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Leković A, Živković V, Nikolić S. Penile Pearls and Pearling: Characteristics and Social Identity from the Perspective of Forensic Pathologists. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1395-1401. [PMID: 38285295 DOI: 10.1007/s10508-023-02791-4] [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: 09/26/2022] [Revised: 07/08/2023] [Accepted: 12/14/2023] [Indexed: 01/30/2024]
Abstract
Penile pearls are artificial implants placed beneath the skin of a penis to provide enhanced sexual experience for the partner or present a stigma of a particular social subgroup (e.g., prisoner, member of a gang). This genital modification is usually encountered in men of low socioeconomic status and prisoners who might (self) implant improvised pearls under poor sanitary conditions. We have only recently started to encounter penile pearls on autopsy, incidentally. The aim of this study was to analyze our autopsy cases with penile pearls to assess the characteristics of these subjects regarding their socioeconomic status, history of imprisonment, substance abuse, as well as the characteristics of implants. Nineteen men were included. Most were born in the 1970s and 1980s, with only elementary/vocational school education (n = 10). Only five men graduated from high school. At least 14 were in prison at some point in life and 13 were unemployed. Ten men were unmarried. In 11 men, regular alcohol consumption was reported. 12 used illicit substances, most with a history of heroin injection. Penile pearls were improvised and made of rigid plastic in 10 men, eight were of soft silicone-like material, and one was of metal. A distinct characteristic was a ribbed contour of some implants. Although this genital modification seems to gain more attention outside of described vulnerable groups, it mostly remains limited to them in our region. It is most likely performed in improvised, non-professional, unsanitary conditions, probably in prisons.
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Affiliation(s)
- Aleksa Leković
- Institute of Forensic Medicine, University of Belgrade- Faculty of Medicine, 31a Deligradska str., 11000, Belgrade, Serbia
| | - Vladimir Živković
- Institute of Forensic Medicine, University of Belgrade- Faculty of Medicine, 31a Deligradska str., 11000, Belgrade, Serbia
| | - Slobodan Nikolić
- Institute of Forensic Medicine, University of Belgrade- Faculty of Medicine, 31a Deligradska str., 11000, Belgrade, Serbia.
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Asa GA, Fauk NK, Ward PR. Traditional male circumcision and the risk for HIV transmission among men: a systematic review. BMJ Open 2023; 13:e072118. [PMID: 37208134 DOI: 10.1136/bmjopen-2023-072118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
OBJECTIVES To synthesise evidence to determine whether, in contrast to medical male circumcision, traditional male circumcision (TMC) practices may contribute to HIV transmission and what the impacts of TMC are on the initiates, their families and societies. DESIGN Systematic review. DATA SOURCE PubMed, CINHAL, SCOPUS, ProQuest, Cochrane database and Medline were searched between 15 and 30 October 2022. ELIGIBILITY CRITERIA (1) Studies involving young men, young male adults, male adults and mixed male and female participants; (2) studies on TMC involving men living with HIV (married and non-married); (3) studies on TMC, HIV transmission and impact in low-income and middle-income countries; (4) qualitative, quantitative and mixed-method studies and (5) studies aimed at exploring TMC and how it contributes to HIV transmission and the impacts of HIV on circumcised men and their families. DATA EXTRACTION Data were extracted based on study details, study design, characteristics of participants and results. RESULT A total of 18 studies were included: 11 were qualitative studies, five were quantitative studies and two were mixed-method studies. All the studies included were conducted in areas where TMC was performed (17 in Africa and one in Papua New Guinea). The review's findings were categorised into themes: TMC as a cultural practice, consequences of not being traditionally circumcised on men and their families and TMC-related risk of HIV transmission. CONCLUSION This systematic review highlights that TMC practice and HIV risk could negatively impact men and their families. Existing evidence suggests that little attention has been paid to men and their families experiencing the impacts of TMC and HIV risk factors. The findings recommend the need for health intervention programmes such as safe circumcision and safe sexual behaviours following TMC and efforts to address psychological and social challenges in communities practising TMC. PROSPERO REGISTRATION NUMBER CRD42022357788.
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Affiliation(s)
- Gregorius Abanit Asa
- Research Centre for Public Health, Equity and Human Flourishing (PHEHF), Torrens University Australia, Adelaide, South Australia, Australia
| | - Nelsensius Klau Fauk
- Research Centre for Public Health, Equity and Human Flourishing (PHEHF), Torrens University Australia, Adelaide, South Australia, Australia
| | - Paul Russell Ward
- Research Centre for Public Health, Equity and Human Flourishing (PHEHF), Torrens University Australia, Adelaide, South Australia, Australia
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Reconsidering the role of patriarchy in upholding female genital modifications: analysis of contemporary and pre-industrial societies. Int J Impot Res 2022; 35:202-211. [PMID: 35701657 PMCID: PMC10159853 DOI: 10.1038/s41443-022-00581-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 11/08/2022]
Abstract
According to the World Health Organization (WHO), customary female genital modification practices common in parts of Africa, South and Southeast Asia, and the Middle East are inherently patriarchal: they reflect deep-rooted inequality between the sexes characterized by male dominance and constitute an extreme form of discrimination against women. However, scholars have noted that while many societies have genital modification rites only for boys, with no equivalent rite for girls, the inverse does not hold. Rather, almost all societies that practice ritual female genital modification also practice ritual male genital modification, often for comparable reasons on children of similar ages, with the female rites led by women and the male rites led by men. In contrast, then, to the situation for boys in various cultures, girls are not singled out for genital modification on account of their sex or gender; nor do the social meanings of the female rites necessarily reflect a lower status. In some cases, the women's rite serves to promote female within-sex bonding and network building-as the men's rite typically does for males-thereby counterbalancing gendered asymmetries in political power and weakening male dominance in certain spheres. In such cases, and to that extent, the female rites can be described as counter-patriarchal. Selective efforts to discourage female genital modifications may thus inadvertently undermine women-centered communal networks while leaving male bonding rites intact. Scholars and activists should not rely on misleading generalizations from the WHO about the relationship between genital cutting and the social positioning of women as compared to men. To illustrate the complexity of this relationship, we compare patterns of practice across contemporary societies while also highlighting anthropological data regarding pre-industrial societies. Regarding the latter, we find no association between the presence of a female initiation rite and a key aspect of patriarchy as it is classically understood, namely, social endorsement of a gendered double-standard regarding premarital sexual activity. We situate this finding within the broader literature and discuss potential implications.
