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Sun Y, He L, Gao Y, Fitzpatrick T, Zhang W, Yang L, Fu L, Luo S, Zou H. Barriers and Facilitators to, and Experience of, Voluntary Medical Male Circumcision Among Men Who Have Sex with Men in China: A Mixed-Methods Study. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:2065-2081. [PMID: 37296334 PMCID: PMC11034941 DOI: 10.1007/s10508-023-02634-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/17/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023]
Abstract
Voluntary medical male circumcision (VMMC) may be incorporated into HIV prevention services for men who have sex with men (MSM). We conducted a mixed-methods study to elucidate barriers and facilitators to, and experience of, VMMC among MSM. Participants were MSM aged 18 years and older who were enrolled in an ongoing multicenter randomized controlled trial (RCT) to evaluate VMMC to prevent HIV among MSM in China. RCT participants completed a questionnaire before and after VMMC to assess perceptions of and complications after the procedure. A subset of RCT participants were selected for in-depth interviews. Interviewees answered open-ended questions about barriers and facilitators to and experience of undergoing VMMC. Six-step thematic analysis incorporating inductive and deductive approaches was used to interpret interview responses. A total of 457 MSM completed the pre-VMMC survey, 115 circumcised MSM completed post-VMMC surveys, and 30 MSM completed an interview. Main barriers to VMMC uptake were concerns about pain, length of wound healing, cost, lack of knowledge about or misconceptions of VMMC, and stigma related to surgery. Facilitators to VMMC could be categorized as internal factors (foreskin) and external factors (motivation and follow-up care). Interestingly, the VMMC experiences of others could be transformed from a barrier into a facilitator to VMMC in some circumstances. After VMMC participants transitioned from a negative state of pain, remorse, difficulty sleeping, and discomfort to a positive state of symptom alleviation and personal hygiene improvement. Optimizing facilitators and addressing barriers may encourage VMMC among MSM. Joint efforts should be made by relevant stakeholders to improve the awareness and uptake of VMMC among MSM.
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Affiliation(s)
- Yinghui Sun
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, 66 Gongchang Road, Guangming District, Shenzhen, 518107, Guangdong, China
| | - Longtao He
- Research Institute of Social Development, Southwestern University of Finance and Economics, Chengdu, China
| | - Yanxiao Gao
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, 66 Gongchang Road, Guangming District, Shenzhen, 518107, Guangdong, China
| | - Thomas Fitzpatrick
- Department of Internal Medicine, University of Washington, Seattle, WA, USA
| | - Weijie Zhang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, 66 Gongchang Road, Guangming District, Shenzhen, 518107, Guangdong, China
| | - Luoyao Yang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, 66 Gongchang Road, Guangming District, Shenzhen, 518107, Guangdong, China
| | - Leiwen Fu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, 66 Gongchang Road, Guangming District, Shenzhen, 518107, Guangdong, China
| | - Sitong Luo
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, 66 Gongchang Road, Guangming District, Shenzhen, 518107, Guangdong, China.
- Kirby Institute, University of New South Wales, Sydney, Australia.
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Factors influencing satisfaction with male circumcision in Taiwan. Sci Rep 2023; 13:2313. [PMID: 36759665 PMCID: PMC9911792 DOI: 10.1038/s41598-022-20140-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 09/09/2022] [Indexed: 02/11/2023] Open
Abstract
We aimed to investigate patient satisfaction with male circumcision in Taiwan. An online, questionnaire-based, cross-sectional study involving 376 circumcised men 20 to 40 years of age in Taiwan was conducted. Circumcision-related satisfaction was defined as a visual analogue scale score ≥ 6 (range, 1-10). Pearson's chi-square test was performed to compare differences between satisfied and unsatisfied participants. Factors predictive of participant satisfaction were analysed using multivariate logistic regression. Statistical significance was set at P < 0.05. Among 376 circumcised men, 249 (66.2%) reported satisfaction with circumcision. Satisfied participants had higher levels of education, underwent circumcision for phimosis or balanitis, underwent circumcision during adulthood, reported a larger penile size, and had fewer long-term complaints. Furthermore, 89.4% had various long-term complaints, including skin colour mismatch, changes in masturbation methods, hypertrophic scarring, excessive shortening of the prepuce, and redundant prepuce. Multivariate analysis revealed that adult circumcision and the absence of long-term conditions were predictive of satisfaction. Two-thirds of participants were satisfied with their circumcision outcome, especially those who underwent circumcision for phimosis or balanitis during adulthood. Proper preoperative patient selection and postoperative symptom prevention would improve patient satisfaction.
