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Wiginton JM, King EJ, Fuller AO. 'We can act different from what we used to': Findings from experiences of religious leader participants in an HIV-prevention intervention in Zambia. Glob Public Health 2018; 14:636-648. [PMID: 30238830 DOI: 10.1080/17441692.2018.1524921] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Faith-based organisations (FBOs) have long been part of the fight against HIV and AIDS. International bodies continue to collaborate with FBOs to implement HIV-prevention programmes with mixed success. Zambia has been a target of such programmes in part due to its high HIV prevalence. The Trusted Messenger approach to provide religious leader networks with biomedical, science-focused education about HIV and AIDS was piloted in 2006, but participant experiences of the intervention have not been explored qualitatively. In 2016, in-depth interviews were conducted of 34 randomly chosen individuals who attended Trusted Messenger workshops between 2006 and 2016 in Livingstone, Lusaka, and the Copperbelt region. Findings indicate that the religious leader attendees gained scientific insights about HIV which motivated their action in personal, social, and religious contexts. Participants found the science comprehensible and empowering and identified workshop frequency and language as challenging. Utilising science-focused education within contextual settings of religious leader networks can combat the spread of HIV and the mistreatment of people living with HIV and AIDS.
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Affiliation(s)
- John Mark Wiginton
- a Department of Health Behaviour & Health Education , School of Public Health, University of Michigan , Ann Arbor , MI , USA
| | - Elizabeth J King
- a Department of Health Behaviour & Health Education , School of Public Health, University of Michigan , Ann Arbor , MI , USA
| | - A Oveta Fuller
- b Department of Microbiology & Immunology , School of Medicine, University of Michigan , Ann Arbor , MI , USA
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Gichuru E, Kombo B, Mumba N, Sariola S, Sanders EJ, van der Elst EM. Engaging religious leaders to support HIV prevention and care for gays, bisexual men, and other men who have sex with men in coastal Kenya. CRITICAL PUBLIC HEALTH 2018; 28:294-305. [PMID: 29770367 PMCID: PMC5935049 DOI: 10.1080/09581596.2018.1447647] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 02/28/2018] [Indexed: 01/18/2023]
Abstract
In Kenyan communities, religious leaders are important gatekeepers in matters of health and public morality. In a context that is generally homophobic, religious leaders may aggravate or reduce stigmatization of sexual minorities such as gay and bisexual men, and other men who have sex with men (GBMSM). Literature indicates mixed results in efforts to encourage religious leaders to work effectively and sensitively with issues regarding HIV and sexuality. This paper describes the implementation of an engagement intervention with religious leaders from different denominations, which took place following a homophobic hate attack that was led by local religious leaders, at an HIV research clinic for GBMSM on the Kenyan coast. After the homophobic attack, tailored engagement activities, including a comprehensive four-day online sensitivity training course took place between June 2015 and October 2016 in the Kenyan coast. HIV researchers, together with trained GBMSM activists, organized the series of engagement activities for religious leaders which unfolded iteratively, with each subsequent activity informed by the results of the previous one. Facilitated conversations were used to explore differences and disagreements in relation to questions of scripture, mission, HIV, and human sexuality. As a result, researchers noted that many religious leaders, who initially expressed exceedingly negative attitudes towards GBMSM, started to express far more accepting and supportive views of sexuality, sexual identities, and same-sex relations. This paper describes the changes in religious leaders’ discourses relating to GBMSM, and highlights the possibility of using engagement interventions to build trust between research institutes, religious leaders, and GBMSM.
