D P" uniqKey="Wheeler D">D.P. Wheeler</name></author><author><name sortKey="Grant, R M" uniqKey="Grant R">R.M. Grant</name></author><author><name sortKey="Grinsztejn, B" uniqKey="Grinsztejn B">B. Grinsztejn</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Goodreau, S M" uniqKey="Goodreau S">S.M. Goodreau</name></author><author><name sortKey="Carnegie, N B" uniqKey="Carnegie N">N.B. Carnegie</name></author><author><name sortKey="Vittinghoff, E" uniqKey="Vittinghoff E">E. Vittinghoff</name></author><author><name sortKey="Lama, J R" uniqKey="Lama J">J.R. Lama</name></author><author><name sortKey="Fuchs, J D" uniqKey="Fuchs J">J.D. Fuchs</name></author><author><name sortKey="Sanchez, J" uniqKey="Sanchez J">J. Sanchez</name></author><author><name sortKey="Buchbinder, S P" uniqKey="Buchbinder S">S.P. Buchbinder</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kripke, K" uniqKey="Kripke K">K. Kripke</name></author><author><name sortKey="Okello, V" uniqKey="Okello V">V. Okello</name></author><author><name sortKey="Maziya, V" uniqKey="Maziya V">V. Maziya</name></author><author><name sortKey="Benzerga, W" uniqKey="Benzerga W">W. Benzerga</name></author><author><name sortKey="Mirira, M" uniqKey="Mirira M">M. Mirira</name></author><author><name sortKey="Gold, E" uniqKey="Gold E">E. Gold</name></author><author><name sortKey="Schnure, M" uniqKey="Schnure M">M. Schnure</name></author><author><name sortKey="Sgaier, S" uniqKey="Sgaier S">S. Sgaier</name></author><author><name sortKey="Castor, D" uniqKey="Castor D">D. Castor</name></author><author><name sortKey="Reed, J" uniqKey="Reed J">J. Reed</name></author></analytic></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Int J Environ Res Public Health</journal-id><journal-id journal-id-type="iso-abbrev">Int J Environ Res Public Health</journal-id><journal-id journal-id-type="publisher-id">ijerph</journal-id><journal-title-group><journal-title>International Journal of Environmental Research and Public Health</journal-title></journal-title-group><issn pub-type="ppub">1661-7827</issn><issn pub-type="epub">1660-4601</issn><publisher><publisher-name>MDPI</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28934174</article-id><article-id pub-id-type="pmc">5664598</article-id><article-id pub-id-type="doi">10.3390/ijerph14101097</article-id><article-id pub-id-type="publisher-id">ijerph-14-01097</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Attitudes, Beliefs and Predictors of Male Circumcision Promotion among Medical University Students in a Traditionally Non-Circumcising Region</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Ganczak</surname><given-names>Maria</given-names></name><xref ref-type="aff" rid="af1-ijerph-14-01097">1</xref><xref rid="c1-ijerph-14-01097" ref-type="corresp">*</xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="true">https://orcid.org/0000-0002-1306-7146</contrib-id><name><surname>Korzeń</surname><given-names>Marcin</given-names></name><xref ref-type="aff" rid="af2-ijerph-14-01097">2</xref></contrib><contrib contrib-type="author"><name><surname>Olszewski</surname><given-names>Maciej</given-names></name><xref ref-type="aff" rid="af3-ijerph-14-01097">3</xref></contrib></contrib-group><aff id="af1-ijerph-14-01097"><label>1</label>Department of Epidemiology and Management, Faculty of Medical Sciences, Pomeranian Medical University, 71-210 Szczecin, Poland</aff><aff id="af2-ijerph-14-01097"><label>2</label>Department of Methods of Artificial Intelligence and Applied Mathematics, Faculty of Computer Science and Information Technology, West Pomeranian University of Technology, 71-210 Szczecin, Poland;<email>mkorzen@wi.zut.edu.pl</email></aff><aff id="af3-ijerph-14-01097"><label>3</label>Students’ Scientific Association, Pomeranian Medical University, 70-204 Szczecin, Poland;<email>olschevski@gmail.com</email></aff><author-notes><corresp id="c1-ijerph-14-01097"><label>*</label>Correspondence: <email>mganczak@pum.edu.pl</email>; Tel.: +48-91-4800965</corresp></author-notes><pub-date pub-type="epub"><day>21</day><month>9</month><year>2017</year></pub-date><pub-date pub-type="ppub"><month>10</month><year>2017</year></pub-date><volume>14</volume><issue>10</issue><elocation-id>1097</elocation-id><history><date date-type="received"><day>08</day><month>8</month><year>2017</year></date><date date-type="accepted"><day>18</day><month>9</month><year>2017</year></date></history><permissions><copyright-statement>© 2017 by the authors.</copyright-statement><copyright-year>2017</copyright-year><license license-type="open-access"><license-p>Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>).</license-p></license></permissions><abstract><p><italic>Objective</italic>: To evaluate the beliefs of medical university students regarding male circumcision (MC), as well as attitudes and the predictors of its promotion in the case of adults at risk of HIV. <italic>Methods</italic>: A cross-sectional survey was conducted between 2013–2016 at the Medical University in Szczecin, Poland, among final year Polish/foreign students from Northern Europe, using a standardized questionnaire. <italic>Results</italic>: There were 539 participants, median age 25 years, 40.8% males, and 66.8% were Polish nationals. The MC rate was 16.7%. Regarding HIV/AIDS knowledge, 66.6% of the students scored more than 75%; and, 34.2% knew that MC reduces the risk of HIV infection. One in eleven respondents (9.1%) believed that circumcised men felt more intense sexual pleasure. More than half of the respondents (54.8%) declared that they would recommend MC to adult patients at risk for HIV. The belief that circumcised men felt more intense sexual pleasure, and knowledge on MC regarding HIV risk reduction was associated with greater odds of recommending adult MC (OR = 3.35 and OR = 2.13, respectively). <italic>Conclusions</italic>: Poor knowledge of its benefits and a low willingness to promote the procedure—strongly dependent on personal beliefs—suggest that medical students may need additional training to help them to discuss MC more openly with adult men at risk for HIV infection. Knowledge may be an effective tool when making decisions regarding MC promotion.</p></abstract><kwd-group><kwd>male circumcision</kwd><kwd>attitudes</kwd><kwd>beliefs</kwd><kwd>determinants</kwd><kwd>promotion</kwd><kwd>medical students</kwd></kwd-group></article-meta></front><body><sec id="sec1-ijerph-14-01097"><title>1. Introduction</title><p>It is important to tackle HIV transmission by using strategies that may improve population health; and this includes male circumcision (MC). Three large randomized controlled trials (RCTs) conducted in African countries have shown that MC reduces the risk of acquiring HIV through heterosexual intercourse in males by 51–60% [<xref rid="B1-ijerph-14-01097" ref-type="bibr">1</xref>], and has been associated with a decreased risk of acquiring human papillomavirus, syphilis, and urinary tract infections [<xref rid="B2-ijerph-14-01097" ref-type="bibr">2</xref>,<xref rid="B3-ijerph-14-01097" ref-type="bibr">3</xref>]. These findings are currently being taken into account with regards to health recommendations and policy proposals. In areas with high endemic rates of HIV, the World Health Organization and Joint United Nations Programme on HIV and AIDS recommend MC as a part of a comprehensive program for prevention of HIV transmission. MC is a procedure that can be performed not only during infancy, but also in adolescence or adulthood [<xref rid="B4-ijerph-14-01097" ref-type="bibr">4</xref>]. As such, it could be discussed with those adults at risk of contracting HIV [<xref rid="B1-ijerph-14-01097" ref-type="bibr">1</xref>]. </p><p>However, the inclusion of MC in the health policy of developed countries with low endemic HIV rates, such as those in Europe, requires further scrutiny [<xref rid="B5-ijerph-14-01097" ref-type="bibr">5</xref>]. Currently, no major medical organization has either recommended or banned universal neonatal circumcision in these regions. In 2012, the American Academy of Pediatrics (APP) and the American Congress of Obstetricians and Gynecologists published recommendations stating that doctors should discuss the benefits and risks of newborn MC with parents [<xref rid="B6-ijerph-14-01097" ref-type="bibr">6</xref>]. This stance is very similar to that of the Centers for Disease Control and Prevention, the Canadian Medical Society, the British Medical Association, the Royal Australasian College of Physicians, and the Circumcision Academy of Australia [<xref rid="B7-ijerph-14-01097" ref-type="bibr">7</xref>,<xref rid="B8-ijerph-14-01097" ref-type="bibr">8</xref>]. These policy statements have arisen in the context of a growing body of evidence supporting the medical benefits of MC. Despite this evidence, MC rates in developed countries have been in decline in recent years [<xref rid="B9-ijerph-14-01097" ref-type="bibr">9</xref>]. </p><p>In some European countries, especially Poland, negative attitudes towards MC persist, largely stemming from the period of Nazi occupation during World War II, when MC was perceived as Judaism-related and possibly provoking repression and even leading to a death sentence [<xref rid="B10-ijerph-14-01097" ref-type="bibr">10</xref>]. </p><p>Thus, MC promotion in the region remains challenging. MC opponents in Europe may also point to its minimal anticipated impact, since HIV rates per 100,000 of the population [<xref rid="B11-ijerph-14-01097" ref-type="bibr">11</xref>] are much lower than in some African countries [<xref rid="B12-ijerph-14-01097" ref-type="bibr">12</xref>], where the overall risk regarding HIV transmission is very high. </p><p>In Europe, males are reported as the more affected gender. In Poland, in 2014, almost two thirds of newly diagnosed infections among men with known transmission category were acquired by men who had sex with other men (MSM). However, no increase has been observed in the number of cases in this population group as compared to 2013 [<xref rid="B13-ijerph-14-01097" ref-type="bibr">13</xref>]. There has been a 32% increase among people infected through heterosexual contact. Sex between men accounted for more than half of new diagnoses in 14 other European countries (Austria, Croatia, Cyprus, the Czech Republic, Germany, Greece, Hungary, Ireland, Malta, the Netherlands, Slovakia, Slovenia, Spain, and the United Kingdom). The prevalence rates of new HIV cases per 100,000 of the population in those countries varied between 1.6 in Slovakia and 9.6 in the UK. In Scandinavia, the prevalence rates were low (3.3–5.2), although higher than that observed in Poland (2.8). However, a different pattern regarding the transmission mode was reported, with heterosexual transmission being the most commonly reported known mode in Finland, Norway, and Sweden. </p><p>Before effective interventions to promote MC can be introduced on a national scale in traditionally non-circumcising European regions, thorough studies need to be conducted. MC rates and its cost-effectiveness need to be analyzed in order to determine whether the policy of promoting and providing inexpensive access to voluntary circumcision for adult men would indeed result in lower overall societal healthcare costs [<xref rid="B14-ijerph-14-01097" ref-type="bibr">14</xref>]. Of note, in Poland, MC performed for non-medical reasons has to be covered by the patient and costs on average, around 260–400 USD. The cost of medical MC is paid for through health insurance. It is estimated that about 13,500 procedures are performed annually, mainly to treat pathological phimosis and refractory balanoposthitis [<xref rid="B15-ijerph-14-01097" ref-type="bibr">15</xref>].</p><p>Another obstacle regarding adult MC promotion might be a reluctance to accept circumcision as an HIV preventative measure by communities that do not traditionally circumcise. Therefore, to study predictors regarding the acceptability of this practice among health care providers and patients would be also of value.