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Earp BD. Genital Cutting as Gender Oppression: Time to Revisit the WHO Paradigm. FRONTIERS IN HUMAN DYNAMICS 2022. [DOI: 10.3389/fhumd.2022.778592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The World Health Organization (WHO) condemns all medically unnecessary female genital cutting (FGC) that is primarily associated with people of color and the Global South, claiming that such FGC violates the human right to bodily integrity regardless of harm-level, degree of medicalization, or consent. However, the WHO does not condemn medically unnecessary FGC that is primarily associated with Western culture, such as elective labiaplasty or genital piercing, even when performed by non-medical practitioners (e.g., body artists) or on adolescent girls. Nor does it campaign against any form of medically unnecessary intersex genital cutting (IGC) or male genital cutting (MGC), including forms that are non-consensual or comparably harmful to some types of FGC. These and other apparent inconsistencies risk undermining the perceived authority of the WHO to pronounce on human rights. This paper considers whether the WHO could justify its selective condemnation of non-Western-associated FGC by appealing to the distinctive role of such practices in upholding patriarchal gender systems and furthering sex-based discrimination against women and girls. The paper argues that such a justification would not succeed. To the contrary, dismantling patriarchal power structures and reducing sex-based discrimination in FGC-practicing societies requires principled opposition to medically unnecessary, non-consensual genital cutting of all vulnerable persons, including insufficiently autonomous children, irrespective of their sex traits or socially assigned gender. This conclusion is based, in part, on an assessment of the overlapping and often mutually reinforcing roles of different types of child genital cutting—FGC, MGC, and IGC—in reproducing oppressive gender systems. These systems, in turn, tend to subordinate women and girls as well as non-dominant males and sexual and gender minorities. The selective efforts of the WHO to eliminate only non-Western-associated FGC exposes the organization to credible accusations of racism and cultural imperialism and paradoxically undermines its own stated goals: namely, securing the long-term interests and equal rights of women and girls in FGC-practicing societies.
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Hakim AJ, Iwamoto C, Badman SG, Willie B, Pekon S, Aeno H, Neo-Boli R, Ase S, Weikum D, Vallely AJ, Kelly-Hanku A. High Prevalence of Chlamydia and Gonorrhea and the Need for Sexually Transmitted Infection Testing Among Men Who Have Sex With Men and Transgender Women in Papua New Guinea. Sex Transm Dis 2021; 48:109-117. [PMID: 32976356 PMCID: PMC8667082 DOI: 10.1097/olq.0000000000001300] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Papua New Guinea has among the highest prevalence of sexually transmitted infections in the world but no estimates of Chlamydia trachomatis, Neisseria gonorrhoeae, or hepatitis B virus (HBV) are available among men who have sex with men (MSM) or transgender women (TGW). METHODS We conducted respondent-driven sampling surveys among MSM and TGW in Port Moresby, Lae, and Mt Hagen (2016-2017) to characterize the prevalence of these infections. Eligibility criteria were as follows: aged ≥12 years, born male, could speak English or Tok Pisin, and had oral or anal sex with another person born male in the past 6 months. Participants were surveyed face-to-face and offered testing for anorectal and genital chlamydia and gonorrhea, syphilis, HIV, and HBV. All results are respondent-driven sampling weighted. RESULTS We enrolled 400 participants in Port Moresby, 352 in Lae, and 111 in Mt Hagen. Chlamydia prevalence rates in the 3 cities regardless of anatomical site were 19.9%, 19.2%, and 24.3%, respectively. Gonorrhea prevalence rates regardless of anatomical site were 10.3%, 9.4%, and 9.6%, respectively. Hepatitis B virus prevalence rates were 11.7%, 13.8%, and 13.6%, respectively. In multivariable analysis, syphilis was associated with having either chlamydia or gonorrhea in Port Moresby (adjusted odds ratio, 4.0; 95% confidence interval, 2.0-7.9) and Lae (adjusted odds ratio, 2.4; 95% confidence interval, 1.2-5.0). CONCLUSIONS There is a large unmet need among MSM and TGW in Papua New Guinea for chlamydia and gonorrhea detection and treatment. The high prevalence of HBV reinforces the importance of ensuring introduction and scale-up of HBV treatment and immunization. Urgent efforts are needed to introduce laboratory-based diagnosis for chlamydia and gonorrhea to ensure these populations have access to much needed treatment services.