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Affiliation(s)
- Evans Gichuru
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya
| | - Bernadette Kombo
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya
| | - Noni Mumba
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya
| | - Salla Sariola
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.,University of Turku, Turku, Finland
| | - Eduard J Sanders
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Elise M van der Elst
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Downs JA, Mwakisole AH, Chandika AB, Lugoba S, Kassim R, Laizer E, Magambo KA, Lee MH, Kalluvya SE, Downs DJ, Fitzgerald DW. Educating religious leaders to promote uptake of male circumcision in Tanzania: a cluster randomised trial. Lancet 2017; 389:1124-1132. [PMID: 28214093 PMCID: PMC5364327 DOI: 10.1016/s0140-6736(16)32055-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 08/09/2016] [Accepted: 09/22/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Male circumcision is being widely deployed as an HIV prevention strategy in countries with high HIV incidence, but its uptake in sub-Saharan Africa has been below targets. We did a study to establish whether educating religious leaders about male circumcision would increase uptake in their village. METHODS In this cluster randomised trial in northwest Tanzania, eligible villages were paired by proximity (<60 km) and the time that a free male circumcision outreach campaign from the Tanzanian Ministry of Health became available in their village. All villages received the standard male circumcision outreach activities provided by the Ministry of Health. Within the village pairs, villages were randomly assigned by coin toss to receive either additional education for Christian church leaders on scientific, religious, and cultural aspects of male circumcision (intervention group), or standard outreach only (control group). Church leaders or their congregations were not masked to random assignment. The educational intervention consisted of a 1-day seminar co-taught by a Tanzanian pastor and a Tanzanian clinician who worked with the Ministry of Health, and meetings with the study team every 2 weeks thereafter, for the duration of the circumcision campaign. The primary outcome was the proportion of male individuals in a village who were circumcised during the campaign, using an intention-to-treat analysis that included all men in the village. This trial is registered with ClinicalTrials.gov, number NCT 02167776. FINDINGS Between June 15, 2014, and Dec 10, 2015, we provided education for church leaders in eight intervention villages and compared the outcomes with those in eight control villages. In the intervention villages, 52·8% (30 889 of 58 536) of men were circumcised compared with 29·5% (25 484 of 86 492) of men in the eight control villages (odds ratio 3·2 [95% CI, 1·4-7·3]; p=0·006). INTERPRETATION Education of religious leaders had a substantial effect on uptake of male circumcision, and should be considered as part of male circumcision programmes in other sub-Saharan African countries. This study was conducted in one region in Tanzania; however, we believe that our intervention is generalisable. We equipped church leaders with knowledge and tools, and ultimately each leader established the most culturally-appropriate way to promote male circumcision. Therefore, we think that the process of working through religious leaders can serve as an innovative model to promote healthy behaviour, leading to HIV prevention and other clinically relevant outcomes, in a variety of settings. FUNDING Bill & Melinda Gates Foundation, National Institutes of Health, and the Mulago Foundation.
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Affiliation(s)
- Jennifer A Downs
- Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, NY, USA; Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania.
| | - Agrey H Mwakisole
- St Paul College, Mwanza, Tanzania; Fuller Theological Seminary, Pasadena, California
| | | | - Shibide Lugoba
- Care and Treatment Centre, Bugando Medical Centre, Mwanza, Tanzania
| | - Rehema Kassim
- Care and Treatment Centre, Bugando Medical Centre, Mwanza, Tanzania
| | | | | | - Myung Hee Lee
- Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Samuel E Kalluvya
- Care and Treatment Centre, Bugando Medical Centre, Mwanza, Tanzania; Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - David J Downs
- St Paul College, Mwanza, Tanzania; Fuller Theological Seminary, Pasadena, California
| | - Daniel W Fitzgerald
- Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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What research tells us about knowledge transfer strategies to improve public health in low-income countries: a scoping review. Int J Public Health 2015; 60:849-63. [PMID: 26298445 PMCID: PMC4636521 DOI: 10.1007/s00038-015-0716-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 07/03/2015] [Accepted: 07/08/2015] [Indexed: 11/22/2022] Open
Abstract
Objectives This study describes the current state of research on knowledge transfer strategies to improve public health in low-income countries, to identify the knowledge gaps on this topic. Methods In this scoping review, a descriptive and systematic process was used to analyse, for each article retained, descriptions of research context and methods, types of knowledge transfer activities and results reported. Results 28 articles were analysed. They dealt with the evaluation of transfer strategies that employed multiple activities, mostly targeting health professionals and women with very young children. Most often these studies used quantitative designs and measurements of instrumental use with some methodological shortcomings. Results were positive and suggested recommendations for improving professional practices, knowledge and health-related behaviours. The review highlights the great diversity of transfer strategies used, strategies and many conditions for knowledge use. Conclusions The review provides specific elements for understanding the transfer processes in low-income countries and highlights the need for systematic evaluation of the conditions for research results utilization. Electronic supplementary material The online version of this article (doi:10.1007/s00038-015-0716-5) contains supplementary material, which is available to authorized users.
