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Agot K, Onyango J, Otieno G, Musingila P, Gachau S, Ochillo M, Grund J, Joseph R, Mboya E, Ohaga S, Omondi D, Odoyo-June E. Shifting reasons for older men remaining uncircumcised: Findings from a pre- and post-demand creation intervention among men aged 25-39 years in western Kenya. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003188. [PMID: 38820408 PMCID: PMC11142559 DOI: 10.1371/journal.pgph.0003188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 04/04/2024] [Indexed: 06/02/2024]
Abstract
Voluntary medical male circumcision (VMMC) reduces men's risk of acquiring Human immunodeficiency virus (HIV) through vaginal sex. However, VMMC uptake remains lowest among Kenyan men ages 25-39 years among whom the impact on reducing population-level HIV incidence was estimated to be greatest at the start of the study in 2014. We conducted a pre- and post-intervention survey as part of a cluster randomized controlled trial to determine the effect of two interventions (interpersonal communication (IPC) and dedicated service outlets (DSO), delivered individually or together) on improving VMMC uptake among men ages 25-39 years in western Kenya between 2014 and 2016. The study had three intervention arms and a control arm. In arm one, an IPC toolkit was used to address barriers to VMMC. In arm two, men were referred to DSO that were modified to address their preferences. Arm three combined the IPC and DSO. The control arm had standard of care. At baseline, uncircumcised men ranked the top three reasons for remaining uncircumcised. An IPC demand creation toolkit was used to address the identified barriers and men were referred for VMMC at study-designated facilities. At follow-up, those who remained uncircumcised were again asked to rank the top three reasons for not getting circumcised. There was inconsistency in ranking of reported barriers at pre- and post- intervention: 'time/venue not convenient' was ranked third at baseline and seventh at follow-up; 'too busy to go for circumcision' was tenth at baseline but second at follow-up, and concern about 'what I/family will eat' was ranked first at both baseline and follow-up, but the proportion reduced from 62% to 28%. Men ages 25-39 years cited a variety of logistical and psychosocial barriers to receiving VMMC. After exposure to IPC, most of these barriers shifted while some remained the same. Additional innovative interventions to address on-going and shifting barriers may help improve VMMC uptake among older men.
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Affiliation(s)
- Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Jacob Onyango
- Impact Research and Development Organization, Kisumu, Kenya
| | - George Otieno
- Center for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Paul Musingila
- Division of Global HIV and TB (DGHT), Center for Global Health (CGH), US Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Susan Gachau
- Division of Global HIV and TB (DGHT), Center for Global Health (CGH), US Centers for Disease Control and Prevention, Kisumu, Kenya
| | | | - Jonathan Grund
- Division of Global HIV and TB (DGHT), Center for Global Health (CGH), US Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Rachael Joseph
- Division of Global HIV and TB (DGHT), Center for Global Health (CGH), US Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Edward Mboya
- Impact Research and Development Organization, Kisumu, Kenya
| | - Spala Ohaga
- Impact Research and Development Organization, Kisumu, Kenya
| | - Dickens Omondi
- Jaramogi Oginga Odinga University of Science and Technology, Bondo, Kenya
| | - Elijah Odoyo-June
- Division of Global HIV and TB (DGHT), Center for Global Health (CGH), US Centers for Disease Control and Prevention, Kisumu, Kenya