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Affiliation(s)
| | - Chelsea Iwamoto
- US Centers for Disease Control and Prevention
- Emory University Rollins School of Public Health, Atlanta, GA
| | | | - Barne Willie
- Papua New Guinea Institute of Medical Research, Goroka
| | - Simon Pekon
- Papua New Guinea National Department of Health, Port Moresby, Papua New Guinea
| | - Herick Aeno
- Papua New Guinea Institute of Medical Research, Goroka
| | | | - Sophie Ase
- Papua New Guinea Institute of Medical Research, Goroka
| | | | - Andrew J. Vallely
- Kirby Institute, UNSW Sydney, Sydney, Australia
- Papua New Guinea Institute of Medical Research, Goroka
| | - Angela Kelly-Hanku
- Kirby Institute, UNSW Sydney, Sydney, Australia
- Papua New Guinea Institute of Medical Research, Goroka
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Swali RN, Patel RR, Tyring SK. Penile nodules. Int J Dermatol 2020; 60. [PMID: 32964445 DOI: 10.1111/ijd.15175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/08/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Ritu N Swali
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ravi R Patel
- Department of Dermatology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Stephen K Tyring
- Department of Dermatology, University of Texas Houston Health Science Center, Houston, TX, USA
- Center for Clinical Studies, Houston Skin Associates, Houston, TX, USA
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Manineng CM, MacLaren D, Baigry M, Trowalle E, Muller R, Vallely A, Gesch P, Hombhanje F, McBride WJ. Re-establishing safer medical-circumcision-integrated initiation ceremonies for HIV prevention in a rural setting in Papua New Guinea. A multi-method acceptability study. PLoS One 2017; 12:e0187577. [PMID: 29117244 PMCID: PMC5678725 DOI: 10.1371/journal.pone.0187577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 10/23/2017] [Indexed: 12/14/2022] Open
Abstract
Background Efforts to stem the spread of Human Immunodeficiency Virus (HIV) in Papua New Guinea (PNG) are hampered by multiple interrelated factors including limited health services, extreme diversities in culture and language and highly prevalent gender inequity, domestic violence and poverty. In the rural district of Yangoru-Saussia, a revival of previously ceased male initiation ceremonies (MICs) is being considered for a comprehensive approach to HIV prevention. In this study, we explore the local acceptability of this undertaking including replacing traditional penile cutting practices with medical male circumcision (MMC). Methods A multi-method study comprising three phases. Phase one, focus group discussions with male elders to explore locally appropriate approaches to HIV prevention; Phase two, interviews and a cross-sectional survey with community men and women to assess views on MICs that include MMC for HIV prevention; Phase three, interviews with cultural leaders and a cross sectional survey to assess the acceptability of replacing traditional penile bleeding with MMC. Results Cultural leaders expressed that re-establishing MICs was locally appropriate for HIV prevention given the focus on character building and cultural preservation. Most surveyed participants (81.5%) supported re-establishing MICs and 92.2% supported adapting MICs with MMC. Changes to penile bleeding emerged as a contentious and contested issue given its cultural significance in symbolizing initiates’ transition from childhood to adulthood. Participants were concerned about potential clash with modern education, introduced religious beliefs and limited government support in leadership and funding. Conclusions Most people in this study in Yangoru-Saussia support re-establishing MICs and replacing traditional penile bleeding with MMC. This culturally-sensitive alignment of MMC (and HIV prevention) with revived MICs responds to a national health priority in PNG and acts as an example of providing culturally-sensitive male circumcision for HIV prevention recommended by WHO/UNAIDS. However, the implementation of this undertaking will require considerable effort, especially when modern pursuits in education and religion must be factored and when there is expectation for local authorities to lead and provide funding.