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Endeshaw M, Alemu S, Andrews N, Dessie A, Frey S, Rawlins S, Walson JL, Rao D. Involving religious leaders in HIV care and treatment at a university-affiliated hospital in Ethiopia: Application of formative inquiry. Glob Public Health 2015; 12:416-431. [PMID: 26256618 DOI: 10.1080/17441692.2015.1069868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In sub-Saharan Africa, religious views strongly influence how people relate to illness, health, and healing. Belief in the curative power of religion, including for HIV, persists in many communities. As such, many funding agencies and organisations working in the field of HIV have incorporated religious institutions into their programmes in various capacities. Yet, debate continues regarding the benefits and drawbacks of including sectarian organisations in the fight against HIV. In the current study, we sought to explore whether patients with HIV would be amenable to receiving HIV-related psychosocial support from religious leaders. We interviewed 48 Ethiopian Orthodox Church followers who presented for routine HIV care at Gondar University Hospital ART (antiretroviral treatment) clinic. Although almost half (46%) of participants self-identified as 'very religious', the majority of them (73%) had not disclosed their HIV status to a religious leader. Study participants highlighted multiple factors that could potentially affect their willingness to involve religious leaders in their HIV care. We discuss these findings in relation to religion and HIV in the African context. Our findings support the use of formative qualitative work prior to developing and implementing programmes that integrate faith and medical communities.
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Affiliation(s)
- Meheret Endeshaw
- a Department of Global Health , University of Washington , Seattle , WA , USA
| | - Shitaye Alemu
- b Internal Medicine , University of Gondar , Gondar , Ethiopia
| | - Nancy Andrews
- c Care Opportunities through Partnership in Ethiopia (SCOPE) , Seattle , WA , USA
| | - Abere Dessie
- b Internal Medicine , University of Gondar , Gondar , Ethiopia
| | - Sarah Frey
- a Department of Global Health , University of Washington , Seattle , WA , USA
| | - Sarah Rawlins
- d Harborview Medical Center , University of Washington , Seattle , WA , USA
| | - Judd L Walson
- a Department of Global Health , University of Washington , Seattle , WA , USA
| | - Deepa Rao
- a Department of Global Health , University of Washington , Seattle , WA , USA
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Voluntary Counseling and Testing for HIV in Rural Area of Democratic Republic of the Congo: Knowledge, Attitude, and Practice Survey among Service Users. J Trop Med 2015; 2015:281093. [PMID: 26347477 PMCID: PMC4546770 DOI: 10.1155/2015/281093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 07/31/2015] [Accepted: 08/03/2015] [Indexed: 11/24/2022] Open
Abstract
Aims. To determine the prevalence of HIV, the level of sexual risk for HIV, and determinants of VCT attendance among adult population living in a rural area. Methods. A cross-sectional study was conducted in Mbanza-Ngungu, Democratic Republic of the Congo. An anonymous questionnaire was designed to extract relevant data. Results. In our cohort, 69% were respondents of more than 24 years of age and the single marital status was most represented (64.1%). A high proportion of respondents (90.6%) visited VCT service for requiring information (good acceptability). Positive test for HIV was reported in 9.4% of respondents. In this cohort, 49.6% of respondents had declared themselves to never use condom. In binary analysis, there was association between positive HIV test and age (p = 0.04) and religions (p = 0.02). In this cohort, it was observed that positive HIV test was significantly associated with confidentiality (p = 0.02). However, there was no association between positive HIV test and condom use (p = 0.25), knowledge of VCT (p = 0.81), service requested (p = 0.20), and previous HIV test (p = 0.68). Conclusions. Preventive information for AIDS should be recommended in the population living in rural zone.
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Shacham E, Thornton R, Godlonton S, Murphy R, Gilliland J. Geospatial analysis of condom availability and accessibility in urban Malawi. Int J STD AIDS 2015; 27:44-50. [PMID: 25681262 DOI: 10.1177/0956462415571373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/12/2015] [Indexed: 11/16/2022]
Abstract
Prevalence of HIV in sub-Saharan African countries persists at alarming rates. There are currently four promoted methods to prevent HIV infection: adherence to antiretroviral therapy, male circumcision, pre-exposure prophylaxis and use of condoms. This study aimed to assess the availability and accessibility of one of the prevention efforts, condoms, in Kawale, Lilongwe, Malawi. A total of 220 potential condom-selling establishments were surveyed in 2012. Data were collected with store owners or staff and locations were geocoded to assess store density. Descriptive analyses were conducted. Of those audited, 96 stores sold condoms, 13 of which distributed free condoms. The stores were most often small shops and located in markets or trading centres. Condoms were most often found at the back of the store in an open space. There were approximately 1.2 stores per ¼ mile; 44% of the businesses in the study region carried condoms. This one method of prevention exhibited multiple barriers in this region: few stores sold condoms, high costs, condom locations within stores and limited availability. The limited accessibility is likely to influence social norms surrounding condom use. Future research should incorporate assessing norms and addressing barriers to uptake of HIV prevention efforts.