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Elsayed B, Elmarasi M, Madzime RJ, Mapahla L, ElBadway MMS, Chivese T. Estimates of the prevalence of male circumcision in sub-Saharan Africa from 2010-2023-A systematic review and meta-analysis. PLoS One 2024; 19:e0298387. [PMID: 38478528 PMCID: PMC10936832 DOI: 10.1371/journal.pone.0298387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/23/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Male circumcision (MC) is a key part of the package of interventions to prevent HIV, the biggest health challenge in sub-Saharan Africa. OBJECTIVE To estimate the male circumcision prevalence and to evaluate the progress towards meeting WHO targets in sub-Saharan Africa during the period 2010-2023. METHODS We carried out a systematic review and meta-analysis of studies published during the period 2010-2023. We searched PubMed, Scopus, Cochrane CENTRAL, Google Scholar, WHO and the Demographic and Health Survey for reports on MC prevalence in sub-Saharan Africa. MC prevalence was synthesized using inverse-variance heterogeneity models, heterogeneity using I2 statistics and publication bias using funnel plots. RESULTS A total of 53 studies were included. The overall prevalence during the study period was 45.9% (95% CI 32.3-59.8), with a higher MC prevalence in Eastern (69.9%, 95%CI 49.9-86.8) compared to Southern African (33.3%, 95%CI 21.7-46.2). The overall prevalence was higher in urban (45.3%, 95%CI 27.7-63.4) compared to rural settings (42.6%, 95% 26.5-59.5). Male circumcision prevalence increased from 40.2% (95% CI 25.0-56.3) during 2010-2015 to 56.2% (95% CI 31.5-79.5) during 2016-2023. Three countries exceeded 80% MC coverage, namely, Ethiopia, Kenya and Tanzania. CONCLUSION Overall, the current MC prevalence is below 50%, with higher prevalence in Eastern African countries and substantially lower prevalence in Southern Africa. Most of the priority countries need to do more to scale up medical male circumcision programs.
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Affiliation(s)
- Basant Elsayed
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Qatar
| | - Mohamed Elmarasi
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Qatar
| | - Ruvarashe J. Madzime
- Department of Global Health, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lovemore Mapahla
- Department of Global Health, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Tawanda Chivese
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Qatar
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Knowledge, attitudes and acceptance of voluntary medical male circumcision among males attending high school in Shiselweni region, Eswatini: a cross sectional study. BMC Public Health 2023; 23:349. [PMID: 36797696 PMCID: PMC9933013 DOI: 10.1186/s12889-023-15228-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 02/07/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND In countries such as Eswatini, where there is a high HIV prevalence and low male circumcision the World Health Organization and the Joint United Nations Programme for HIV/AIDS recommend infant and adult circumcision be implemented. The aim of this study was to assess the knowledge, attitudes and acceptability of voluntary medical male circumcision amongst males attending high school in Eswatini. METHODS An observational cross-sectional study was conducted during February and March of 2018 amongst 407 young males (15-21 years) attending Form 4, in nine high schools in the Shiselweni region of Eswatini using a self-administered questionnaire of 42 close ended questions. Sociodemographic details, circumcision status, acceptance of voluntary medical male circumcision, knowledge and attitude scores analysed in Stata® 14 statistical software were described using frequencies, medians and ranges respectively. Bivariate and multivariate linear regression was used to assess the impact of independent variables on circumcision status and acceptance of voluntary medical male circumcision. The level of statistical significance was p < 0.05. RESULTS Amongst the 407 high school-going males, 48.98% (n = 201) reported being circumcised. The majority of the adolescents (75.74%; n = 306) were knowledgeable about voluntary medical male circumcision. However, an even larger majority (84.90% (n = 343) had a negative attitude towards it. In the multivariate logistic regression analysis, having parented their own children (aOR: 3.55; 95%CI: 1.2-10.48), and having circumcised friends (aOR: 3.99; 95%CI: 1.81-8.84) were significantly associated with being circumcised. Neither knowledge nor attitude were associated with the acceptability of voluntary medical male circumcision. CONCLUSION In Eswatini male high school students are knowledgeable about voluntary medical male circumcision but have a negative attitude towards it. Having parented their own children, and having circumcised friends influenced being circumcised.