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Affiliation(s)
- Clement Morris Manineng
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
- Faculty of Medicine and Health Sciences, Divine Word University, Madang, Papua New Guinea
- * E-mail:
| | - David MacLaren
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
| | - Maggie Baigry
- Faculty of Medicine and Health Sciences, Divine Word University, Madang, Papua New Guinea
| | - Emil Trowalle
- East Sepik Provincial AIDS Committee, Wewak, Papua New Guinea
| | - Reinhold Muller
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
| | - Andrew Vallely
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Patrick Gesch
- Faculty of Medicine and Health Sciences, Divine Word University, Madang, Papua New Guinea
| | - Francis Hombhanje
- Faculty of Medicine and Health Sciences, Divine Word University, Madang, Papua New Guinea
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Redman-MacLaren M, Mills J, Tommbe R, MacLaren D, Speare R, McBride WJH. Implications of male circumcision for women in Papua New Guinea: a transformational grounded theory study. BMC WOMENS HEALTH 2017; 17:53. [PMID: 28750615 PMCID: PMC5530961 DOI: 10.1186/s12905-017-0406-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 07/14/2017] [Indexed: 11/17/2022]
Abstract
Background Male circumcision reduces the risk of female-to-male transmission of human immunodeficiency virus (HIV) and is being explored for HIV prevention in Papua New Guinea (PNG). PNG has a concentrated HIV epidemic which is largely heterosexually transmitted. There are a diverse range of male circumcision and penile modification practices across PNG. Exploring the implications of male circumcision for women in PNG is important to inform evidence-based health policy that will result in positive, intended consequences. Methods The transformational grounded theory study incorporated participatory action research and decolonizing methodologies. In Phase One, an existing data set from a male circumcision study of 861 male and 519 female participants was theoretically sampled and analyzed for women’s understanding and experience of male circumcision. In Phase Two of the study, primary data were co-generated with 64 women in seven interpretive focus group discussions and 11 semi-structured interviews to develop a theoretical model of the processes used by women to manage the outcomes of male circumcision. In Phase Three participants assisted to refine the developing transformational grounded theory and identify actions required to improve health. Results Many women know a lot about male circumcision and penile modification and the consequences for themselves, their families and communities. Their ability to act on this knowledge is determined by numerous social, cultural and economic factors. A transformational grounded theory was developed with connecting categories of: Women Know a Lot, Increasing Knowledge; Increasing Options; and Acting on Choices. Properties and dimensions of each category are represented in the model, along with the intervening condition of Safety. The condition of Safety contextualises the overarching lived realty for women in PNG, enables the inclusion of men in the transformational grounded theory model, and helps to explain relationships between men and women. The theory presents the core category as Power of Choice. Conclusions This transformational grounded theory provides a means to explore how women experience male circumcision and penile modification in PNG, including for HIV prevention. Women who have had opportunities for education have a greater range of choices and an increased opportunity to act upon these choices. However, women can only exercise their power of choice in the context of safety. The concept of Peace drawn from the Social Determinants of Health is applied in order to extend the explanatory power of the transformational grounded theory. This study shows that women’s ambivalence about male circumcision is often related to lack of safety, a consequence of gender inequality in PNG.
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Affiliation(s)
- Michelle Redman-MacLaren
- College of Medicine and Dentistry, James Cook University, PO Box 6811, Cairns, Australia. .,Centre for Indigenous Health Equity Research, School of Health, Medical and Applied Sciences, Cairns, Australia.
| | - Jane Mills
- College of Health, Massey University, Wellington, New Zealand
| | - Rachael Tommbe
- College of Medicine and Dentistry, James Cook University, PO Box 6811, Cairns, Australia.,School of Health Science, Pacific Adventist University, Port Moresby, Papua New Guinea
| | - David MacLaren
- College of Medicine and Dentistry, James Cook University, PO Box 6811, Cairns, Australia
| | - Rick Speare
- Tropical Health Solutions, Pty Ltd, Topaz, Australia
| | - William J H McBride
- College of Medicine and Dentistry, James Cook University, PO Box 6811, Cairns, Australia
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Dorsal longitudinal foreskin cut is associated with reduced risk of HIV, syphilis and genital herpes in men: a cross-sectional study in Papua New Guinea. J Int AIDS Soc 2017; 20:21358. [PMID: 28406272 PMCID: PMC5515018 DOI: 10.7448/ias.20.01/21358] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Various forms of penile foreskin cutting are practised in Papua New Guinea. In the context of an ecological association observed between HIV infection and the dorsal longitudinal foreskin cut, we undertook an investigation of this relationship at the individual level. Methods: We conducted a cross-sectional study among men attending voluntary confidential HIV counselling and testing clinics. Following informed consent, participants had a face-to-face interview and an examination to categorize foreskin status. HIV testing was conducted on site and relevant specimens collected for laboratory-based Herpes simplex type-2 (HSV-2), syphilis, Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) testing. Results: Overall, 1073 men were enrolled: 646 (60.2%) were uncut; 339 (31.6%) had a full dorsal longitudinal cut; 72 (6.7%) a partial dorsal longitudinal cut; and 14 (1.3%) were circumcised. Overall, the prevalence of HIV was 12.3%; HSV-2, 33.6%; active syphilis, 12.1%; CT, 13.4%; NG, 14.1%; and TV 7.6%. Compared with uncut men, men with a full dorsal longitudinal cut were significantly less likely to have HIV (adjusted odds ratio [adjOR] 0.25, 95%CI: 0.12, 0.51); HSV-2 (adjOR 0.60, 95%CI: 0.41, 0.87); or active syphilis (adjOR 0.55, 95%CI: 0.31, 0.96). This apparent protective effect was restricted to men cut prior to sexual debut. There was no difference between cut and uncut men for CT, NG or TV. Conclusions: In this large cross-sectional study, men with a dorsal longitudinal foreskin cut were significantly less likely to have HIV, HSV-2 and syphilis compared with uncut men, despite still having a complete (albeit morphologically altered) foreskin. The protective effect of the dorsal cut suggests that the mechanism by which male circumcision works is not simply due to the removal of the inner foreskin and its more easily accessible HIV target cells. Exposure of the penile glans and inner foreskin appear to be key mechanisms by which male circumcision confers protection. Further research in this unique setting will help improve our understanding of the fundamental immunohistologic mechanisms by which male circumcision provides protection, and may lead to new biomedical prevention strategies at the mucosal level.
