High complication rates challenge the implementation of male circumcision for HIV prevention in Africa.

This commentary discusses the study by Bailey and colleagues, who aimed to assess the safety of male circumcision practices in both clinical and traditional settings in Bungoma, Kenya. The study evaluated 1,007 males who underwent circumcision in a clinical (n = 562) and traditional (n = 445) setting. All young men who underwent circumcision were interviewed after surgery to assess their satisfaction and complication rates, and a sample of the practitioners who performed the circumcisions were interviewed to determine their circumcision training and experience. Additionally, 24 circumcision procedures (12 each in the clinical and traditional settings) were directly observed by the study investigators. The study found complications rates of 17.7% and 35.2% in the clinical and traditional groups, respectively. Furthermore, the study revealed shortcomings in practitioner knowledge, training and resources in both groups. Before scaling up male circumcision services in countries with a high prevalence of HIV, a careful strategy to minimize unnecessary morbidity, and fundamental improvements on current circumcision techniques, are required.