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Blair RA, Curtice T, Dow D, Grossman G. Public trust, policing, and the COVID-19 pandemic: Evidence from an electoral authoritarian regime. Soc Sci Med 2022; 305:115045. [PMID: 35623233 PMCID: PMC9122739 DOI: 10.1016/j.socscimed.2022.115045] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 01/17/2023]
Abstract
We examine how trust shapes compliance with public health restrictions during the COVID- 19 pandemic in Uganda. We use an endorsement experiment embedded in a mobile phone survey to show that messages from government officials generate more support for public health restrictions than messages from religious authorities, traditional leaders, or international NGOs. We further show that compliance with these restrictions is strongly positively correlated with trust in government, but only weakly correlated with trust in local authorities or other citizens. We use measures of trust from both before and during the pandemic to rule out the possibility that trust is a function of the pandemic itself. The relationship between trust and compliance is especially strong for the Ministry of Health and-more surprisingly-the police. We conclude that trust is crucial for encouraging compliance but note that it may be difficult to sustain, particularly in settings where governments and police forces have reputations for repression.
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Affiliation(s)
- Robert A. Blair
- Department of Political Science and Watson Institute for International and Public Affairs, Brown University, United States
| | - Travis Curtice
- Department of Politics and Center for Public Policy, Drexel University, United States,Corresponding author
| | - David Dow
- School of Government and Public Policy, University of Arizona, United States
| | - Guy Grossman
- Department of Political Science, University of Pennsylvania, United States
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Abstract
Medical male circumcision has been recommended by the World Health Organization as part of a comprehensive approach to HIV prevention. Zimbabwe is one of the fourteen sub-Saharan countries that embarked on the Medical Male Circumcision (MMC) programme. However, the country has not yet met male circumcision targets. This paper examines the predictors of male circumcision in Zimbabwe. A cross-sectional survey was conducted on 784 men aged 15-35 years in Harare, Zimbabwe. Negative log-log logistic regression analysis was used to determine the predictors of male circumcision. The main predictors of circumcision were age, employment status, ever tested for HIV, approval of HIV testing prior to circumcision, knowledge about male circumcision and attitudes towards male circumcision. By and large, participants had good knowledge about male circumcision and viewed HIV prevention with a reasonably positive attitude. The identification of these predictors can be used to scale up the demand for male circumcision in Zimbabwe.
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Sano Y, Antabe R, Atuoye KN, Hussey LK, Bayne J, Galaa SZ, Mkandawire P, Luginaah I. Persistent misconceptions about HIV transmission among males and females in Malawi. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2016; 16:16. [PMID: 27267906 PMCID: PMC4896031 DOI: 10.1186/s12914-016-0089-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 05/18/2016] [Indexed: 11/14/2022]
Abstract
Background The prevalence of HIV in Malawi is one of the highest in sub-Saharan Africa, and misconceptions about its mode of transmission are considered a major contributor to the continued spread of the virus. Methods Using the 2010 Malawi Demographic and Health Survey, the current study explored factors associated with misconceptions about HIV transmission among males and females. Results We found that higher levels of ABC prevention knowledge were associated with lower likelihood of endorsing misconceptions among females and males (OR = 0.85, p < 0.001; OR = 0.85, p < 0.001, respectively). Compared to those in the Northern region, both females and males in the Central (OR = 0.54, p < 0.001; OR = 0.53, p < 0.001, respectively) and Southern regions (OR = 0.49, p < 0.001; OR = 0.43, p < 0.001, respectively) were less likely to endorse misconceptions about HIV transmission. Moreover, marital status and ethnicity were significant predictors of HIV transmission misconceptions among females but not among males. Also, household wealth quintiles, education, religion, and urban–rural residence were significantly associated with endorsing misconceptions about HIV transmission. Conclusion Based on our findings, we recommend that education on HIV transmission in Malawi should integrate cultural and ethnic considerations of HIV/AIDS.