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Bendera A, Nakamura K, Seino K, Al-Sobaihi S. Factors Associated with Low Uptake of Medical Male Circumcision Among Adolescent Boys in Tanzania: A Multinomial Logistic Regression Modeling. HIV AIDS (Auckl) 2022; 14:565-575. [PMID: 36571074 PMCID: PMC9785118 DOI: 10.2147/hiv.s387380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) remains the leading cause of years of life lost among adolescent boys in eastern and southern Africa. Medical male circumcision (MMC) is a cost-effective one-time intervention that can reduce the risk of heterosexual HIV acquisition in men by approximately 60%. Despite its importance in HIV prevention, the uptake of MMC remains suboptimal among adolescent boys. This study aimed to identify factors associated with low MMC uptake among adolescent boys in Tanzania. Methods This study was a secondary analysis of the 2016-17 Tanzania HIV Impact Survey. Descriptive statistics were used to summarize the participants' characteristics. Unadjusted and adjusted multinomial logistic regression models were fitted to identify factors associated with low MMC uptake among adolescent boys. Results A total of 2605 older adolescents (15-19 years) and 1296 young adolescents (10-14 years) were analyzed. The MMC uptake rates among older and young adolescents were 56.5% and 45.1%, respectively. Lower MMC uptake was found among respondents in rural areas (adjusted relative risk ratio [aRRR] = 0.40, 95% CI: 0.28-0.57), in the traditionally non-circumcising zone (aRRR = 0.30, 95% CI: 0.23-0.41), participants with no formal education (aRRR = 0.32, 95% CI: 0.23-0.41), and those living in lower wealth quintile households (aRRR = 0.20, 95% CI: 0.11-0.36). Respondents who were not covered by health insurance (aRRR = 0.67, 95% CI: 0.48-0.94) and those who had no comprehensive HIV knowledge (aRRR = 0.55, 95% CI: 0.44-0.70) were also found to have lower uptake of MMC. Conclusion To achieve and maintain high MMC coverage, MMC interventions for HIV prevention should focus on uncircumcised adolescent boys who are rural residents, of lower socioeconomic status, and residing in traditionally non-circumcising communities. Furthermore, dissemination of HIV knowledge and increasing health insurance coverage may encourage more adolescent boys to undergo MMC.
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Affiliation(s)
- Anderson Bendera
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiko Nakamura
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, Japan,Correspondence: Keiko Nakamura, Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, Japan, Tel +81 3-5803-4048, Fax +81-3-5803-4034, Email
| | - Kaoruko Seino
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, Japan
| | - Saber Al-Sobaihi
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, Japan
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Tusabe J, Muyinda H, Nangendo J, Kwesiga D, Nabikande S, Muhoozi M, Agwang W, Okello T, Rutebemberwa E. Factors Influencing the Uptake of Voluntary Medical Male Circumcision Among Boda-Boda Riders Aged 18–49 Years in Hoima, Western Uganda. HIV AIDS (Auckl) 2022; 14:437-449. [PMID: 36188163 PMCID: PMC9516793 DOI: 10.2147/hiv.s382219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/16/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Methods Results Conclusion
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Affiliation(s)
- Joan Tusabe
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
- Correspondence: Joan Tusabe, Email
| | - Herbert Muyinda
- Child Health and Development Center, School of Medicine Makerere University, Kampala, Uganda
| | - Joanita Nangendo
- Clinical epidemiology Unit, School of Medicine, Makerere University, Kampala, Uganda
| | - Doris Kwesiga
- Department of Health Policy, Planning and Management, School of public health, Makerere University, Kampala, Uganda
| | - Sherifah Nabikande
- Department of Health Policy, Planning and Management, School of public health, Makerere University, Kampala, Uganda
| | - Michael Muhoozi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Winnie Agwang
- Department of Health Policy, Planning and Management, School of public health, Makerere University, Kampala, Uganda
| | - Tom Okello
- Clinical epidemiology Unit, School of Medicine, Makerere University, Kampala, Uganda
| | - Elizeus Rutebemberwa
- Department of Health Policy, Planning and Management, School of public health, Makerere University, Kampala, Uganda