</p></sec><sec id="sec2-ijerph-14-01097"><title>2. Objectives</title><p>The objective of the study was to assess MC prevalence in a traditionally non-circumcising region, and to evaluate the beliefs of medical university students regarding male circumcision (MC), as well as attitudes, and the predictors of its promotion in the case of adults at risk of HIV. The main goal was to assess the potential for introducing culturally applicable interventions tailored to promote MC as an element of HIV prevention strategy. To our knowledge, similar studies on MC related to European medical students, as prospective health care providers, have not yet been carried out.</p></sec><sec id="sec3-ijerph-14-01097"><title>3. Materials and Methods</title><sec id="sec3dot1-ijerph-14-01097"><title>3.1. Design, Setting, Population and Sampling</title><p>This was a cross-sectional survey, conducted between 2013–2016 at a national government university (The Pomeranian Medical University) situated in Szczecin, in the north west of Poland. The study population consisted of 541 final year medical students who were enrolled in the program—Poles from different regions of the country, as well as foreign students from Scandinavia and Germany, attending a medical course taught in English. All of the students who were present at the time when the questionnaires were administered were asked to participate. As part of the consenting process, it was made clear that there would be no penalty for refusing to participate in this study.</p></sec><sec id="sec3dot2-ijerph-14-01097"><title>3.2. Data Collection </title><p>One research team member (Maciej Olszewski) administered the questionnaires under normal classroom conditions. A structured, anonymous questionnaire, with separate versions for males and females was adapted for local conditions from a questionnaire used in a previous research addressing MC by Westercamp et al. [<xref rid="B16-ijerph-14-01097" ref-type="bibr">16</xref>]. The authors obtained consent to use the original questionnaire and it was then translated for Polish respondents. Participants were asked about:<list list-type="simple"><list-item><label>(i)</label><p>demographic data (age, gender, nationality, religion, and circumcision status in the case of male participants); </p></list-item><list-item><label>(ii)</label><p>sources of knowledge with regard to MC; </p></list-item><list-item><label>(iii)</label><p>knowledge of HIV/AIDS regarding transmission modes; clinical manifestations; testing; treatment; and, preventive measures;</p></list-item><list-item><label>(iv)</label><p>knowledge about MC regarding the risk of HIV transmission, determined by asking participants how likely a circumcised man would become infected with HIV as compared to an uncircumcised individual; </p></list-item><list-item><label>(v)</label><p>if they knew someone who had been circumcised; and,</p></list-item><list-item><label>(vi)</label><p>beliefs about MC measured by asking participants if, in their opinion: (1) circumcised men feel more intense/about the same/less sexual pleasure than uncircumcised men, (2) penis sensitivity decreases/ increases/remains the same after MC, and (3) is MC a safe procedure. </p></list-item></list></p><p>Knowledge of HIV/AIDS was assessed by giving 1 point for each correct answer to the 12 items rated as “true”, “false”, “don’t know”. The scale measured knowledge from a minimum of 0 to a maximum of 12. Scores for individuals were summed up to give a total knowledge score. Scores of 0–5 (less than 50% answered correctly) were arbitrary taken as poor, 6–9 (50–75% correct answers)—as mediocre knowledge, 10–12 (more than 75% correct answers)—as good knowledge. </p><p>Circumcised males were asked about their age at circumcision and the primary reason for the procedure.</p><p>The main question of interest, developed for the purpose of this study, was: “When counseling a male at risk of HIV infection, would you generally recommend adult circumcision?”. The possible answers were (1) yes, (2) no, (3) not sure. Heterosexual men at an increased risk for HIV included those who are in sexual relationships with HIV infected female partners, men with multiple female partners, those in relationships with women who are at high risk of HIV (e.g., commercial sex workers, intravenous drug users). The study was approved by the Pomeranian Medical University Ethics Committee (KB 0012/41/13). </p></sec><sec id="sec3dot3-ijerph-14-01097"><title>3.3. Statistical Analysis </title><p>Data analysis was carried out using STATISTICA PL Version 12.5 (StatSoft, Polska, Kraków, Poland) and R software (Lucent Technologies, New providence, NJ, USA) [<xref rid="B17-ijerph-14-01097" ref-type="bibr">17</xref>]. Bivariate analysis examined demographic and other characteristics: age (<25/≥25years), gender, nationality (Polish/other), religion (Roman Catholic—other Christian—Muslim/atheist), being circumcised (yes/no; analysis referred to males only), knowing a circumcised male (yes/no), participant beliefs in MC (such as: MC is a safe procedure: yes/no–not sure; circumcised men feel more intense sexual pleasure than uncircumcised men/less intense—the same; MC increases penis sensitivity/decreases —no effect), knowledge regarding HIV/AIDS (good/mediocre-poor), and knowledge of MC regarding the impact on HIV risk (it is less likely circumcised men become infected with HIV/more likely—don’t know), associated with an outcome variable. For categoric variables, groups were compared using the chi-square test with Yates correction and Fisher’s exact test; the Mann-Whitney test was used for numeric variables. For the predicted outcome variable listed above, a standard single-outcome logistic model was built; the model was reduced with the use of a stepwise selection [<xref rid="B18-ijerph-14-01097" ref-type="bibr">18</xref>]. For main regression analyses, the three possible responses were dichotomized into two categories: willing (yes) or not willing (no—not sure). Regression coefficients in the regression model were used to assess any change in the model. A change in coefficients was compared and used to determine any variable change.</p></sec></sec><sec id="sec4-ijerph-14-01097"><title>4. Results</title><sec id="sec4dot1-ijerph-14-01097"><title>4.1. Demographics</title><p>The response rate was 99.6%, with 539 students (Me of age 25 years, range 22–38 years) participating. Males constituted 40.8% of the sample, Polish nationals—66.8%. The vast majority of students (79.7%) declared being religious: more than half (59.0%) were Roman Catholics, 16.7%—other Christians, 4.5%—Muslims; 19.9% were atheists (<xref ref-type="table" rid="ijerph-14-01097-t001">Table 1</xref>). There were no statistically significant between-gender differences regarding age (<italic>p</italic> = 0.89), nationalities (<italic>p</italic> = 0.36 and <italic>p</italic> = 0.98, respectively, regarding Polish and other students), and religion (<italic>p</italic> = 0.91, <italic>p</italic> = 0.98 and <italic>p</italic> = 0.29 respectively regarding Roman Catholics, other Christians, and atheists). There were significantly more males among Muslims than females (<italic>p</italic> = 0.02).</p></sec><sec id="sec4dot2-ijerph-14-01097"><title>4.2. Circumcision Rates</title><p>Among the 192 men who answered the question, 32 (16.7%) reported being circumcised (<xref ref-type="table" rid="ijerph-14-01097-t001">Table 1</xref>); the percentage was lower among the Polish students as compared to other nationalities (4.6% vs. 42.6%, respectively), <italic>p</italic> < 0.0001. The median of reported age at circumcision was 1.5 years (range 0–26 years). All of the Polish students were circumcised for medical reasons, 61.5% foreign students were circumcised for religious reasons. More than one fourth of participants (29.7%) knew someone who had been circumcised.</p></sec><sec id="sec4dot3-ijerph-14-01097"><title>4.3. Sources of MC Information</title><p>Most frequently students had obtained information on MC from university staff (66.1%), media-radio/TV/newspapers (60.2%), medical personnel (29.4%), and an individual who had been circumcised (28.0%); this was a multiple-choice question.</p></sec><sec id="sec4dot4-ijerph-14-01097"><title>4.4. Beliefs of MC </title><p>Of the 343/539 (63.6%) respondents who answered this question, 295 (86.0%) stated that MC is a safe procedure, 28 (8.2%) answered that it is not safe, 20 (5.8%) were not sure. In terms of the impact on sexual satisfaction, of the 471 participants (87.4%) who responded to this question, 9.1% stated that circumcised men feel more intense sexual pleasure than uncircumcised men, 25.7%—that they feel less intense pleasure, 25.5%—about the same, 39.7%—were unsure. Of the 475 (88.1%) participants who responded to the statement “MC changes the sensitivity of the penis”, 32.2% stated that it decreases sensitivity, 17.5%—that it increases sensitivity, 15.8%—that sensitivity remains about the same, 34.5%—were unsure. Answers to those two questions were correlated (Kendall’s tau-b coefficient r = 0.27, <italic>p</italic> < 0.001).</p></sec><sec id="sec4dot5-ijerph-14-01097"><title>4.5. Knowledge on HIV/AIDS </title><p>The mean score of HIV/AIDS knowledge was 9.49, SD ± 2.2. Two-thirds (n = 359; 66.6%) of the respondents scored more than 75% correct answers, 28 (5.2%)—less than 50%. The majority of students (96.1%) correctly identified mother-to-child transmission (MTCT) as a possible route of HIV transmission, as shown in <xref ref-type="table" rid="ijerph-14-01097-t002">Table 2</xref>. Vaginal receptive intercourse was correctly recognized as not the highest risk in terms of contracting HIV infection by 58.0% of the respondents. The majority of participants (87.4%) were aware that most people with HIV did not show signs of being sick in the first week after infection; and, 71.4% correctly interpreted a positive blood test result. Regarding HIV treatment, 94.8% of respondents had heard about anti-retroviral therapy (ART), the vast majority (71.2–89.4%) correctly answered ART-related questions; only 18.0% correctly marked that globally, ART was not available to almost all of those who needed it. In the overall sample, 95.2% recognized using a condom as a protective measure to prevent HIV infection. </p></sec><sec id="sec4dot6-ijerph-14-01097"><title>4.6. Knowledge on the Association between MC and the Risk of Contracting HIV</title><p>Participants were asked how likely circumcised men become infected with HIV as compared to uncircumcised men. Of the 281 participants who responded to this question, 34.2% stated “less”, 10.3%—“more”, 37.4%—“about the same”, and 18.1%—“don’t know”. Answers to this question were correlated to questions about HIV/AIDS knowledge (Kendall’s tau-b coefficient r = 0.15, <italic>p</italic> < 0.0002).</p></sec><sec id="sec4dot7-ijerph-14-01097"><title>4.7. Willingness to Recommend MC to Adults at Risk of Contracting HIV</title><p>Of 305/539 respondents who answered this question (56.6%), 167 (54.8%) declared they would recommend MC to adults at risk of contracting HIV, 78 (25.6%) would not, and 60 (19.7%) were not sure.</p></sec><sec id="sec4dot8-ijerph-14-01097"><title>4.8. Factors Associated with Students Willingness to Recommend Adult MC </title><p><xref ref-type="table" rid="ijerph-14-01097-t003">Table 3</xref> demonstrates bivariate analyses of determinants for the willingness among final year medical students to recommend MC to adults at high risk for HIV. Poles were on average more willing to discuss (60.9% vs. 41.8%; <italic>p</italic> = 0.003). Among those who believed that circumcised men felt more intense sexual pleasure, more were willing to discuss MC (73.2% vs. 52.2%; <italic>p</italic> = 0.03). Among students with knowledge, MC reduces HIV risk, and more were willing to discuss it with the patient (60.8% vs. 39.0%; <italic>p</italic> = 0.001). Among students familiar with knowledge on MC ex re HIV risk reduction, more were willing to discuss MC (60.8% vs. 39.0%; <italic>p</italic> = 0.001).</p><p>Statistically significant differences between selected determinants are presented in <xref ref-type="fig" rid="ijerph-14-01097-f001">Figure 1</xref>.