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Kelly-Hanku A, Kawage T, Vallely A, Mek A, Mathers B. Sex, violence and HIV on the inside: cultures of violence, denial, gender inequality and homophobia negatively influence the health outcomes of those in closed settings. CULTURE, HEALTH & SEXUALITY 2015; 17:990-1003. [PMID: 25853184 DOI: 10.1080/13691058.2015.1020877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
To map the context of HIV in closed settings in Papua New Guinea (PNG), semi-structured interviews were undertaken with 56 prisoners and detainees and 60 key stakeholders. The nature of HIV-related risk differs for detained women and men, and reflects important gender-based issues present in PNG society more broadly. Women in detention are vulnerable to sexual violence and exploitation and at greatest risk of HIV while detained in police holding cells, where they are typically supervised by male officers, in contrast to prisons, where they have little contact with male staff. HIV risk for men in prison is associated with consensual and non-consensual sex; this risk is perpetuated by a pervasive culture of denial and institutionalised homophobia. The illegal nature of sodomy and male-to-male sex provides Correctional Services the legal grounds by which to refuse access to condoms for prisoners. Addressing HIV risk among detained men and women in PNG requires the reform of legislation, police and prison practices and an understanding of broader structural problems of gender-based violence and stigma and discrimination.
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Affiliation(s)
- Angela Kelly-Hanku
- a School of Public Health and Community Medicine, UNSW Australia , Sydney , Australia
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Impact of male circumcision on the HIV epidemic in Papua New Guinea: a country with extensive foreskin cutting practices. PLoS One 2014; 9:e104531. [PMID: 25111058 PMCID: PMC4128698 DOI: 10.1371/journal.pone.0104531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 07/14/2014] [Indexed: 11/19/2022] Open
Abstract
The degree to which adult medical male circumcision (MC) programs can reduce new HIV infections in a moderate HIV prevalence country like Papua New Guinea (PNG) are uncertain especially given the widespread prevalence of longitudinal foreskin cuts among adult males. We estimated the likely impact of a medical MC intervention in PNG using a mathematical model of HIV transmission. The model was age-structured and incorporated separate components for sex, rural/urban, men who have sex with men and female sex workers. Country-specific data of the prevalence of foreskin cuts, sexually transmitted infections, condom usage, and the acceptability of MC were obtained by our group through related studies. If longitudinal foreskin cutting has a protective efficacy of 20% compared to 60% for MC, then providing MC to 20% of uncut males from 2012 would require 376,000 procedures, avert 7,900 HIV infections by 2032, and require 143 MC per averted infection. Targeting uncut urban youths would achieve the most cost effective returns of 54 MC per HIV infection averted. These numbers of MC required to avert an HIV infection change little even with coverage up to 80% of men. The greater the protective efficacy of longitudinal foreskin cuts against HIV acquisition, the less impact MC interventions will have. Dependent on this efficacy, increasing condom use could have a much greater impact with a 10 percentage point increase averting 18,400 infections over this same period. MC programs could be effective in reducing HIV infections in PNG, particularly in high prevalence populations. However the overall impact is highly dependent on the protective efficacy of existing longitudinal foreskin cutting in preventing HIV.
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Vallely A, Ryan CE, Allen J, Sauk JC, Simbiken CS, Wapling J, Kaima P, Kombati Z, Law G, Fehler G, Murray JM, Siba P, Kaldor JM. High prevalence and incidence of HIV, sexually transmissible infections and penile foreskin cutting among sexual health clinic attendees in Papua New Guinea. Sex Health 2014; 11:58-66. [PMID: 24618046 DOI: 10.1071/sh13197] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 02/02/2014] [Indexed: 11/23/2022]
Abstract
UNLABELLED Background Papua New Guinea (PNG) has one of the highest prevalences of HIV and sexually transmissible infections (STIs) in the Asia-Pacific region, and one of the highest burdens of maternal syphilis and cervical cancer globally. Despite this disease burden, only limited clinical research in sexual and reproductive health has been conducted in PNG. METHODS A longitudinal clinical cohort study was conducted at two sexual health clinics. Participants completed a behavioural interview, clinical assessment and genital examination at baseline, and at 12, 24 and 50 weeks, including specimen collection for STI diagnostics. RESULTS In total, 154 people attended a screening visit. Reattendance at 12, 24 and 50-weeks was 87%, 78% and 80% respectively. At baseline, HIV prevalence was 3.3%; chlamydia (Chlamydia trachomatis), 29.2%; gonorrhoea (Neisseria gonorrhoeae), 22.1%; Trichomonas vaginalis 15.6%; herpes simplex type-2 (HSV-2), 46.1%; active syphilis, 11.7%. Multiple infections were common particularly among women. The incidence of chlamydia was 27 per 100 person-years (PY); gonorrhoea, 15 out of 100 PY; T. vaginalis, 29 out of 100 PY; HSV-2, 12 out of 100 PY; syphilis, 8 out of 100 PY. No incident HIV cases were recorded. At baseline, 39% of men in Mt Hagen and 65% in Port Moresby had a penile foreskin cut, with a dorsal slit being the most common. Two men underwent penile cutting during the follow-up period. CONCLUSIONS The prevalence and incidence of STIs, HIV and penile cutting were high among sexual health clinic attendees. High retention figures suggest that this population may be suitable for future interventions research and clinical trials.