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Affiliation(s)
- Enbal Shacham
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Rebecca Thornton
- Department of Economics, University of Michigan, Ann Arbor, MI, USA
| | - Susan Godlonton
- Department of Economics, Williams College, Williamstown, MA, USA and International Food Policy Research Institute, Markets, Trade and Institution, Washington, DC, USA
| | - Ryan Murphy
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Jake Gilliland
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
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Community-academic partnerships in HIV-related research: a systematic literature review of theory and practice. J Int AIDS Soc 2015; 18:19354. [PMID: 25630823 PMCID: PMC4309828 DOI: 10.7448/ias.18.1.19354] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 11/07/2014] [Accepted: 11/28/2014] [Indexed: 11/23/2022] Open
Abstract
Introduction Community involvement in HIV research has increased over recent years, enhancing community-academic partnerships. Several terms have been used to describe community participation in research. Clarification is needed to determine whether these terms are synonymous or actually describe different research processes. In addition, it remains unclear if the role that communities play in the actual research process follows the recommendations given in theoretical frameworks of community-academia research. Objectives The objective of this study is to review the existing terms and definitions regarding community-academic partnerships and assess how studies are implementing these in relation to conceptual definitions. Methods A systematic literature review was conducted in PubMed. Two reviewers independently assessed each article, applying the following inclusion criteria: the article must be published in English before 2013; it must provide an explicit definition and/or defining methodology for a term describing research with a community component; and it has to refer to HIV or AIDS, reproductive health and/or STDs. When disagreements about the relevance of an article emerged, a third reviewer was involved until concordance was reached. Data were extracted by one reviewer and independently verified by a second. Qualitative data were analyzed using MaxQDA for content and thematic analyses while quantitative data were analyzed using descriptive statistics. Community feedback on data analysis and presentation of results was also incorporated. Results In total, 246 articles were retrieved, 159 of which fulfilled the inclusion criteria. The number of studies that included community participation in the field of HIV research increased between 1991 and 2012, and the terms used to describe these activities have changed, moving away from action research (AR) to participatory action research (PAR), community-based research (CBR) and community-based participatory research (CBPR), with the latter being the most commonly used term. While definitions of all terms had common characteristics (e.g. participation of community in research process), they varied with regard to the emphasis placed on these characteristics. The nature of community participation in reviewed studies differed considerably from that described in theoretical models. Conclusions This study indicates the increase of participatory approaches in HIV research and underlines the need for clarification of terms and a framework providing orientation to community-academia partnerships.
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Mavhu W, Mupambireyi Z, Hart G, Cowan FM. Factors associated with parental non-adoption of infant male circumcision for HIV prevention in Sub-Saharan Africa: a systematic review and thematic synthesis. AIDS Behav 2014; 18:1776-84. [PMID: 24980247 PMCID: PMC4125745 DOI: 10.1007/s10461-014-0835-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Infant male circumcision (IMC) may be more effective at preventing HIV than adult male circumcision as the procedure is carried out before the individual becomes sexually active. Successful scale-up will depend on identifying and overcoming parental concerns that may act as barriers for IMC. We conducted a systematic review to identify qualitative studies reporting on parental reasons for non-adoption of IMC for HIV prevention in sub-Saharan Africa. Thematic synthesis was subsequently conducted. Five descriptive themes were identified; these were later condensed into two main analytical themes: "poor knowledge" and "social constructs". While barriers and motivators are to some degree context specific, this review suggests that there are common themes that need to be addressed across the region if uptake of IMC for HIV prevention is to be widely adopted. Study findings are therefore likely to have broad implications for IMC roll out.