</p><p>Regression analyses were performed to assess the factors associated with a willingness of the students to recommend adult MC. Those aware that MC reduces HIV risk, as well as those who believed that circumcised men feel more intense sexual pleasure were more willing to recommend the procedure (OR = 2.13 and OR = 3.35, respectively). There was no significant association between student willingness to propose MC and: age, gender, religion, being circumcised, knowing someone who is circumcised, belief that MC is safe or that it increases penis sensitivity, and HIV/AIDS knowledge (<xref ref-type="table" rid="ijerph-14-01097-t004">Table 4</xref>). </p></sec></sec><sec id="sec5-ijerph-14-01097"><title>5. Discussion</title><sec id="sec5dot1-ijerph-14-01097"><title>5.1. Overview of the Results</title><p>One in six male respondents was circumcised, and the rate was nine times higher among foreign students as compared to Polish students. Although overall HIV/AIDS knowledge was high, only about one-third of participants knew that MC reduces the chance of HIV infection. More than half of the respondents declared that they would recommend MC for adult patients with HIV infection risk. Regression analysis revealed that personal belief that circumcised men felt more intense sexual pleasure and knowledge that MC reduces HIV risk were predictors of a willingness to recommend adult MC. </p></sec><sec id="sec5dot2-ijerph-14-01097"><title>5.2. Male Circumcision Rates</title><p>According to most recent estimations, 37–39% of men are circumcised globally; with approximately half of these procedures being carried out for religious/cultural reasons [<xref rid="B9-ijerph-14-01097" ref-type="bibr">9</xref>,<xref rid="B19-ijerph-14-01097" ref-type="bibr">19</xref>]. Morris et al. [<xref rid="B19-ijerph-14-01097" ref-type="bibr">19</xref>] estimated that MC prevalence rates in Europe vary between 0.1–48%, noting higher figures for countries in which males are circumcised for religious reasons. In Poland, where MC is performed mainly to treat adverse medical conditions, the estimated MC prevalence rate is 0.11%, which is the lowest in the EU. However, that estimation is regarded as conservative by the authors. According to our results, about 5% of men were circumcised; all for medical reasons. This is in line with the results of a survey conducted in Denmark (4.5%), where non-medical circumcision is rare [<xref rid="B20-ijerph-14-01097" ref-type="bibr">20</xref>]. MC prevalence rates estimated for other Central European countries vary from very low (Czech Republic, Slovakia, Hungary) to moderately low (Austria, Slovenia, Germany), with the same being true for Scandinavia (3.0–5.3%) [<xref rid="B19-ijerph-14-01097" ref-type="bibr">19</xref>]. High MC prevalence rates observed among foreign students can be explained by a higher number of circumcisions performed for religious reasons.</p></sec><sec id="sec5dot3-ijerph-14-01097"><title>5.3. Knowledge of MC Health Benefits Regarding HIV Infection</title><p>We found that knowledge of HIV/AIDS among final year medical students was high (around two-thirds scored higher than 75% in knowledge level scores). Students gained information about MC from credible sources, including university staff and healthcare personnel. Despite this, most lacked the knowledge of MC and its health benefits regarding HIV infection. Only a third knew that circumcised men were less likely to become infected with HIV, which is alarming, given that prospective doctors should be knowledgeable on the potential benefits of MC. </p><p>The reason for this gap in knowledge might be that, although the issue of MC is well covered by the medical curriculum, the procedure is usually discussed only when studying urology, and therefore students are taught mainly about its medical indications, performance, and complications, rather than its health benefits regarding HIV. A similar lack of knowledge among medical staff was reported previously [<xref rid="B21-ijerph-14-01097" ref-type="bibr">21</xref>,<xref rid="B22-ijerph-14-01097" ref-type="bibr">22</xref>,<xref rid="B23-ijerph-14-01097" ref-type="bibr">23</xref>]. For instance, only 23% of health care providers in the United States correctly answered that MC could reduce HIV acquisition by 60% [<xref rid="B21-ijerph-14-01097" ref-type="bibr">21</xref>].</p></sec><sec id="sec5dot4-ijerph-14-01097"><title>5.4. Willingness to Recommend Adult MC </title><p>This study also illustrates that for medical students, MC is an area that seems to have cultural sensitivity. We have experienced challenges when tackling this subject and the response rate to questions about the willingness to discuss adult MC was surprisingly low. </p><p>In our study, females were less willing to recommend MC, although the differences were not statistically significant. This is in line with the results of a study conducted by Carbery et al. [<xref rid="B21-ijerph-14-01097" ref-type="bibr">21</xref>], who found that a relatively large proportion of American female physicians were not comfortable counseling patients on MC. Many reported they did not understand the benefits and risks well enough to counsel adult men or parents of newborns (one-fourth and more than a half, respectively). The authors suggest that one of the reasons for this gender disparity might be that males identify with the procedure to a greater extent, as a significantly higher percentage of MCs are performed by male physicians. </p><p>Around 35–40% of the students in our study were unsure if MC would increase or decrease sexual pleasure and penis sensitivity, which was also found in other research [<xref rid="B23-ijerph-14-01097" ref-type="bibr">23</xref>]. So far, studies have offered conflicting results regarding MC and sexual pleasure or penile sensitivity [<xref rid="B1-ijerph-14-01097" ref-type="bibr">1</xref>,<xref rid="B24-ijerph-14-01097" ref-type="bibr">24</xref>,<xref rid="B25-ijerph-14-01097" ref-type="bibr">25</xref>,<xref rid="B26-ijerph-14-01097" ref-type="bibr">26</xref>]. However, current high-quality surveys suggest that MC has no adverse effect on sexual function, sensitivity, sexual sensation or satisfaction [<xref rid="B24-ijerph-14-01097" ref-type="bibr">24</xref>,<xref rid="B26-ijerph-14-01097" ref-type="bibr">26</xref>]. This study suggests that personal beliefs influence MC acceptability among future practitioners. The willingness to recommend adult MC was much higher among students who believed that circumcised men felt more intense sexual pleasure. These results do not correspond to AAP recommendations, that physicians should explain the benefits and risks of MC in a nonbiased manner [<xref rid="B6-ijerph-14-01097" ref-type="bibr">6</xref>]. Personal beliefs as determinants of MC acceptance among students could be explained by using the Health Belief Model, in which various psychological factors are to be believed to influence an individual’s decision regarding a beneficial health action [<xref rid="B27-ijerph-14-01097" ref-type="bibr">27</xref>]. The results of this study show that an individual’s assessment of the value of engaging in MC promotion is not necessarily based on its effects in decreasing the risk of HIV transmission, but rather effects which may influence sexual functioning. Probability analysis showed that better knowledge regarding the effect of MC on sexual pleasure might increase the acceptability of MC among healthcare providers [<xref rid="B23-ijerph-14-01097" ref-type="bibr">23</xref>]. </p><p>Sahay et al. [<xref rid="B28-ijerph-14-01097" ref-type="bibr">28</xref>] identified religion as a cohesive force within circumcising (CC) and non-circumcising communities (NCC) in India. According to the authors, non-medical MC is a religious faith based ritual, which results in cohesion and bonding within the practicing community, but also in polarization with opposing views between CC and NCC. However, religion did not emerge as an important determinant of student willingness to counsel on adult MC. Thus, it can be concluded that in northern Europe and Poland, religious practice may not play a role in influencing decisions made by prospective doctors regarding this issue. Even though MC is universally associated with Islam and Judaism and could face challenges in its acceptability among other religious followers, most other religions currently maintain a neutral position on the practice of non-religious circumcision [<xref rid="B9-ijerph-14-01097" ref-type="bibr">9</xref>,<xref rid="B29-ijerph-14-01097" ref-type="bibr">29</xref>]. </p><p>Regarding the HIV epidemic in Europe, the males are the more affected gender [<xref rid="B11-ijerph-14-01097" ref-type="bibr">11</xref>]. Voluntary non-medical adult MC can make a contribution to combination prevention due to its unique features: it is a single event without ongoing adherence challenges that has lifetime direct benefits [<xref rid="B30-ijerph-14-01097" ref-type="bibr">30</xref>,<xref rid="B31-ijerph-14-01097" ref-type="bibr">31</xref>]. However, assuming that adult MC might be promoted at a national level in traditionally non-circumcising countries, several issues should be taken into consideration. Firstly, evidence that MC reduces the risk of contracting HIV infection should be thoroughly studied among countries and also among subgroups, which vary from those reported in RCTs by socioeconomic status, culture, and tradition. It would also be valuable to consider evidence from subgroups that vary in demographics or sexual orientations. </p><p>A literature review of the impact of MC on HIV-related issues is mainly based on RCTs conducted among adult men in Africa [<xref rid="B1-ijerph-14-01097" ref-type="bibr">1</xref>], which revealed that MC reduces the risk of infection with HIV and some STIs in the settings of high HIV and STIs (Sexually Transmitted Infections) endemicity; post-trial follow-up demonstrated that the efficacy of MC to reduce HIV acquisition increased even further over time [<xref rid="B9-ijerph-14-01097" ref-type="bibr">9</xref>]. Further support has been provided by meta-analyses [<xref rid="B32-ijerph-14-01097" ref-type="bibr">32</xref>], effectiveness studies in the implementation of MC [<xref rid="B33-ijerph-14-01097" ref-type="bibr">33</xref>] and biological evidence [<xref rid="B34-ijerph-14-01097" ref-type="bibr">34</xref>]. The African trials results also appear to be relevant to heterosexuals at high risk of STIs in countries with the highest levels of socioeconomic development, as well as among different cultures and traditions [<xref rid="B9-ijerph-14-01097" ref-type="bibr">9</xref>]. Observational studies in the United States involving circumcised heterosexual men have found the protective medical effects of MC consistent with those found in the African trials. For instance, in a study among men with known heterosexual HIV exposure visiting an STI clinic in Baltimore, Maryland, HIV prevalence among uncircumcised men was 22%, but only 10% among circumcised men [<xref rid="B35-ijerph-14-01097" ref-type="bibr">35</xref>]. A recent study by Chemtob et al. has provided much needed evidence demonstrating that MC was associated with reduced HIV acquisition in heterosexuals in Israel—the country in which HIV prevalence is low [<xref rid="B36-ijerph-14-01097" ref-type="bibr">36</xref>]. </p><p>Socioeconomic factors may influence circumcision prevalence, especially in countries with a more recent uptake of the practice. Studies conducted in England, the United States, and Australia found that the rate of MC was associated with higher levels of education and income. Low circumcision prevalence was observed among recent immigrants, many of whom were more likely to be of lower socioeconomic status [<xref rid="B37-ijerph-14-01097" ref-type="bibr">37</xref>]. Further studies from traditionally non-circumcising European countries are needed to better assess this issue. </p><p>Regarding other sexual orientations, it is unknown whether MC prevents HIV acquisition in MSM, although there might be a protective effect for men who engage mainly in insertive anal intercourse [<xref rid="B1-ijerph-14-01097" ref-type="bibr">1</xref>]. The International Antiviral Society-USA suggests