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Kankaka EN, Nalugoda F, Serwadda D, Makumbi F, Wawer MJ, Gray RH, Quinn TC, Reynolds SJ, Nakigozi G, Lutalo T, Kigozi G, Sewankambo NK, Kagaayi J. Makerere's contribution to the development of a high impact HIV research population-based cohort in the Rakai Region, Uganda. Afr Health Sci 2022; 22:42-50. [PMID: 36321125 PMCID: PMC9590336 DOI: 10.4314/ahs.v22i2.7s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Longitudinal population-based cohort studies can provide critical insights on temporal, spatial and sociodemographic changes in health status and health determinants that are not obtained by other study designs. However, establishing and maintaining such a cohort study can be challenging and expensive. Here, we describe the role of Makerere University in the development and conduct of such a cohort. We chronicle the first academia-led reports of HIV in East Africa; how this led to initiation of the Rakai Community Cohort Study in 1988, the first and oldest HIV cohort in sub-Saharan Africa; its impact on HIV prevention, care and treatment; how the cohort has been maintained; and opportunities, challenges, and future directions including non-communicable diseases.
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Affiliation(s)
| | | | - David Serwadda
- Rakai Health Sciences Program
- Makerere University College of Health Sciences, School of Public Health
| | - Fredrick Makumbi
- Rakai Health Sciences Program
- Makerere University College of Health Sciences, School of Public Health
| | - Maria J Wawer
- Rakai Health Sciences Program
- Johns Hopkins Bloomberg School of Public Health
- Johns Hopkins University School of Medicine
| | - Ronald H Gray
- Rakai Health Sciences Program
- Johns Hopkins Bloomberg School of Public Health
| | - Thomas C Quinn
- Johns Hopkins University School of Medicine
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH
| | - Steven J Reynolds
- Johns Hopkins University School of Medicine
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH
| | | | - Tom Lutalo
- Rakai Health Sciences Program
- Uganda Virus Research Institute
| | | | - Nelson K Sewankambo
- Rakai Health Sciences Program
- Makerere University College of Health Sciences, School of Medicine
| | - Joseph Kagaayi
- Rakai Health Sciences Program
- Makerere University College of Health Sciences, School of Public Health
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Morris BJ, Hankins CA, Banerjee J, Lumbers ER, Mindel A, Klausner JD, Krieger JN. Does Male Circumcision Reduce Women's Risk of Sexually Transmitted Infections, Cervical Cancer, and Associated Conditions? Front Public Health 2019; 7:4. [PMID: 30766863 PMCID: PMC6365441 DOI: 10.3389/fpubh.2019.00004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/04/2019] [Indexed: 12/16/2022] Open
Abstract
Background: Male circumcision (MC) is proven to substantially reduce men's risk of a number of sexually transmitted infections (STIs). We conducted a detailed systematic review of the scientific literature to determine the relationship between MC and risk of STIs and associated conditions in women. Methods: Database searches by "circumcision women" and "circumcision female" identified 68 relevant articles for inclusion. Examination of bibliographies of these yielded 14 further publications. Each was rated for quality using a conventional rating system. Results: Evaluation of the data from the studies retrieved showed that MC is associated with a reduced risk in women of being infected by oncogenic human papillomavirus (HPV) genotypes and of contracting cervical cancer. Data from randomized controlled trials and other studies has confirmed that partner MC reduces women's risk not only of oncogenic HPV, but as well Trichomonas vaginalis, bacterial vaginosis and possibly genital ulcer disease. For herpes simplex virus type 2, Chlamydia trachomatis, Treponema pallidum, human immunodeficiency virus and candidiasis, the evidence is mixed. Male partner MC did not reduce risk of gonorrhea, Mycoplasma genitalium, dysuria or vaginal discharge in women. Conclusion: MC reduces risk of oncogenic HPV genotypes, cervical cancer, T. vaginalis, bacterial vaginosis and possibly genital ulcer disease in women. The reduction in risk of these STIs and cervical cancer adds to the data supporting global efforts to deploy MC as a health-promoting and life-saving public health measure and supplements other STI prevention strategies.
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Affiliation(s)
- Brian J. Morris
- School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, NSW, Australia
| | - Catherine A. Hankins
- Faculty of Medicine, McGill University, Montreal, QC, Canada
- London School of Hygiene and Tropical Medicine, Bloomsbury, London, United Kingdom
| | | | - Eugenie R. Lumbers
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine and Priority Research Centre for Reproductive Science, University of Newcastle, Callaghan, NSW, Australia
- Mothers and Babies Research Centre, Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - Adrian Mindel
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Jeffrey D. Klausner
- Division of Infectious Diseases and the Program in Global Health, Fielding School of Public Health, University of California Los Angeles Care Center, Los Angeles, CA, United States
| | - John N. Krieger
- Department of Urology, University of Washington School of Medicine, Seattle, WA, United States
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