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Affiliation(s)
- Andrew Vallely
- The Kirby Institute, University of New South Wales, Darlinghurst, NSW 2010, Australia
| | - Claire E Ryan
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Joyce Allen
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Joyce C Sauk
- National Capital District Department of Health, Port Moresby, Papua New Guinea
| | - Cassey S Simbiken
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Johanna Wapling
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Petronia Kaima
- Mount Hagen General Hospital, Mount Hagen, Papua New Guinea
| | - Zure Kombati
- Mount Hagen General Hospital, Mount Hagen, Papua New Guinea
| | - Greg Law
- National Department of Health, Port Moresby, Papua New Guinea
| | - Glenda Fehler
- Melbourne Sexual Health Centre, 580 Swanston Street, Carlton, Vic. 3053, Australia
| | - John M Murray
- School of Mathematics and Statistics, University of New South Wales, Sydney, NSW 2052, Australia
| | - Peter Siba
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - John M Kaldor
- The Kirby Institute, University of New South Wales, Darlinghurst, NSW 2010, Australia
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Tynan A, Vallely A, Kelly A, Kupul M, Naketrumb R, Aeno H, Siba P, Kaldor JM, Hill PS. Building social currency with foreskin cuts: a coping mechanism of Papua New Guinea health workers and the implications for new programmes. Health Policy Plan 2013; 29:902-11. [PMID: 24105013 DOI: 10.1093/heapol/czt072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recent research as part of a multi-disciplinary investigation on the acceptability and impact of male circumcision for HIV prevention in Papua New Guinea (PNG) has shown that health workers (HWs) undertake unauthorized forms of penile cutting practices in public health facilities or in community settings, at times within a traditional context. Participation in these activities shares common features with coping mechanisms, strategies used by HWs to alleviate the burden of unsatisfactory living and working conditions. Coping mechanisms, however, are typically described as motivated by economic advantage, but in PNG evidence exists that the behaviours of HWs are also influenced by opportunities for social capital. METHODS Twenty-five in-depth interviews (IDIs) were completed with a variety of HWs from 2009 until 2011 and were triangulated with findings from 45 focus group discussions and 82 IDIs completed with community members as part of a wider qualitative study. Thematic analysis examined HW participation in unauthorized penile cutting services. RESULTS The emergence of unauthorized practices as a coping mechanism in PNG is compelled by mutual obligations and social capital arising from community recognition and satisfaction of moral, professional and cultural obligations. Using the example of unauthorized penile cutting practices amongst HWs in PNG, the research shows that although economic gains are not explicitly derived, evidence exists that they meet other community and socio cultural responsibilities forming a social currency within local traditional economies. CONCLUSIONS Coping mechanisms create an opportunity to extend the boundaries of a health system at the discretion of the HW. Fragile health systems create opportunities for coping mechanisms to become institutionalized, pre-empting appropriate policy development or regulation in the introduction of new programmes. In order to ensure the success of new programmes, the existence of such practices and their potential implications must be addressed within programme design, and in implementation and regulation.
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Affiliation(s)
- Anna Tynan
- Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Andrew Vallely
- Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Angela Kelly
- Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Martha Kupul
- Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Richard Naketrumb
- Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Herick Aeno
- Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Peter Siba
- Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - John M Kaldor
- Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Peter S Hill
- Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
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MacLaren D, Tommbe R, Mafile’o T, Manineng C, Fregonese F, Redman-MacLaren M, Wood M, Browne K, Muller R, Kaldor J, McBride WJ. Foreskin cutting beliefs and practices and the acceptability of male circumcision for HIV prevention in Papua New Guinea. BMC Public Health 2013; 13:818. [PMID: 24015786 PMCID: PMC3846639 DOI: 10.1186/1471-2458-13-818] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 09/05/2013] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Male circumcision (MC) reduces HIV acquisition and is a key public health intervention in settings with high HIV prevalence, heterosexual transmission and low MC rates. In Papua New Guinea (PNG), where HIV prevalence is 0.8%, there is no medical MC program for HIV prevention. There are however many different foreskin cutting practices across the country's 800 language groups. The major form exposes the glans but does not remove the foreskin. This study aimed to describe and quantify foreskin cutting styles, practices and beliefs. It also aimed to assess the acceptability of MC for HIV prevention in PNG. METHODS Cross-sectional multicentre study, at two university campuses (Madang Province and National Capital District) and at two 'rural development' sites (mining site Enga Province; palm-oil plantation in Oro Province). Structured questionnaires were completed by participants originating from all regions of PNG who were resident at each site for study or work. RESULTS Questionnaires were completed by 861 men and 519 women. Of men, 47% reported a longitudinal foreskin cut (cut through the dorsal surface to expose the glans but foreskin not removed); 43% reported no foreskin cut; and 10% a circumferential foreskin cut (complete removal). Frequency and type of cut varied significantly by region of origin (p < .001). Most men (72-82%) were cut between the ages of 10-20 years. Longitudinal cuts were most often done in a village by a friend, with circumferential cuts most often done in a clinic by a health professional. Most uncut men (71%) and longitudinal cut men (84%) stated they would remove their foreskin if it reduced the risk of HIV infection. More than 95% of uncut men and 97% of longitudinal cut men would prefer the procedure in a clinic or hospital. Most men (90%) and women (74%) stated they would remove the foreskin of their son if it reduced the risk of HIV infection. CONCLUSION Although 57% of men reported some form of foreskin cut only 10% reported the complete removal of the foreskin, the procedure on which international HIV prevention strategies are based. The acceptability of MC (complete foreskin removal) is high among men (for themselves and their sons) and women (for their sons). Potential MC services need to be responsive to the diversity of beliefs and practices and consider health system constraints. A concerted research effort to investigate the potential protective effects of longitudinal cuts for HIV acquisition is essential given the scale of longitudinal cuts in PNG.