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Affiliation(s)
- Webster Mavhu
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Avondale, Harare, Zimbabwe,
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Sahay S, Nagarajan K, Mehendale S, Deb S, Gupta A, Bharat S, Bhatt S, Kumar AB, Kanthe V, Sinha A, Chandhiok N. Community and healthcare providers' perspectives on male circumcision: a multi-centric qualitative study in India. PLoS One 2014; 9:e91213. [PMID: 24614575 PMCID: PMC3948789 DOI: 10.1371/journal.pone.0091213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 02/09/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although male circumcision (MC) is recommended as an HIV prevention option, the religious, cultural and biomedical dimensions of its feasibility, acceptability and practice in India have not been explored till date. This study explores beliefs, experiences and understanding of the community and healthcare providers (HCPs) about adult MC as an HIV prevention option in India. METHODS This qualitative study covered 134 in-depth interviews from Belgaum, Kolkata, Meerut and Mumbai cities of India. Of these, 62 respondents were the members of circumcising (CC)/non-circumcising communities (NCC); including medically and traditionally circumcised men, parents of circumcised children, spouses of circumcised men, and religious clerics. Additionally, 58 registered healthcare providers (RHCPs) such as general and pediatric surgeons, pediatricians, skin and venereal disease specialists, general practitioners, and operation theatre nurses were interviewed. Fourteen traditional circumcisers were also interviewed. The data were coded and analyzed in QSR NUD*IST ver. 6.0. The study has not explored the participants' views about neonatal versus adult circumcision. RESULTS Members of CC/NCC, traditional circumcisers and RCHPs expressed sharp religious sensitivities around the issue of MC. Six themes emerged: Male circumcision as the religious rite; Multiple meanings of MC: MC for 'religious identity/privilege/sacrifice' or 'hygiene'; MC inflicts pain and cost; Medical indications outweigh faith; Hesitation exists in accepting 'foreign' evidence supporting MC; and communication is the key for acceptance of MCs. Medical indications could make members of NCC accept MC following appropriate counseling. Majority of the RHCPs demanded local in-country evidence. CONCLUSION HCPs must educate high-risk groups regarding the preventive and therapeutic role of MC. Communities need to discuss and create new social norms about male circumcision for better societal acceptance especially among the NCC. Feasibility studies on MC as an individual specific option for the high risk groups in health care setting needs to be explored.
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Affiliation(s)
- Seema Sahay
- National AIDS Research Institute, Pune, India
| | | | | | | | | | | | | | | | | | - Anju Sinha
- Indian Council of Medical Research, Delhi, India
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Downs JA, Fuunay LD, Fuunay M, Mbago M, Mwakisole A, Peck RN, Downs DJ. 'The body we leave behind': a qualitative study of obstacles and opportunities for increasing uptake of male circumcision among Tanzanian Christians. BMJ Open 2013; 3:bmjopen-2013-002802. [PMID: 23793672 PMCID: PMC3657636 DOI: 10.1136/bmjopen-2013-002802] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Male circumcision (MC) reduces HIV infection by approximately 60% among heterosexual men and is recommended by the WHO for HIV prevention in sub-Saharan Africa. In northwest Tanzania, over 60% of Muslims but less than 25% of Christian men are circumcised. We hypothesised that the decision to circumcise may be heavily influenced by religious identity and that specific religious beliefs may offer both obstacles and opportunities to increasing MC uptake, and conducted focus group discussions to explore reasons for low rates of MC among Christian church attenders in the region. DESIGN Qualitative study using focus group discussions and interpretative phenomenological analysis. SETTING Discussions took place at churches in both rural and urban areas of the Mwanza region of northwest Tanzania. PARTICIPANTS We included 67 adult Christian churchgoers of both genders in a total of 10 single-gender focus groups. RESULTS Christians frequently reported perceiving MC as a Muslim practice, as a practice for the sexually promiscuous, or as unnecessary since they are taught to focus on 'circumcision of the heart'. Only one person had ever heard MC discussed at church, but nearly all Christian parishioners were eager for their churches to address MC and felt that MC could be consistent with their faith. CONCLUSIONS Christian religious beliefs among Tanzanian churchgoers provide both obstacles and opportunities for increasing uptake of MC. Since half of adults in sub-Saharan Africa identify themselves as Christians, addressing these issues is critical for MC efforts in this region.
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Affiliation(s)
- Jennifer A Downs
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | | | | | | | | | - Robert N Peck
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - David J Downs
- School of Theology, Fuller Theological Seminary, Pasadena, California, USA
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