that circumcision be discussed with MSM who primarily engage in insertive anal sex, especially in areas where HIV is common [<xref rid="B38-ijerph-14-01097" ref-type="bibr">38</xref>]. Existing work suggests that MC for MSM should reach its maximum potential in settings where HIV incidence among MSM is high, reported willingness for prophylactic circumcision is high, and pre-existing circumcision rates are low [<xref rid="B39-ijerph-14-01097" ref-type="bibr">39</xref>]. Further analysis is needed to properly address this challenging issue in the European region. The potential impact and cost-effectiveness of voluntary MC are not uniform and vary by age of circumcised males [<xref rid="B40-ijerph-14-01097" ref-type="bibr">40</xref>]. Therefore, studies based on mathematical models should be initiated to help examine the potential effects on programme impact and the cost-effectiveness of prioritizing specific subpopulations by age [<xref rid="B30-ijerph-14-01097" ref-type="bibr">30</xref>,<xref rid="B40-ijerph-14-01097" ref-type="bibr">40</xref>]. </p><p>It is important that prospective doctors have the knowledge needed to counsel adult men being at risk of HIV infection. Given the observed lack of knowledge among students about MC health benefits, it could be concluded that one of the main barriers to scaling up the procedure identified in this study, might be the healthcare professionals themselves. Having adequate knowledge was significantly associated with student support for adult MC, which is in line with the results of a previous study carried out among physicians [<xref rid="B21-ijerph-14-01097" ref-type="bibr">21</xref>]. </p></sec></sec><sec id="sec6-ijerph-14-01097"><title>6. Limitations</title><p>There were several potential limitations to the study. Firstly, the response rate regarding outcome variables was less than 100%, which may have resulted in a response bias. Secondly, not all of the relevant variables may have been measured; for instance, to study participant views on patient anxiety regarding the procedure would be of value. Furthermore, the sample is drawn from one medical university, and therefore, limits the generalizability outside of the studied population. The study presents hypothetical conditions that might not guarantee that students would be willing to propose MC in real life circumstances. However, the strength of the study lays in its pioneering character and the diversity of its respondents, who spanned multiple European countries, with different cultures and religions.</p></sec><sec id="sec7-ijerph-14-01097"><title>7. Conclusions</title><p>Any strategy that reduces HIV infection risk should be recommended. There is still room for further investigation of the potential impact and cost-effectiveness of voluntary adult MC in countries with low HIV prevalence. Still, independent studies have so far demonstrated considerable benefits of MC regarding heterosexual HIV prevention and a protective effect among MSM who predominantly practice insertive anal intercourse [<xref rid="B1-ijerph-14-01097" ref-type="bibr">1</xref>]. While voluntary MC should attract little opposition in developed countries that enjoy a cultural or religious tradition of MC [<xref rid="B31-ijerph-14-01097" ref-type="bibr">31</xref>,<xref rid="B35-ijerph-14-01097" ref-type="bibr">35</xref>,<xref rid="B36-ijerph-14-01097" ref-type="bibr">36</xref>], it might be met with skepticism in some European countries where cultural bias against MC persists, also among health care professionals [<xref rid="B10-ijerph-14-01097" ref-type="bibr">10</xref>,<xref rid="B26-ijerph-14-01097" ref-type="bibr">26</xref>,<xref rid="B41-ijerph-14-01097" ref-type="bibr">41</xref>].</p><p>This study has disclosed challenges in implementing this prevention modality in the North European region and Poland. More than half of the final year medical students declared that they would recommend MC for adult patients at HIV risk. It is a significant finding, given that physicians are often perceived as a credible source of information when making decisions about health care [<xref rid="B21-ijerph-14-01097" ref-type="bibr">21</xref>]; this refers also to MC [<xref rid="B28-ijerph-14-01097" ref-type="bibr">28</xref>]. </p><p>Although medical students presented a good level of HIV/AIDS knowledge overall, they seem to be poorly trained in the benefits of MC regarding HIV risk reduction. Their willingness to discuss MC was often dependent on personal beliefs rather than scientific information. Given that the knowledgeable students were more willing to discuss MC, it is vital to provide additional evidence-based information about the procedure. That should bring about an attitudinal change and help prospective physicians feel more comfortable discussing MC with adult patients at risk of HIV. Medical curriculum should be revised to encourage topics related to MC as a strategy that reduces HIV risk. </p><p>Our study, which is a preliminary report, encourages further analyses based on prospective studies conducted among additional groups of medical professionals, such as other medical university students, physicians, and nurses, possibly with the active involvement of other countries in the region.</p></sec></body><back><ack><title>Acknowledgments</title><p>The authors would like to thank final year medical students from the Pomeranian Medical University for sharing their views and sensitive information. We would also like to sincerely thank Mathew Westercamp from the University of Illinois, Chicago, USA, for his permission to use his standardized questionnaire and warm encouragement. </p></ack><notes><title>Author Contributions</title><p>Maria Ganczak together with Maciej Olszewski were involved in conception and design of the study. Maciej Olszewski made contributions to acquisition of data. Marcin Korzeń analyzed the data together with Maria Ganczak and Maciej Olszewski. Maria Ganczak was involved in literature search, in drafting the manuscript and finalizing the version to be published. All authors read and approved the final manuscript.</p></notes><notes notes-type="COI-statement"><title>Conflicts of Interest</title><p>The authors declare no conflict of interests.</p></notes><ref-list><title>References</title><ref id="B1-ijerph-14-01097"><label>1.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Friedman</surname><given-names>B.</given-names></name><name><surname>Khoury</surname><given-names>J.</given-names></name><name><surname>Petersiel</surname><given-names>N.</given-names></name><name><surname>Yahalomi</surname><given-names>T.</given-names></name><name><surname>Paul</surname><given-names>M.</given-names></name><name><surname>Neuberger</surname><given-names>A.</given-names></name></person-group><article-title>Pros and cons of circumcision: An evidence-based overview</article-title><source>Clin. Microbiol. Infect.</source><year>2016</year><volume>22</volume><fpage>768</fpage><lpage>774</lpage><pub-id pub-id-type="doi">10.1016/j.cmi.2016.07.030</pub-id><pub-id pub-id-type="pmid">27497811</pub-id></element-citation></ref><ref id="B2-ijerph-14-01097"><label>2.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Weiss</surname><given-names>H.A.</given-names></name><name><surname>Thomas</surname><given-names>S.L.</given-names></name><name><surname>Munabi</surname><given-names>S.K.</given-names></name><name><surname>Hayes</surname><given-names>R.J.</given-names></name></person-group><article-title>Male circumcision and risk of syphilis, chancroid, and genital herpes: A systematic review and meta-analysis</article-title><source>Sex. Transm. Infect.</source><year>2006</year><volume>82</volume><fpage>101</fpage><lpage>110</lpage><pub-id pub-id-type="doi">10.1136/sti.2005.017442</pub-id><pub-id pub-id-type="pmid">16581731</pub-id></element-citation></ref><ref id="B3-ijerph-14-01097"><label>3.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Zhu</surname><given-names>Y.P.</given-names></name><name><surname>Jia</surname><given-names>Z.W.</given-names></name><name><surname>Dai</surname><given-names>B.</given-names></name><name><surname>Ye</surname><given-names>D.W.</given-names></name><name><surname>Kong</surname><given-names>Y.Y.</given-names></name><name><surname>Chang</surname><given-names>K.</given-names></name><name><surname>Wang</surname><given-names>Y.</given-names></name></person-group><article-title>Relationship between circumcision and human papillomavirus infection: A systematic review and meta-analysis</article-title><source>Asian J. Androl.</source><year>2017</year><volume>19</volume><fpage>125</fpage><lpage>131</lpage><pub-id pub-id-type="doi">10.4103/1008-682X.175092</pub-id><pub-id pub-id-type="pmid">26975489</pub-id></element-citation></ref><ref id="B4-ijerph-14-01097"><label>4.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kilmarx</surname><given-names>P.H.</given-names></name><name><surname>Kretsinger</surname><given-names>K.</given-names></name><name><surname>Millett</surname><given-names>G.A.</given-names></name></person-group><article-title>Considerations in the role of male circumcision in the prevention of HIV transmission in the USA</article-title><source>HIV Ther.</source><year>2009</year><volume>3</volume><fpage>241</fpage><lpage>254</lpage><pub-id pub-id-type="doi">10.2217/hiv.09.6</pub-id></element-citation></ref><ref id="B5-ijerph-14-01097"><label>5.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kim</surname><given-names>H.H.</given-names></name><name><surname>Li</surname><given-names>P.S.</given-names></name><name><surname>Goldstein</surname><given-names>M.</given-names></name></person-group><article-title>Male circumcision: Africa and beyond?</article-title><source>Curr. Opin. Urol.</source><year>2010</year><volume>20</volume><fpage>515</fpage><lpage>519</lpage><pub-id pub-id-type="doi">10.1097/MOU.0b013e32833f1b21</pub-id><pub-id pub-id-type="pmid">20844437</pub-id></element-citation></ref><ref id="B6-ijerph-14-01097"><label>6.</label><element-citation publication-type="journal"><person-group person-group-type="author"><collab>American Academy of Pediatrics</collab></person-group><article-title>Task Force on Circumcision. Circumcision policy statement</article-title><source>Pediatrics</source><year>2012</year><volume>130</volume><fpage>585</fpage><lpage>586</lpage><pub-id pub-id-type="pmid">22926180</pub-id></element-citation></ref><ref id="B7-ijerph-14-01097"><label>7.</label><element-citation publication-type="gov"><person-group person-group-type="author"><collab>Centers for Disease Control and Prevention</collab></person-group><article-title>Recommendations for Providers Counseling Male Patients and Parents Regarding Male Circumcision and the Prevention of HIV Infection, STIs, and Other Health Outcomes</article-title><comment>Available online: <ext-link ext-link-type="uri" xlink:href="https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/mc-factsheet-508pdf">https:// www.cdc.gov/nchhstp/newsroom/ docs/ factsheets/mc-factsheet-508pdf</ext-link></comment><date-in-citation content-type="access-date" iso-8601-date="2017-05-13">(accessed on 13 May 2017)</date-in-citation></element-citation></ref><ref id="B8-ijerph-14-01097"><label>8.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Morris</surname><given-names>B.J.</given-names></name><name><surname>Kennedy</surname><given-names>S.E.</given-names></name><name><surname>Wodak</surname><given-names>A.D.</given-names></name><name><surname>Mindel</surname><given-names>A.</given-names></name><name><surname>Golovsky</surname><given-names>D.</given-names></name><name><surname>Schrieber</surname><given-names>L.</given-names></name><name><surname>Lumbers</surname><given-names>E.R.</given-names></name><name><surname>Handelsman</surname><given-names>D.J.</given-names></name><name><surname>Ziegler</surname><given-names>J.B.</given-names></name></person-group><article-title>Early infant male circumcision: Systematic review, risk-benefit analysis, and progress in policy</article-title><source>World J. Clin. Pediatr.