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Affiliation(s)
- David MacLaren
- School of Medicine and Dentistry, James Cook University, McGregor Road, Smithfield, Cairns 4878, Queensland, Australia
| | - Rachael Tommbe
- School of Health Science, Pacific Adventist University, Port Moresby, National Capital District, Papua New Guinea
| | - Tracie Mafile’o
- Deputy Vice Chancellor, Pacific Adventist University, Port Moresby, National Capital District, Papua New Guinea
| | - Clement Manineng
- Faculty of Health Science, Divine Word University, Madang, Madang Province, Papua New Guinea
| | - Federica Fregonese
- Global Health Unit, University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
| | - Michelle Redman-MacLaren
- School of Medicine and Dentistry, James Cook University, McGregor Road, Smithfield, Cairns 4878, Queensland, Australia
| | - Michael Wood
- School of Arts and Social Science, James Cook University, Cairns, Queensland, Australia
| | - Kelwyn Browne
- Rural Primary Health Services Delivery Project, National Department of Health, Port Moresby, Papua New Guinea
| | - Reinhold Muller
- School of Public Health, Tropical Medicine and Rehabilitation Science, James Cook University, Cairns, Queensland, Australia
- Tropical Health Solutions, Townsville, Australia
| | - John Kaldor
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - William John McBride
- School of Medicine and Dentistry, James Cook University, McGregor Road, Smithfield, Cairns 4878, Queensland, Australia
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15
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Tynan A, Hill PS, Kelly A, Kupul M, Aeno H, Naketrumb R, Siba P, Kaldor J, Vallely A. Listening to diverse community voices: the tensions of responding to community expectations in developing a male circumcision program for HIV prevention in Papua New Guinea. BMC Public Health 2013; 13:749. [PMID: 23941536 PMCID: PMC3751450 DOI: 10.1186/1471-2458-13-749] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 08/06/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The success of health programs is influenced not only by their acceptability but also their ability to meet and respond to community expectations of service delivery. The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have recommended medical male circumcision (MC) as an essential component of comprehensive HIV prevention programs in high burden settings. This study investigated community-level perceptions of MC for HIV prevention in Papua New Guinea (PNG), a setting where diverse traditional and contemporary forms of penile foreskin cutting practices have been described. METHODS A multi-method qualitative study was undertaken in four provinces in two stages from 2009 to 2011. A total of 82 in-depth interviews, and 45 focus group discussions were completed during Stage 1. Stage 2 incorporated eight participatory workshops that were an integral part of the research dissemination process to communities. The workshops also provided opportunity to review key themes and consolidate earlier findings as part of the research process. Qualitative data analysis used a grounded theory approach and was facilitated using qualitative data management software. RESULTS A number of diverse considerations for the delivery of MC for HIV prevention in PNG were described, with conflicting views both between and within communities. Key issues included: location of the service, service provider, age eligibility, type of cut, community awareness and potential shame amongst youth. Key to developing appropriate health service delivery models was an appreciation of the differences in expectations and traditions of unique cultural groups in PNG. Establishing strong community coalitions, raising awareness and building trust were seen as integral to success. CONCLUSIONS Difficulties exist in the implementation of new programs in a pluralistic society such as PNG, particularly if tensions arise between biomedical knowledge and medico-legal requirements, compared to existing socio-cultural interests. Community participatory approaches offer important opportunities to explore and design culturally safe, specific and accessible programs.