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Affiliation(s)
- Yujiro Sano
- Department of Sociology, University of Western Ontario, 1151 Richmond Street, London, ON, Canada
| | - Roger Antabe
- Environmental Health and Hazards Lab, Department of Geography, University of Western Ontario, 1151 Richmond Street, London, ON, Canada
| | - Kilian Nasung Atuoye
- Environmental Health and Hazards Lab, Department of Geography, University of Western Ontario, 1151 Richmond Street, London, ON, Canada
| | - Lucia Kafui Hussey
- Environmental Health and Hazards Lab, Department of Geography, University of Western Ontario, 1151 Richmond Street, London, ON, Canada
| | - Jason Bayne
- Environmental Health and Hazards Lab, Department of Geography, University of Western Ontario, 1151 Richmond Street, London, ON, Canada
| | - Sylvester Zackaria Galaa
- Faculty of Integrated Development Studies, University for Development Studies, Wa Campus, Wa, Ghana.
| | - Paul Mkandawire
- Institute of Interdisciplinary Studies, Human Rights Program, Carleton University, Ottawa, Canada
| | - Isaac Luginaah
- Department of Geography, University of Western Ontario, 1151 Richmond Street, London, ON, Canada
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Maughan-Brown B, Godlonton S, Thornton R, Venkataramani AS. What Do People Actually Learn from Public Health Campaigns? Incorrect Inferences About Male Circumcision and Female HIV Infection Risk Among Men and Women in Malawi. AIDS Behav 2015; 19:1170-7. [PMID: 25155700 DOI: 10.1007/s10461-014-0882-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Qualitative studies and polling data from sub-Saharan Africa indicate that many individuals may mistakenly believe that male circumcision directly protects women from contracting HIV. This study examines whether individuals who learn that male circumcision reduces female-to-male HIV transmission also erroneously infer a reduction in direct male-to-female transmission risk (i.e. from an HIV-positive man to an uninfected woman). We used data on Malawian men (n = 917) randomized to receive information about voluntary medical male circumcision (VMMC) and HIV risk in 2008 and a random sample of their wives (n = 418). We found that 72 % of men and 82 % of women who believed that male circumcision reduces HIV risk for men also believed that it reduces HIV risk for women. Regression analyses indicated that men randomly assigned to receive information about the protective benefits of circumcision were more likely to adopt the erroneous beliefs, and that the underlying mechanism was the formation of the belief that male circumcision reduces HIV risk for men. The results suggest the need for VMMC campaigns to make explicit that male circumcision does not directly protect women from HIV-infection.
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Affiliation(s)
- Brendan Maughan-Brown
- Southern Africa Labour and Development Research Unit, University of Cape Town, Private Bag, Rondebosch, Cape Town, 7701, South Africa
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Bulled N, Green EC. Making voluntary medical male circumcision a viable HIV prevention strategy in high prevalence countries by engaging the traditional sector. CRITICAL PUBLIC HEALTH 2015; 26:258-268. [PMID: 27110065 DOI: 10.1080/09581596.2015.1055319] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Voluntary medical male circumcision (VMMC) has been rapidly accepted by global HIV policy and donor institutions as a highly valuable HIV prevention strategy given its cost-effectiveness, limited interactions with a health facility, and projected long-lasting benefits. Many southern African countries have incorporated VMMC into their national HIV prevention strategies. However, intensive VMMC promotion programs have met with limited success to date and many HIV researchers have voiced concerns. This commentary discusses reasons behind the less-than-desired public demand and suggests how inclusion of the traditional sector - traditional leaders, healers, and circumcisers - with their local knowledge, cultural expertise and social capital, particularly in the realm of social meanings ascribed to male circumcision, may improve the uptake of this HIV prevention strategy. We offer Lesotho and Swaziland as case studies of the integration of universal VMMC policies; these are countries with a shared HIV burden, yet contrasting contemporary socio-cultural practices of male circumcision. The similar hesitant responses expressed by these two countries towards VMMC remind us that the incorporation of any new or revised and revitalized public health strategy must be considered within unique historical, political, economic, and socio-cultural contexts.
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Affiliation(s)
- Nicola Bulled
- The Center for Global Health, University of Virginia, Charlottesville, VA, USA
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Parkhurst JO, Chilongozi D, Hutchinson E. Doubt, defiance, and identity: Understanding resistance to male circumcision for HIV prevention in Malawi. Soc Sci Med 2015; 135:15-22. [PMID: 25939072 DOI: 10.1016/j.socscimed.2015.04.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Global policy recommendations to scale up of male circumcision (MC) for HIV prevention tend to frame the procedure as a simple and efficacious public health intervention. However, there has been variable uptake of MC in countries with significant HIV epidemics. Kenya, for example, has embraced MC and has been dubbed a 'leader' by the global health community, while Malawi has been branded a 'laggard' in its slow adoption of a national programme, with a strong political discourse of resistance forming around MC. Regardless of any epidemiological or technical evidence, the uptake of international recommendations will be shaped by how a policy, and the specific artefacts that constitute that policy, intersect with local concerns. MC holds particular significance within many ethnic and religious groups, serving as an important rite of passage, but also designating otherness or enabling the identification of the social and political self. Understanding how the artefact of MC intersects with local social, economic, and political contexts, is therefore essential to understand the acceptance or resistance of global policy recommendations. In this paper we present an in-depth analysis of Malawi's political resistance to MC, finding that ethnic and religious divisions dominating recent political movements aligned well with differing circumcision practices. Political resistance was further found to manifest through two key narratives: a 'narrative of defiance' around the need to resist donor manipulation, and a 'narrative of doubt' which seized on a piece of epidemiological evidence to refute global claims of efficacy. Further, we found that discussions over MC served as an additional arena through which ethnic identities and claims to power could themselves be negotiated, and therefore used to support claims of political legitimacy.