</source><year>2017</year><volume>6</volume><fpage>89</fpage><lpage>102</lpage><pub-id pub-id-type="doi">10.5409/wjcp.v6.i1.89</pub-id><pub-id pub-id-type="pmid">28224100</pub-id></element-citation></ref><ref id="B9-ijerph-14-01097"><label>9.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Tobian</surname><given-names>A.A.</given-names></name><name><surname>Kacker</surname><given-names>S.</given-names></name><name><surname>Quinn</surname><given-names>T.C.</given-names></name></person-group><article-title>Male circumcision: A globally relevant but under-utilized method for the prevention of HIV and other sexually transmitted infections</article-title><source>Annu. Rev. Med.</source><year>2014</year><volume>65</volume><fpage>293</fpage><lpage>306</lpage><pub-id pub-id-type="doi">10.1146/annurev-med-092412-090539</pub-id><pub-id pub-id-type="pmid">24111891</pub-id></element-citation></ref><ref id="B10-ijerph-14-01097"><label>10.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Rogowska-Szadkowska</surname><given-names>D.</given-names></name></person-group><article-title>Letter to the editor: Is adult male circumcision a viable public health strategy for HIV prevention outside sub-saharan Africa?</article-title><source>AIDS Patient Care STDs</source><year>2010</year><volume>24</volume><fpage>751</fpage><lpage>752</lpage><pub-id pub-id-type="doi">10.1089/apc.2010.0253</pub-id><pub-id pub-id-type="pmid">21091227</pub-id></element-citation></ref><ref id="B11-ijerph-14-01097"><label>11.</label><element-citation publication-type="web"><person-group person-group-type="author"><collab>European Centre for Disease Prevention and Control/WHO Regional Office for Europe</collab></person-group><article-title>HIV/AIDS Surveillance in Europe. Stockholm ECDC 2016</article-title><comment>Available online: <ext-link ext-link-type="uri" xlink:href="http://www.euro.who.int/__data/assets/pdf_file/0019/324370/HIV-AIDS-surveillance-Europe2015.pdf?ua=1">http://www.euro.who.int/__data/assets/pdf_file/0019/324370/HIV-AIDS-surveillance-Europe 2015.pdf?ua=1</ext-link></comment><date-in-citation content-type="access-date" iso-8601-date="2017-09-03">(accessed on 3 September 2017)</date-in-citation></element-citation></ref><ref id="B12-ijerph-14-01097"><label>12.</label><element-citation publication-type="web"><person-group person-group-type="author"><collab>UNAIDS AIDSInfo Map</collab></person-group><article-title>People Living with HIV-Prevalence</article-title><comment>Available online: <ext-link ext-link-type="uri" xlink:href="http://aidsinfo.unaids.org">http://aidsinfo.unaids.org</ext-link></comment><date-in-citation content-type="access-date" iso-8601-date="2017-05-27">(accessed on 27 May 2017)</date-in-citation></element-citation></ref><ref id="B13-ijerph-14-01097"><label>13.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Niedźwiedzka-Stadnik</surname><given-names>M.</given-names></name><name><surname>Pielacha</surname><given-names>M.</given-names></name><name><surname>Rosińska</surname><given-names>M.</given-names></name></person-group><article-title>HIV and AIDS in Poland in 2014</article-title><source>Przegl. Epidemiol.</source><year>2016</year><volume>70</volume><fpage>249</fpage><lpage>259</lpage><pub-id pub-id-type="pmid">27822949</pub-id></element-citation></ref><ref id="B14-ijerph-14-01097"><label>14.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Xu</surname><given-names>X.</given-names></name><name><surname>Patel</surname><given-names>D.A.</given-names></name><name><surname>Dalton</surname><given-names>V.K.</given-names></name><name><surname>Pearlman</surname><given-names>M.D.</given-names></name><name><surname>Johnson</surname><given-names>T.R.</given-names></name></person-group><article-title>Can routine neonatal circumcision help prevent human immunodeficiency virus transmission in the United States?</article-title><source>Am. J. Mens. Health</source><year>2009</year><volume>3</volume><fpage>79</fpage><lpage>84</lpage><pub-id pub-id-type="doi">10.1177/1557988308323616</pub-id><pub-id pub-id-type="pmid">19430583</pub-id></element-citation></ref><ref id="B15-ijerph-14-01097"><label>15.</label><element-citation publication-type="web"><article-title>Circumcision in Poland</article-title><comment>Available online: <ext-link ext-link-type="uri" xlink:href="http://obrzezanie.pl/obrzezanie-w-polsce.html">http://obrzezanie.pl/obrzezanie-w-polsce.html</ext-link></comment><date-in-citation content-type="access-date" iso-8601-date="2017-05-17">(accessed on 17 May 2017)</date-in-citation></element-citation></ref><ref id="B16-ijerph-14-01097"><label>16.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Westercamp</surname><given-names>M.</given-names></name><name><surname>Agot</surname><given-names>K.E.</given-names></name><name><surname>Ndinya-Achola</surname><given-names>J.</given-names></name><name><surname>Bailey</surname><given-names>R.C.</given-names></name></person-group><article-title>Circumcision preference among women and uncircumcised men prior to scale-up of male circumcision for HIV prevention in Kisumu, Kenya</article-title><source>AIDS Care</source><year>2012</year><volume>24</volume><fpage>157</fpage><lpage>166</lpage><pub-id pub-id-type="doi">10.1080/09540121.2011.597944</pub-id><pub-id pub-id-type="pmid">21854351</pub-id></element-citation></ref><ref id="B17-ijerph-14-01097"><label>17.</label><element-citation publication-type="book"><person-group person-group-type="author"><collab>R Development Core Team</collab></person-group><article-title>A Language and Environment for Statistical Computing. R Foundation for Statistical Computing. Mining the Most Interesting Rules</article-title><publisher-loc>Vienna, Austria</publisher-loc><year>2015</year><comment>Available online: <ext-link ext-link-type="uri" xlink:href="http://www.R-project.org">http://www.R-project.org</ext-link></comment><date-in-citation content-type="access-date" iso-8601-date="2017-05-10">(accessed on 10 May 2017)</date-in-citation></element-citation></ref><ref id="B18-ijerph-14-01097"><label>18.</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Venables</surname><given-names>W.N.</given-names></name><name><surname>Ripley</surname><given-names>B.D.</given-names></name></person-group><source>Modern Applied Statistics with S</source><publisher-name>Springer</publisher-name><publisher-loc>New York, NY, USA</publisher-loc><year>2002</year></element-citation></ref><ref id="B19-ijerph-14-01097"><label>19.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Morris</surname><given-names>B.J.</given-names></name><name><surname>Wamai</surname><given-names>R.G.</given-names></name><name><surname>Henebeng</surname><given-names>E.B.</given-names></name><name><surname>Tobian</surname><given-names>A.A.</given-names></name><name><surname>Klausner</surname><given-names>J.D.</given-names></name><name><surname>Banerjee</surname><given-names>J.</given-names></name><name><surname>Hankins</surname><given-names>C.A.</given-names></name></person-group><article-title>Estimation of country-specific and global prevalence of male circumcision</article-title><source>Popul. Health Metr.</source><year>2016</year><volume>14</volume><fpage>11</fpage><pub-id pub-id-type="doi">10.1186/s12963-016-0080-6</pub-id><pub-id pub-id-type="pmid">27051352</pub-id></element-citation></ref><ref id="B20-ijerph-14-01097"><label>20.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Frisch</surname><given-names>M.</given-names></name><name><surname>Lindholm</surname><given-names>M.</given-names></name><name><surname>Grønbeck</surname><given-names>M.</given-names></name></person-group><article-title>Male circumcision and sexual function in men and women: A survey-based-cross-sectional study in Denmark</article-title><source>Int. J. Epidemiol.</source><year>2011</year><volume>40</volume><fpage>1367</fpage><lpage>1381</lpage><pub-id pub-id-type="doi">10.1093/ije/dyr104</pub-id><pub-id pub-id-type="pmid">21672947</pub-id></element-citation></ref><ref id="B21-ijerph-14-01097"><label>21.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Carbery</surname><given-names>B.</given-names></name><name><surname>Zhu</surname><given-names>J.</given-names></name><name><surname>Gust</surname><given-names>D.A.</given-names></name><name><surname>Chen</surname><given-names>R.T.</given-names></name><name><surname>Kretsinger</surname><given-names>K.</given-names></name><name><surname>Kilmarx</surname><given-names>P.H.</given-names></name></person-group><article-title>Need for physician education on the benefits and risks of male circumcision in the United States</article-title><source>AIDS Educ. Prev.</source><year>2012</year><volume>24</volume><fpage>377</fpage><lpage>387</lpage><pub-id pub-id-type="doi">10.1521/aeap.2012.24.4.377</pub-id><pub-id pub-id-type="pmid">22827906</pub-id></element-citation></ref><ref id="B22-ijerph-14-01097"><label>22.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Castro</surname><given-names>J.G.</given-names></name><name><surname>Jones</surname><given-names>D.L.</given-names></name><name><surname>Lopez</surname><given-names>M.</given-names></name><name><surname>Barradas</surname><given-names>I.</given-names></name><name><surname>Weiss</surname><given-names>S.M.</given-names></name></person-group><article-title>Making the case for circumcision as a public health strategy: Opening the dialogue</article-title><source>AIDS Patient Care STDs</source><year>2010</year><volume>24</volume><fpage>367</fpage><lpage>372</lpage><pub-id pub-id-type="doi">10.1089/apc.2009.0353</pub-id><pub-id pub-id-type="pmid">20565321</pub-id></element-citation></ref><ref id="B23-ijerph-14-01097"><label>23.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Dévieux</surname><given-names>J.G.</given-names></name><name><surname>Saxena</surname><given-names>A.</given-names></name><name><surname>Rosenberg</surname><given-names>R.</given-names></name><name><surname>Klausner</surname><given-names>J.D.</given-names></name><name><surname>Jean-Gilles</surname><given-names>M.</given-names></name><name><surname>Madhivanan</surname><given-names>P.</given-names></name><name><surname>Gaston</surname><given-names>S.</given-names></name><name><surname>Rubens</surname><given-names>M.</given-names></name><name><surname>Theodore</surname><given-names>H.</given-names></name><name><surname>Deschamps</surname><given-names>M.M.</given-names></name><etal></etal></person-group><article-title>Knowledge, attitudes, practices and beliefs about medical male circumcision (MMC) among a sample of health care providers in Haiti</article-title><source>PLoS ONE</source><year>2015</year><volume>10</volume><elocation-id>e0134667</elocation-id><pub-id pub-id-type="doi">10.1371/journal.pone.0134667</pub-id><pub-id pub-id-type="pmid">26237217</pub-id></element-citation></ref><ref id="B24-ijerph-14-01097"><label>24.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Morris</surname><given-names>B.J.</given-names></name><name><surname>Krieger</surname><given-names>J.N.</given-names></name></person-group><article-title>Does male circumcision affect sexual function, sensitivity, or satisfaction—A systematic review</article-title><source>J. Sex. Med.</source><year>2013</year><volume>10</volume><fpage>2644</fpage><lpage>2657</lpage><pub-id pub-id-type="doi">10.1111/jsm.12293</pub-id><pub-id pub-id-type="pmid">23937309</pub-id></element-citation></ref><ref id="B25-ijerph-14-01097"><label>25.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Cox</surname><given-names>G.</given-names></name><name><surname>Krieger</surname><given-names>J.N.</given-names></name><name><surname>Morris</surname><given-names>B.J.</given-names></name></person-group><article-title>Histological correlates of penile sexual sensation: Does circumcision make a difference?</article-title><source>Sex. Med.</source><year>2015</year><volume>3</volume><fpage>76</fpage><lpage>85</lpage><pub-id pub-id-type="doi">10.1002/sm2.67</pub-id><pub-id pub-id-type="pmid">26185672</pub-id></element-citation></ref><ref id="B26-ijerph-14-01097"><label>26.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Shabanzadeh</surname><given-names>D.M.</given-names></name><name><surname>Düring</surname><given-names>S.</given-names></name><name><surname>Frimodt-Møller</surname><given-names>C.