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Rosen JG, Carrasco MA, Traub AM, Kumoji E‘K. Barriers, benefits, and behaviour: Voluntary medical male circumcision ideation in a population-based sample of Zambian men. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2021; 20:314-323. [PMID: 34905454 PMCID: PMC8994851 DOI: 10.2989/16085906.2021.2006727] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Reaching ambitious voluntary medical male circumcision (VMMC) coverage targets requires a deeper understanding of the multifaceted processes shaping men's willingness to access VMMC. Guided by the Ideation Model for Health Communication, this population-based study identifies correlates of Zambian men's future VMMC intentions. Multistage cluster sampling was used to identify households with adult men in 14 districts. Multivariable Poisson regression with robust standard errors modelled associations of future VMMC intent with ideational factors (e.g. perceived benefits and barriers) and sexual behaviours respectively. Forty per cent (40%) of uncircumcised men (N = 1 204) expressed future VMMC intentions. In multivariable analysis, VMMC intent was associated with secondary education or higher (Adjusted Prevalence Ratio [APR] 1.30, 95% Confidence Interval [95% CI]: 1.02-1.66), perceiving VMMC to increase sexual satisfaction (APR 1.45, 95% CI: 1.11-1.89), reporting distance to services as a barrier to VMMC uptake (APR = 0.54, 95% CI: 1.27-1.87), unprotected last sex (APR 1.54, 95% CI: 1.11-2.14), and ≥ 2 sexual partners in the past 12 months (APR 1.45, 95% CI: 1.05-1.99). Being aged ≥ 45 years (vs 18-24 years: APR 0.23, 95% CI: 0.13-0.40) and perceiving that circumcision: (1) is unimportant (APR 0.71, 95% CI: 0.51-0.98); (2) is incompatible with local customs (APR 0.41, 95% CI: 0.18-0.94); or (3) reduces sexual satisfaction (APR 0.10, 95% CI: 0.02-0.62) were inversely associated with future VMMC intent. Demand-creation efforts must confront salient cognitive and social barriers to VMMC uptake, including concerns around incompatibility with local customs. Simultaneously, promotional efforts should emphasise relevant VMMC benefits beyond HIV prevention that resonate with men (e.g. penile hygiene) without reinforcing harmful gender norms.
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Affiliation(s)
- Joseph G Rosen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Maria A Carrasco
- Office of Family Planning and Reproductive Health, United States Agency for International Development, Washington DC, USA
| | - Ariana M Traub
- Office of HIV/AIDS, United States Agency for International Development, Washington DC, USA
| | - E ‘Kuor Kumoji
- Research and Evaluation Division, Johns Hopkins Center for Communication Programs, Baltimore, USA
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Nzamwita P, Biracyaza E. Factors Associated with Low Uptake of Voluntary Medical Male Circumcision as HIV-Prevention Strategy among Men Aged 18-49 Years from Nyanza District, Rwanda. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:377-388. [PMID: 33833586 PMCID: PMC8021263 DOI: 10.2147/hiv.s301045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/15/2021] [Indexed: 01/22/2023]
Abstract
Background Voluntary medical male circumcision (VMMC) is an effective biomedical intervention against HIV in developed and developing countries. However, there is low uptake of VMMC due to various factors, which hinders achievement of health-policy goals to increase uptake. Numerous campaigns offering the procedure free of charge exist in developing countries, but such initiatives seem to bear little fruit in attracting men to these services. This study assessed risk factors associated with the low uptake of VMMC among men in Nyanza district, Southern Province, Rwanda. Methods A cross-sectional study was conducted among adult males in Nyanza. A total of 438 men participated in individual interviews. Bivariate and multivariate logistic regression models were used with 95% confidence intervals and p≤0.05 was taken as statistically significant. Results Our results indicated that a low update of VMMC was highly prevalent (35.8%). A majority (84.7%) of participants had heard about VMMC, its complications, advantages in preventiing penile cancer, sexually transmitted infections, and HIV, condom use after circumcision, abstinence for 6 weeks after circumcision, and improving penile hygiene. Religion and education were significant factors in low uptake. Catholics were less likely to undergo VMMC than Muslims (OR 7.19, 95% CI 1.742–29.659; p=0.01). Those of other faiths were less likely to undergo VMMC than Muslims (OR 6.035, 95% CI 1.731–21.039; p=0.005). Participants with secondary education were less likely to undergo VMMC than those with primary education only (OR 1.4, 95% CI 0.74–2.64; p=0.03). Having no formal education decreased the odds of being uncircumcised (OR 0.37, 95% CI 0.14–0.977; p=0.045) when compared to those with primary education. Conclusion Uptake of VMMC remains low in Nyanza, but most men had sufficient knowledge about it. Education, religion, and marital status were major factors in the low uptake. Programs targeting peer influences and parents need to be prioritized.