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Affiliation(s)
| | - David Chilongozi
- I-TECH (International Training & Education Centre for Health), Malawi
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Rennie S, Perry B, Corneli A, Chilungo A, Umar E. Perceptions of voluntary medical male circumcision among circumcising and non-circumcising communities in Malawi. Glob Public Health 2015; 10:679-91. [PMID: 25630610 DOI: 10.1080/17441692.2015.1004737] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Three randomised controlled trials in Africa indicated that voluntary medical male circumcision (VMMC) is an effective method to reduce a man's risk of becoming infected through sex with an HIV-positive female partner. The success of recent public health initiatives to increase numbers of circumcised men in Malawi has been very limited. We conducted in-depth interviews and focus group discussions (FGDs) with men, women and male adolescents from non-circumcising and circumcising communities in southern Malawi to better understand their beliefs about male circumcision and the promotion of VMMC for HIV prevention. Results revealed that beliefs about male circumcision, in general, are strongly mediated by Malawian culture and history. Participants have attempted to develop a new meaning for circumcision in light of the threat of HIV infection and the publicised risk reduction benefits of VMMC. Several study participants found it difficult to distinguish VMMC from traditional circumcision practices (jando and lupanda), despite awareness that the new form of circumcision was an expression of (western) modern medicine performed largely for public health purposes. Greater recognition of background cultural beliefs and practices could inform future efforts to promote medical male circumcision as an HIV prevention strategy in this context.
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Affiliation(s)
- Stuart Rennie
- a Department of Social Medicine, UNC Bioethics Center , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
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Wamai RG, Morris BJ, Bailey RC, Klausner JD, Boedicker MN. Male circumcision for protection against HIV infection in sub-Saharan Africa: the evidence in favour justifies the implementation now in progress. Glob Public Health 2015; 10:639-66. [PMID: 25613581 PMCID: PMC6352987 DOI: 10.1080/17441692.2014.989532] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This article responds to a recent 'controversy study' in Global Public Health by de Camargo et al. directed at three randomised controlled trials (RCTs) of male circumcision (MC) for HIV prevention. These trials were conducted in three countries in sub-Saharan Africa (SSA) and published in 2005 and 2007. The RCTs confirmed observational data that had accumulated over the preceding two decades showing that MC reduces by 60% the risk of HIV infection in heterosexual men. Based on the RCT results, MC was adopted by global and national HIV policy-makers as an additional intervention for HIV prevention. Voluntary medical MC (VMMC) is now being implemented in 14 SSA countries. Thus referring to MC for HIV prevention as 'debate' and viewing MC through a lens of controversy seems mistaken. In their criticism, de Camargo et al. misrepresent and misinterpret current science supporting MC for HIV prevention, omit previous denunciations of arguments similar to theirs, and ignore evidence from ongoing scientific research. Here we point out the flaws in three areas de Camargo et al. find contentious. In doing so, we direct readers to growing evidence of MC as an efficacious, safe, acceptable, relatively low-cost one-off biomedical intervention for HIV prevention.
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Affiliation(s)
- Richard G. Wamai
- Department of African-American Studies, Northeastern University, Boston, Massachusetts, USA
| | - Brian J. Morris
- School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Robert C. Bailey
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jeffrey D. Klausner
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, California, USA
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Angotti N, Frye M, Kaler A, Poulin M, Watkins SC, Yeatman S. Popular Moralities and Institutional Rationalities in Malawi's Struggle Against AIDS. POPULATION AND DEVELOPMENT REVIEW 2014; 40:447-473. [PMID: 26877567 PMCID: PMC4751039 DOI: 10.1111/j.1728-4457.2014.00693.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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