</given-names></name></person-group><article-title>Male circumcision does not result in inferior perceived male sexual function—A systematic review</article-title><source>Dan. Med. J.</source><year>2016</year><volume>63</volume><fpage>A5245</fpage><pub-id pub-id-type="pmid">27399981</pub-id></element-citation></ref><ref id="B27-ijerph-14-01097"><label>27.</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Glanz</surname><given-names>K.</given-names></name><name><surname>Rimer</surname><given-names>B.K.</given-names></name><name><surname>Viswanath</surname><given-names>K.</given-names></name></person-group><source>Health Behavior and Health Education: Theory, Research, and Practice</source><edition>4th ed.</edition><publisher-name>Jossey-Bass</publisher-name><publisher-loc>San Francisco, CA, USA</publisher-loc><year>2008</year></element-citation></ref><ref id="B28-ijerph-14-01097"><label>28.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sahay</surname><given-names>S.</given-names></name><name><surname>Nagarajan</surname><given-names>K.</given-names></name><name><surname>Mehendale</surname><given-names>S.</given-names></name><name><surname>Deb</surname><given-names>S.</given-names></name><name><surname>Gupta</surname><given-names>A.</given-names></name><name><surname>Bharat</surname><given-names>S.</given-names></name><name><surname>Kumar</surname><given-names>A.B.</given-names></name><name><surname>Kanthe</surname><given-names>V.</given-names></name><name><surname>Sinha</surname><given-names>A.</given-names></name><name><surname>Chandhiok</surname><given-names>N.</given-names></name></person-group><article-title>Community and healthcare providers’ perspectives on male circumcision: A multi-centric qualitative study in India</article-title><source>PLoS ONE</source><year>2014</year><volume>9</volume><elocation-id>e91213</elocation-id><pub-id pub-id-type="doi">10.1371/journal.pone.0091213</pub-id><pub-id pub-id-type="pmid">24614575</pub-id></element-citation></ref><ref id="B29-ijerph-14-01097"><label>29.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Slosar</surname><given-names>J.P.</given-names></name><name><surname>O’Brien</surname><given-names>D.</given-names></name></person-group><article-title>The ethics of neonatal male circumcision: A catholic perspective</article-title><source>Am. J. Bioeth.</source><year>2003</year><volume>3</volume><fpage>62</fpage><lpage>64</lpage><pub-id pub-id-type="doi">10.1162/152651603766436306</pub-id><pub-id pub-id-type="pmid">12859824</pub-id></element-citation></ref><ref id="B30-ijerph-14-01097"><label>30.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hankins</surname><given-names>C.</given-names></name><name><surname>Warren</surname><given-names>M.</given-names></name><name><surname>Njeuhmel</surname><given-names>E.</given-names></name></person-group><article-title>Voluntary medical male circumcision for HIV prevention: New mathematical models for strategic demand creation prioritizing sub-populations by age and geography</article-title><source>PLoS ONE</source><year>2016</year><volume>11</volume><elocation-id>e0160699</elocation-id><pub-id pub-id-type="doi">10.1371/journal.pone.0160699</pub-id><pub-id pub-id-type="pmid">27783613</pub-id></element-citation></ref><ref id="B31-ijerph-14-01097"><label>31.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Morris</surname><given-names>B.J.</given-names></name><name><surname>Klausner</surname><given-names>J.D.</given-names></name></person-group><article-title>In developed countries male circumcision prevalence is inversely related to HIV prevalence</article-title><source>Isr. J. Health Policy Res.</source><year>2015</year><volume>4</volume><fpage>40</fpage><pub-id pub-id-type="doi">10.1186/s13584-015-0034-7</pub-id><pub-id pub-id-type="pmid">26269739</pub-id></element-citation></ref><ref id="B32-ijerph-14-01097"><label>32.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Siegfied</surname><given-names>N.</given-names></name><name><surname>Muller</surname><given-names>M.</given-names></name><name><surname>Deeks</surname><given-names>J.J.</given-names></name><name><surname>Volmink</surname><given-names>J.</given-names></name></person-group><article-title>Male circumcision for prevention of heterosexual acquisition in men</article-title><source>Cochrane Database Syst. Rev.</source><year>2009</year><pub-id pub-id-type="doi">10.1002/14651858.CD003362.pub2</pub-id></element-citation></ref><ref id="B33-ijerph-14-01097"><label>33.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Auvert</surname><given-names>B.</given-names></name><name><surname>Taljaard</surname><given-names>D.</given-names></name><name><surname>Rech</surname><given-names>D.</given-names></name><name><surname>Lissouba</surname><given-names>P.</given-names></name><name><surname>Singh</surname><given-names>B.</given-names></name><name><surname>Bouscaillou</surname><given-names>J.</given-names></name><name><surname>Peytavin</surname><given-names>G.</given-names></name><name><surname>Mahiane</surname><given-names>S.G.</given-names></name><name><surname>Sitta</surname><given-names>R.</given-names></name><name><surname>Puren</surname><given-names>A.</given-names></name><etal></etal></person-group><article-title>Association of the ANRS-12126 male circumcision project with HIV levels among men in a South African township: Evaluation of effectiveness using cross-sectional surveys</article-title><source>PLoS Med.</source><year>2013</year><pub-id pub-id-type="doi">10.1371/journal.pmed.1001509</pub-id><pub-id pub-id-type="pmid">24019763</pub-id></element-citation></ref><ref id="B34-ijerph-14-01097"><label>34.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Morris</surname><given-names>B.J.</given-names></name><name><surname>Wamai</surname><given-names>R.G.</given-names></name></person-group><article-title>Biological basis for the protective effect conferred by male circumcision against HIV infection</article-title><source>Int. J. STD AIDS</source><year>2012</year><pub-id pub-id-type="doi">10.1258/ijsa.2011.011228</pub-id><pub-id pub-id-type="pmid">22581866</pub-id></element-citation></ref><ref id="B35-ijerph-14-01097"><label>35.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Warner</surname><given-names>L.</given-names></name><name><surname>Ghanem</surname><given-names>K.G.</given-names></name><name><surname>Newman</surname><given-names>D.R.</given-names></name><name><surname>Macaluso</surname><given-names>M.</given-names></name><name><surname>Sullivan</surname><given-names>P.S.</given-names></name><name><surname>Erbelding</surname><given-names>E.J.</given-names></name></person-group><article-title>Male circumcision and risk of HIV infection among heterosexual African American men attending Baltimore sexually transmitted disease clinics</article-title><source>J. Infect. Dis.</source><year>2009</year><volume>199</volume><fpage>59</fpage><lpage>65</lpage><pub-id pub-id-type="doi">10.1086/595569</pub-id><pub-id pub-id-type="pmid">19086815</pub-id></element-citation></ref><ref id="B36-ijerph-14-01097"><label>36.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chemtob</surname><given-names>D.</given-names></name><name><surname>Op de Coul</surname><given-names>E.</given-names></name><name><surname>van Sighem</surname><given-names>A.</given-names></name><name><surname>Mor</surname><given-names>Z.</given-names></name><name><surname>Cazein</surname><given-names>F.</given-names></name><name><surname>Semaille</surname><given-names>C.</given-names></name></person-group><article-title>Impact of male circumcision among heterosexual HIV cases: Comparisons between three low HIV prevalence countries</article-title><source>Isr. J. Health Policy Res.</source><year>2015</year><volume>4</volume><fpage>36</fpage><pub-id pub-id-type="doi">10.1186/s13584-015-0033-8</pub-id><pub-id pub-id-type="pmid">26244087</pub-id></element-citation></ref><ref id="B37-ijerph-14-01097"><label>37.</label><element-citation publication-type="book"><person-group person-group-type="author"><collab>Joint United Nations Programme on HIV/AIDS, World Health Organization</collab></person-group><source>Male Circumcision: Global Trends and Determinants of Prevalence, Safety, and Acceptability</source><publisher-name>World Health Organization, UNAIDS</publisher-name><publisher-loc>Geneva, Switzerland</publisher-loc><year>2008</year></element-citation></ref><ref id="B38-ijerph-14-01097"><label>38.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Marrazzo</surname><given-names>J.M.</given-names></name><name><surname>del Rio</surname><given-names>C.</given-names></name><name><surname>Holtgrave</surname><given-names>D.R.</given-names></name><name><surname>Cohen</surname><given-names>M.S.</given-names></name><name><surname>Kalichman</surname><given-names>S.C.</given-names></name><name><surname>Mayer</surname><given-names>K.H.</given-names></name><name><surname>Montaner</surname><given-names>J.S.</given-names></name><name><surname>Wheeler</surname><given-names>D.P.</given-names></name><name><surname>Grant</surname><given-names>R.M.</given-names></name><name><surname>Grinsztejn</surname><given-names>B.</given-names></name><etal></etal></person-group><article-title>International antiviral society-USA, panel. HIV prevention in clinical care settings: 2014 recommendations of the international antiviral society-USA panel</article-title><source>JAMA</source><year>2014</year><volume>312</volume><fpage>390</fpage><lpage>409</lpage><pub-id pub-id-type="doi">10.1001/jama.2014.7999</pub-id><pub-id pub-id-type="pmid">25038358</pub-id></element-citation></ref><ref id="B39-ijerph-14-01097"><label>39.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Goodreau</surname><given-names>S.M.</given-names></name><name><surname>Carnegie</surname><given-names>N.B.</given-names></name><name><surname>Vittinghoff</surname><given-names>E.</given-names></name><name><surname>Lama</surname><given-names>J.R.</given-names></name><name><surname>Fuchs</surname><given-names>J.D.</given-names></name><name><surname>Sanchez</surname><given-names>J.</given-names></name><name><surname>Buchbinder</surname><given-names>S.P.</given-names></name></person-group><article-title>Can male circumcision have an impact on the HIV epidemic in men who have sex with men?</article-title><source>PLoS ONE</source><year>2014</year><volume>9</volume><elocation-id>e102960</elocation-id><pub-id pub-id-type="doi">10.1371/journal.pone.0102960</pub-id><pub-id pub-id-type="pmid">25076493</pub-id></element-citation></ref><ref id="B40-ijerph-14-01097"><label>40.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kripke</surname><given-names>K.</given-names></name><name><surname>Okello</surname><given-names>V.</given-names></name><name><surname>Maziya</surname><given-names>V.</given-names></name><name><surname>Benzerga</surname><given-names>W.</given-names></name><name><surname>Mirira</surname><given-names>M.</given-names></name><name><surname>Gold</surname><given-names>E.</given-names></name><name><surname>Schnure</surname><given-names>M.</given-names></name><name><surname>Sgaier</surname><given-names>S.</given-names></name><name><surname>Castor</surname><given-names>D.</given-names></name><name><surname>Reed</surname><given-names>J.</given-names></name><etal></etal></person-group><article-title>Voluntary medical male circumcision for HIV prevention in Swaziland: Modeling the impact of age targeting</article-title><source>PLoS ONE</source><year>2016</year><volume>11</volume><elocation-id>e0156776</elocation-id><pub-id pub-id-type="doi">10.1371/journal.pone.0156776</pub-id><pub-id pub-id-type="pmid">27410687</pub-id></element-citation></ref><ref id="B41-ijerph-14-01097"><label>41.</label><element-citation publication-type="journal"><person-group person-group-type="author"><collab>Task Force on Circumcision</collab></person-group><article-title>Cultural bias and circumcision: The AAP task force on circumcision responds</article-title><source>Pediatrics</source><year>2013</year><volume>131</volume><fpage>801</fpage><lpage>804</lpage><pub-id pub-id-type="pmid">23509171</pub-id></element-citation></ref></ref-list></back><floats-group><fig id="ijerph-14-01097-f001" orientation="portrait" position="float"><label>Figure 1</label><caption><p>Willingness to recommend male circumcision (MC) to adults at high risk for HIV by nationality, belief that circumcised men experience more sexual pleasure, and knowledge about HIV/AIDS.</p></caption><graphic xlink:href="ijerph-14-01097-g001"></graphic></fig><table-wrap id="ijerph-14-01097-t001" orientation="portrait" position="float"><object-id pub-id-type="pii">ijerph-14-01097-t001_Table 1</object-id><label>Table 1</label><caption><p>Demographic characteristics of the participants, Poland, 2013–2016; n = 539.</p></caption><table frame="hsides" rules="groups"><thead><tr><th rowspan="2" align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" colspan="1">Variable</th><th colspan="2" align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1">Total</th><th colspan="2" align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1">Males</th><th colspan="2" align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1">Females</th><th rowspan="2" align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" colspan="1"><italic>p</italic> *</th></tr><tr><th align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">N