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Affiliation(s)
- Pascal Nzamwita
- Department of Community Health, School of Public Health, University of Rwanda, Kigali, Rwanda.,Department of Prevention, ADIS Healthcare Foundation (AHF) Rwanda, Kigali, Rwanda
| | - Emmanuel Biracyaza
- Department of Community Health, School of Public Health, University of Rwanda, Kigali, Rwanda.,District Manager of Sociotherapy Programme, Prison Fellowship Rwanda (PFR), Kigali, Rwanda
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Nanteza BM, Gray RH, Serwadda D, Kennedy C, Makumbi F. VMMC clients' perception of increased risk of HIV infection, circumcision preferred choice of method, providers' socio-demographics and mode of service delivery. Afr Health Sci 2020; 20:1562-1572. [PMID: 34394216 PMCID: PMC8351818 DOI: 10.4314/ahs.v20i4.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Voluntary medical male circumcision (VMMC) is a scientifically proven HIV prevention intervention. Uganda, like many countries has been implementing VMMC for over 10 years but uptake is still low especially in northern Uganda. To attain 80% needed for public health impact, scale-up was recommended with many innovations implemented with sub-optimal results. This study therefore wanted to find out some of the correlates of VMMC uptake in Gulu district, northern Uganda. Methods Two studies were conducted separately but data was analyzed for this study. For the quantitative study, proportions and frequencies were used to measure perception of increased risk of HIV infection using age, gender, occupation, marital and circumcision status. Qualitative study provided data from FGDs, IDIs and KIIs were first transcribed in Acholi and then translated in English. Transcripts were uploaded in MAXDQA software for data management. A code book for emerging themes was developed. Results A total of 548 respondents were interviewed for the quantitative study, where two thirds (66%) of the participants perceived themselves to be at increased risk of HIV infection. For the qualitative study, 149 participants from 19 FGDs, 11 KIIs and 9 IDIs were interviewed. Data were analyzed thematically using both inductive and deductive approaches. Devices were preferred to conventional surgery while mobile services were preferred to static services. However, there were divergent views regarding circumcision service providers' socio-demographics and these were influenced mainly by age, level of education and location. Conclusion People in Northern Uganda perceived themselves to be at an increased risk of HIV infection. They preferred devices to conventional surgery, mobile services to static services but had varying views about the socio-demographics of the service providers.
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Affiliation(s)
- Barbara M Nanteza
- Makerere University College of Health Sciences, School of Public Health, Department of Epidemiology & Bio statistics
| | - Ronald H Gray
- Johns Hopkins University, Bloomberg School of Public Health, Department of Epidemiology
| | - David Serwadda
- Makerere University College of Health Sciences, School of Public Health, Department of Disease Control and Environment Health
| | - C Kennedy
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health
| | - Fredrick Makumbi
- Makerere University College of Health Sciences, School of Public Health, Department of Epidemiology & Bio statistics
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Nxumalo CT, Mchunu GG. Zulu Men's Conceptions, Understanding, and Experiences of Voluntary Medical Male Circumcision in KwaZulu-Natal, South Africa. Am J Mens Health 2020; 14:1557988319892437. [PMID: 32131678 PMCID: PMC7059234 DOI: 10.1177/1557988319892437] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Voluntary Medical Male Circumcision (VMMC) is proven to reduce transmission of
HIV/AIDS. Despite concerted efforts to scale up VMMC in men aged 18–49, the
number of medically circumcised men in this age group remains suboptimal.
