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In efficacy trials male circumcision (MC) protected men against HIV infection. Planners need information relevant to MC programmes in practice. In 2008, we interviewed 2915 men and 4549 women aged 15–29 years in representative cluster samples in Botswana, Namibia and Swaziland, asking about socio-economic characteristics, knowledge and attitudes about HIV and MC and MC history. We tested finger prick blood samples for HIV. We calculated weighted frequencies of MC knowledge and attitudes, and MC history and HIV status. Multivariate analysis examined associations between MC and other variables and HIV status. In Botswana, 11% of young men reported MC, 28% in Namibia and 8% in Swaziland; mostly (75% in Botswana, 94% – mostly Herero – in Namibia and 68% in Swaziland) as infants or children. Overall, 6.5% were HIV positive (8.3% Botswana, 2.6% Namibia and 9.1% Swaziland). Taking other variables into account, circumcised men were as likely as uncircumcised men to be HIV positive. Nearly half of the uncircumcised young men planned to be circumcised; two-thirds of young men and women planned to have their sons circumcised. Some respondents had inaccurate beliefs and unhelpful views about MC and HIV, with variation between countries. Between 9 and 15% believed a circumcised man is fully protected against HIV; 20–26% believed men need not be tested for HIV before MC; 14–26% believed HIV-positive men who are circumcised cannot transmit the virus; and 8–34% thought it was “okay for a circumcised man to expect sex without a condom”. Inaccurate perceptions about protection from MC could lead to risk compensation and reduce women's ability to negotiate safer sex. More efforts are needed to raise awareness about the limitations of MC protection, especially for women, and to study the interactions between MC roll out programmes and primary HIV prevention programmes. [ABSTRACT FROM PUBLISHER]

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Multiple sexual partnerships are a driver of the HIV epidemic in southern Africa. Five linked cluster surveys in 2002, 2005, 2006, 2007 and 2008 allowed us to measure changes in rates of multiple partnerships in these clusters in Swaziland. We selected a stratified random sample of census enumeration areas in 2002 and survey teams subsequently revisited this same sample (a random sub-sample in 2005 and 2006). For this study, analysis includes only people aged 18-29 years interviewed in communities included in all five surveys (1862 men and 2701 women). Among men, there was a significant fall in the proportion having multiple partners in the last 12 months (MP12), among those that had any, between 2002 (61%) and 2007 (46%), followed by a slight rise in 2008 (49%). For multiple partnerships in the last six months (MP6 - measured in 2005 and 2006), there was a decrease between 2005 (43%) and 2006 (25%). There was a significant decrease in multiple partnerships in the last month (MP1) between 2005 (35%) and 2006 (16%), followed by an increase in 2007 (24%) and 2008 (25%). Among women, there was a significant decrease in MP12 between 2002 (22%) and 2007 (9%), then a significant increase in 2008 (15%). There was little difference in women's MP6 between 2005 (7%) and 2006 (6%). There was also little change in women's MP1 between 2005 (5%) and 2006 (3%), with an increase from 2007 (3%) to 2008 (6%); the 2006-2008 difference was significant. A 2006 campaign to reduce multiple partnerships may have changed behaviour among men or it may have made them less likely to admit to multiple partners. The recent increase in MP12 and MP1, especially among women, may reflect behaviour or it could reflect increased willingness to report. [ABSTRACT FROM AUTHOR]

This paper describes implementation research of an intervention in a complex HIV prevention randomised trial in southern Africa. Researchers collected stories of change attributed by 106 community members to an audio-drama edutainment intervention in 41 sites in Botswana, Namibia and Swaziland. The team analysed themes in the stories following a behaviour change model of conscious knowledge, attitudes, subjective norms, intention to change, agency, discussion and action (CASCADA). Storytellers attributed positive changes to the intervention in the areas of gender violence, multiple sexual partners, transactional and intergenerational sex and condom use. Their stories illustrate each of the steps in the CASCADA behaviour change model. As well as supporting an enabling environment for other interventions in the trial, the audio-drama also helped some participants to make personal changes. Collecting and discussing the stories were encouraging for the trial fieldworkers. Documenting the experiences of participants and framing the analysis of stories in an explicit behaviour change model allowed us to reflect on potential mechanisms and pathways through which the intervention impacts on individuals and communities. It helped in the design of the quantitative instruments to measure intermediate outcomes of the trial.