<break></break>539</th><th align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">%
<break></break>100</th><th align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">n
<break></break>220</th><th align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">%
<break></break>40.8</th><th align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">n
<break></break>319</th><th align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">%
<break></break>59.2</th></tr></thead><tbody><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Age (Me)<break></break>Range</td><td colspan="2" align="center" valign="middle" style="border-bottom:solid thin" rowspan="1">25
<break></break>22–38</td><td colspan="2" align="center" valign="middle" style="border-bottom:solid thin" rowspan="1">25
<break></break>22–35</td><td colspan="2" align="center" valign="middle" style="border-bottom:solid thin" rowspan="1">25
<break></break>22–38</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">0.89</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Gender</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"> Male</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">220</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">40.8</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">-</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">-</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">-</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">-</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">-</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"> Female </td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">319</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">59.2</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">-</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">-</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">-</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">-</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">-</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Nationality</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"> Polish</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">360</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">66.8</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">152</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">28.4</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">207</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">38.4</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">0.36</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"> Other</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">179</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">33.2</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">68</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">12.4</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">97</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">20.8</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">0.98</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Religion</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"> Roman Catholic</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">318</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">59.0</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">128</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">58.2</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">190</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">59.6</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">0.91</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"> Other Christian</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">90</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">16.7</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">27</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">12.3</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">63</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">19.7</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">0.09</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Muslim</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">24</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">4.5</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">16</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">7.3</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">8</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">2.5</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">0.02</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Atheist</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">107</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">19.9</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">49</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">22.2</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">58</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">18.2</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">0.29</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Circumcision **</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">192</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">-</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">32</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">16.7</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">-</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">-</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">-</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Medical reasons</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">-</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">-</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">16</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">-</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">-</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">-</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">-</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Religious reasons</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">-</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">-</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">16</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">-</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">-</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">-</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">-</td></tr></tbody></table><table-wrap-foot><fn><p><italic>p</italic> * males versus females; ** only 192/220 males answered this question.</p></fn></table-wrap-foot></table-wrap><table-wrap id="ijerph-14-01097-t002" orientation="portrait" position="float"><object-id pub-id-type="pii">ijerph-14-01097-t002_Table 2</object-id><label>Table 2</label><caption><p>Knowledge on HIV/AIDS; final year medical students, Poland, 2013–2016; n = 539.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1" colspan="1">Statement</th><th align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1" colspan="1">Correct Answer</th><th align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1" colspan="1">Answer</th><th align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1" colspan="1">n</th><th align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1" colspan="1">(%)</th></tr></thead><tbody><tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">HIV can be transmitted from a mother to a child</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Yes</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Yes<break></break>No<break></break>Don’t know</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">518<break></break>8<break></break>13</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">96.1<break></break>1.5<break></break>2.4</td></tr><tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Vaginal receptive intercourse is the most risky in terms of contracting HIV infection</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">No</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Yes<break></break>No<break></break>Don’t know</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">126<break></break>313<break></break>100</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">23.4<break></break>58.0<break></break>18.6</td></tr><tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Most people with HIV show signs of being sick in the first week after infection </td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">No</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Yes<break></break>No<break></break>Don’t know</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">51<break></break>471<break></break>17</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">9.5<break></break>87.4<break></break>3.1</td></tr><tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">If someone is tested for HIV, a “positive blood test” means that the person is infected with HIV for life </td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Yes</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Yes<break></break>No<break></break>Don’t know</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">385<break></break>140<break></break>14</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">71.4<break></break>26.0<break></break>2.6</td></tr><tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Have you heard about anti-retroviral therapy (ART)</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Yes</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Yes<break></break>No<break></break>Not sure</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">511<break></break>9<break></break>19</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">94.8<break></break>1.7<break></break>3.5</td></tr><tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">HIV/AIDS can be cured with ART</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">No</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Yes<break></break>No<break></break>Don’t know</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">51<break></break>446<break></break>42</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">9.5<break></break>82.7<break></break>7.8</td></tr><tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Taking ART on schedule can help someone with HIV to prolong his/her life</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Yes</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Yes<break></break>No<break></break>Don’t know</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">482<break></break>47<break></break>10</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">89.4<break></break>8.7<break></break>1.9</td></tr><tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Once a person starts ART, he/she should take ART every day for