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Affiliation(s)
- Anna Tynan
- Australian Centre for International & Tropical Health, School of Population Health, University of Queensland Herston Road, Herston, 4006 Queensland, Australia
| | - Peter S Hill
- Australian Centre for International & Tropical Health, School of Population Health, University of Queensland Herston Road, Herston, 4006 Queensland, Australia
| | - Angela Kelly
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research (PNG IMR), Eastern Highlands Province 441, P.O. Box 60, Goroka, Papua New Guinea
- International HIV Research Group, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Martha Kupul
- International HIV Research Group, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Herick Aeno
- International HIV Research Group, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Richard Naketrumb
- International HIV Research Group, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Peter Siba
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research (PNG IMR), Eastern Highlands Province 441, P.O. Box 60, Goroka, Papua New Guinea
| | - John Kaldor
- Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, 2034 New South Wales, Australia
| | - Andrew Vallely
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research (PNG IMR), Eastern Highlands Province 441, P.O. Box 60, Goroka, Papua New Guinea
- Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, 2034 New South Wales, Australia
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Tynan A, Vallely A, Kelly A, Kupul M, Neo J, Naketrumb R, Aeno H, Law G, Milan J, Siba P, Kaldor J, Hill PS. Sociocultural and individual determinants for motivation of sexual and reproductive health workers in Papua New Guinea and their implications for male circumcision as an HIV prevention strategy. HUMAN RESOURCES FOR HEALTH 2013; 11:7. [PMID: 23418879 PMCID: PMC3602021 DOI: 10.1186/1478-4491-11-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 01/28/2013] [Indexed: 06/01/2023]
Abstract
BACKGROUND The motivation of health workers (HWs) to deliver services in developing countries has been described as a critical factor in the success of health systems in implementing programmes. How the sociocultural context of Papua New Guinea (PNG) affects the values, motivation and actions of HWs involved in sexual and reproductive health services is important for policy development and programme planning. With interest in male circumcision (MC) as an HIV prevention option in PNG, this study explored the perceptions and motivations of HWs involved in sexual and reproductive health services in PNG, examining their implications for the possible future roll out of a national MC programme. METHODS A multi-method qualitative study was conducted with HWs across a range of health care professions working in sexual health facilities. A total of 29 in-depth interviews and one focus group discussion were completed. Qualitative thematic analysis of the transcripts and field notes was undertaken using a social constructivist approach and complemented by documentary organizational, programme and policy analysis. RESULTS AND DISCUSSIONS Introduction of new health programmes, such as a MC programme for HIV prevention, are likely to impact upon one or more of the many motivational determinants. Social-cultural and individual factors influencing HW motivation to be involved in sexual and reproductive health services in PNG included community expectation and concern, sense of accomplishment and religious conviction. Strong links to community responsibility outweighed organizational ties. Faced with an often dysfunctional work environment, HWs perceived themselves as responsible to compensate for the failed health system. The impact of community influence and expectation needs to be considered when introducing a MC programme, particularly to communities in PNG where penile foreskin cutting is a common and accepted practice. CONCLUSIONS The potential contribution to the success of a MC programme that HWs may have means that taking into account the differing needs of communities as well as the motivational influences on HWs that exist within the sociocultural environment is important. These findings will assist not only in programme planning for MC, but also in the expansion of other existing sexual and reproductive health services.
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Affiliation(s)
- Anna Tynan
- Australian Centre for International & Tropical Health, School of Population Health, University of Queensland, Herston Road, Herston, Queensland, 4006, Australia
| | - Andrew Vallely
- Public Health Interventions Research Group, Kirby Institute, University of New South Wales, Cliffbrook Campus, 45 Beach Street, Coogee, New South Wales, 2034, Australia
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, P.O. Box 60, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - Angela Kelly
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, P.O. Box 60, Goroka, Eastern Highlands Province, 441, Papua New Guinea
- International HIV Research Group, School of Public Health and Community Medicine, University of New South Wales, High Street, Kensington, 2052, Australia
| | - Martha Kupul
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, P.O. Box 60, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - James Neo
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, P.O. Box 60, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - Richard Naketrumb
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, P.O. Box 60, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - Herick Aeno
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, P.O. Box 60, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - Greg Law
- Sexual Health and Disease Control Branch, National Department of Health, P.O. Box 807, Waigani, National Capital District, 131, Papua New Guinea
| | - John Milan
- Sexual Health and Disease Control Branch, National Department of Health, P.O. Box 807, Waigani, National Capital District, 131, Papua New Guinea
| | - Peter Siba
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, P.O. Box 60, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - John Kaldor
- Public Health Interventions Research Group, Kirby Institute, University of New South Wales, Cliffbrook Campus, 45 Beach Street, Coogee, New South Wales, 2034, Australia
| | - Peter S Hill
- Australian Centre for International & Tropical Health, School of Population Health, University of Queensland, Herston Road, Herston, Queensland, 4006, Australia
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Yap L, Butler T, Richters J, Malacova E, Wand H, Smith AMA, Grant L, Richards A, Donovan B. Penile implants among prisoners-a cause for concern? PLoS One 2013; 8:e53065. [PMID: 23326383 PMCID: PMC3543437 DOI: 10.1371/journal.pone.0053065] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 11/28/2012] [Indexed: 11/18/2022] Open
Abstract
Background We report the prevalence of penile implants among prisoners and determine the independent predictors for having penile implants. Questions on penile implants were included in the Sexual Health and Attitudes of Australian Prisoners (SHAAP) survey following concerns raised by prison health staff that increasing numbers of prisoners reported having penile implants while in prison. Methods Computer-Assisted Telephone Interviewing (CATI) of a random sample of prisoners was carried out in 41 prisons in New South Wales and Queensland (Australia). Men were asked, “Have you ever inserted or implanted an object under the skin of your penis?” If they responded Yes: “Have you ever done so while you were in prison?” Univariate logistic regression and logistic regression were used to determine the factors associated with penile implants. Results A total of 2,018 male prisoners were surveyed, aged between 18 and 65 years, and 118 (5.8%) reported that they had inserted or implanted an object under the skin of their penis. Of these men, 87 (73%) had this done while they were in prison. In the multivariate analysis, a younger age, birth in an Asian country, and prior incarceration were all significantly associated with penile implants (p<0.001). Men with penile implants were also more likely to report being paid for sex (p<0.001), to have had body piercings (p<0.001) or tattoos in prison (p<0.001), and to have taken non-prescription drugs while in prison (p<0.05). Conclusions Penile implants appear to be fairly common among prisoners and are associated with risky sexual and drug use practices. As most of these penile implants are inserted in prison, these men are at risk of blood borne viruses and wound infection. Harm reduction and infection control strategies need to be developed to address this potential risk.
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Affiliation(s)
- Lorraine Yap
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
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