Research has shown that several individual factors hinder and promote uptake of
VMMC. The nature of these factors is not clearly understood within the
dimensions of religion, culture and tradition, particularly in a low-income
rural setting. This study aimed to analyze Zulu men’s conceptions, understanding
and experiences regarding VMMC in KwaZulu-Natal (KZN), South Africa. A
qualitative phenomenographic study approach was used to collect data from 20
uncircumcised males at six different clinics that provide VMMC services. Ethical
approval to collect data was obtained from the Biomedical Research Ethics
Committee of the University of KZN (BREC – BE627/18). Individual in-depth face
to face interviews were conducted using a semistructured interview guide.
Audiotapes were used to record interviews which were transcribed verbatim and
then analyzed manually. The conceptions regarding medical circumcision appeared
to be related to religious and cultural beliefs surrounding circumcision and the
historical traditional practice thereof. The understanding of males regarding
VMMC was mainly attributed to HIV prevention; however, knowledge on the degree
of partial protection appeared to be limited. An array of negative accounted in
the form of complications such as poor wound healing and postoperative pain
undergone by peers and other close influencers’ accounted for participants’
experiences of VMMC. Poor knowledge and negative experiences relating to VMMC
could account for reasons why men choose not to undergo VMMC.
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Affiliation(s)
- Celenkosini Thembelenkosini Nxumalo
- KZN Department of Health, Ndwedwe Community Health Centre, Verulam, KwaZulu-Natal, South Africa.,Discipline of Nursing, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Gugu Gladness Mchunu
- Discipline of Nursing, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
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Nanteza BM, Makumbi FE, Gray RH, Serwadda D, Yeh PT, Kennedy CE. Enhancers and barriers to uptake of male circumcision services in Northern Uganda: a qualitative study. AIDS Care 2019; 32:1061-1068. [PMID: 31795737 DOI: 10.1080/09540121.2019.1698703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Uganda adopted voluntary medical male circumcision (VMMC) in 2010, but uptake remains disproportionately low in the Northern region despite implementing several demand creation strategies. This study explored the socio-cultural and structural enhancers and barriers to uptake of VMMC services in Gulu, a district in Northern Uganda where uptake is lowest. In September 2016, we conducted 19 focus group discussions, 9 in-depth interviews, and 11 key informant interviews with 149 total participants. Data were collected and analyzed thematically using both inductive and deductive approaches, then framed in four levels of the social ecological model. Enhancers included adequate knowledge about VMMC services, being young and single, partner involvement, peer influence, perceived increased libido after circumcision, and availability of free and high-quality VMMC services. Barriers included sexual abstinence during wound healing, penile appearance after circumcision, religion, culture, and misconceptions. Optimizing enhancers and addressing barriers could increase VMMC service uptake in northern Uganda.
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Affiliation(s)
- Barbara M Nanteza
- AIDS Control Program, Ministry of Health, Nakasero, Uganda.,College of Health Sciences, School of Public Health, Department of Epidemiology and Biostatistics, Makerere University, Nakasero, Uganda
| | - Fredrick E Makumbi
- College of Health Sciences, School of Public Health, Department of Epidemiology and Biostatistics, Makerere University, Nakasero, Uganda
| | - Ronald H Gray
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David Serwadda
- College of Health Sciences, School of Public Health, Department of Disease Control and Environmental Health, Makerere University, Nakasero, Uganda
| | - Ping Teresa Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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