life</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Yes</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Yes<break></break>No<break></break>Don’t know</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">384<break></break>97<break></break>58</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">71.2<break></break>18.0<break></break>10.8</td></tr><tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Missing doses of ART leads to worsening an infection</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Yes</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Yes<break></break>No<break></break>Don’t know</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">467<break></break>24<break></break>48</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">86.6<break></break>4.5<break></break>8.9</td></tr><tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">A mother who is infected with HIV can reduce the risk of giving the virus to her baby by taking certain medicines during pregnancy</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Yes</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Yes<break></break>No<break></break>Don’t know</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">480<break></break>24<break></break>35</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">89.1<break></break>4.5<break></break>6.4</td></tr><tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Globally ART is available to almost all people who need it</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">No</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Yes<break></break>No<break></break>Don’t know</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">240<break></break>97<break></break>202</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">44.5<break></break>18.0<break></break>37.5</td></tr><tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">People can reduce their chances of getting HIV by using a condom every time they have sex</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Yes</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Yes<break></break>No<break></break>Don’t know</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">513<break></break>17<break></break>9</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">95.2<break></break>3.2<break></break>1.6</td></tr></tbody></table></table-wrap><table-wrap id="ijerph-14-01097-t003" orientation="portrait" position="float"><object-id pub-id-type="pii">ijerph-14-01097-t003_Table 3</object-id><label>Table 3</label><caption><p>Bivariate analyses of determinants of final year medical students’ willingness to recommend male circumcision (MC) to adults at high risk for HIV, Poland, 2013–2016; n = 539.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1" colspan="1">Variable</th><th align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1" colspan="1">n</th><th align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1" colspan="1">N</th><th align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1" colspan="1">%</th><th align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1" colspan="1"><italic>p</italic></th></tr></thead><tbody><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Gender</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"> Male</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">58</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">92</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">63.0</td><td rowspan="2" align="center" valign="middle" style="border-bottom:solid thin" colspan="1">0.07</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"> Female</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">109</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">213</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">51.2</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Age</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"> <25</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">118</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">200</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">59.0</td><td rowspan="2" align="center" valign="middle" style="border-bottom:solid thin" colspan="1">0.06</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"> ≥25</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">43</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">93</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">46.2</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Religion</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"> Atheist</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">29</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">63</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">46.0</td><td rowspan="2" align="center" valign="middle" style="border-bottom:solid thin" colspan="1">0.13</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"> Other</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">135</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">234</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">57.7</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Nationality</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"> Polish</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">126</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">207</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">60.9</td><td rowspan="2" align="center" valign="middle" style="border-bottom:solid thin" colspan="1">0.003</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"> Other</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">41</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">98</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">41.8</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Being circumcised</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"> Yes</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">11</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">13</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">84.6</td><td rowspan="2" align="center" valign="middle" style="border-bottom:solid thin" colspan="1">0.18</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"> No</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">43</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">71</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">60.6</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Knowing circumcised man</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"> Yes</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">40</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">77</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">51.9</td><td rowspan="2" align="center" valign="middle" style="border-bottom:solid thin" colspan="1">0.66</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"> no</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">127</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">228</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">55.7</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">MC is safe</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"> Yes</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">54</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">106</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">50.9</td><td rowspan="2" align="center" valign="middle" style="border-bottom:solid thin" colspan="1">1.0</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"> No</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">7</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">14</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">50.0</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Circumcised Men experience more sexual pleasure</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"> Yes</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">25</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">34</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">73.5</td><td rowspan="2" align="center" valign="middle" style="border-bottom:solid thin" colspan="1">0.03</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"> No/Not sure</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">141</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">270</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">52.2</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">MC increases the sensitivity of penis</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"> Yes</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">35</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">65</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">53.8</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"> No/Not sure</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">131</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">238</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">55.0</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">0.98</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">HIV/AIDS knowledge level</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"> Good</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">127</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">222</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">57.2</td><td rowspan="2" align="center" valign="middle" style="border-bottom:solid thin" colspan="1">0.16</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"> Mediocre/Poor</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">40</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">83</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">48.2</td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">MC decreases the chance to acquire HIV</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"> Yes</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">135</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">222</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">60.8</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1"> No/Not sure</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">32</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">82</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">39.0</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">0.001</td></tr></tbody></table></table-wrap><table-wrap id="ijerph-14-01097-t004" orientation="portrait" position="float"><object-id pub-id-type="pii">ijerph-14-01097-t004_Table 4</object-id><label>Table 4</label><caption><p>Logistic regression model: association of willingness to recommend male circumcision (MC) to adults at high risk for HIV with variables selected with the use of a stepwise approach (OR’s estimates, 95% CIs of OR estimates), Poland, 2013–2016; n = 539.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1" colspan="1">Variable</th><th align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1" colspan="1">OR *</th><th align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1" colspan="1">CI</th><th align="center" valign="middle" style="border-top:solid thin;border-bottom:solid thin" rowspan="1" colspan="1"><italic>p</italic></th></tr></thead><tbody><tr><td align="center" valign="middle" rowspan="1" colspan="1">Knowledge on MC ex re HIV risk reduction</td><td align="center" valign="middle" rowspan="1" colspan="1">2.13</td><td align="center" valign="middle" rowspan="1" colspan="1">1.22–3.77</td><td align="center" valign="middle" rowspan="1" colspan="1">0.008</td></tr><tr><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">Belief that circumcised men get more sexual pleasure than uncircumcised</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">3.35</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">1.44–8.77</td><td align="center" valign="middle" style="border-bottom:solid thin" rowspan="1" colspan="1">0.008 </td></tr></tbody></table><table-wrap-foot><fn><p>* Odds ratio = ratio between the two categories tested in each variable, controlling for other variables.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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