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Ntshiqa T, Musekiwa A, Manesen R, Mdose H, Ngoma N, Kuonza L, Dlamini T, Reddy C, Williams S. Knowledge, Attitudes, Practices, and Acceptability of Medical Male Circumcision among Males in Traditionally Circumcising Rural Communities of Alfred Nzo District, Eastern Cape, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7091. [PMID: 38063521 PMCID: PMC10706319 DOI: 10.3390/ijerph20237091] [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: 08/26/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023]
Abstract
Male circumcision (MC) reduces HIV transmission risk by up to 60% in heterosexual men. However, uptake of medical male circumcision (MMC) is low in traditionally circumcising communities of South Africa. We assessed knowledge, attitudes, and practices to identify factors predicting acceptability of MMC among males in the Alfred Nzo District. A cross-sectional study was conducted among males aged 15-49 years in this district. Logistic regression was used to identify factors predicting acceptability of MMC. We interviewed 343 males who had a median age of 19 years (interquartile range (IQR): 16-25 years). Of these, 77% (95% confidence interval (CI): 72-82) were circumcised: 77% (95% CI: 71-82) were circumcised in a traditional setting and 21% (95% CI: 16-26) in a medical setting. The median score of knowledge about the benefits of MMC was 62.5% (IQR: 37.5-75.0), with 59% (95% CI: 53-64) demonstrating a positive attitude towards MMC and 68% (95% CI: 63-73) accepting involvement of health workers in MC. Excellent knowledge (adjusted odds ratio (aOR): 3.07, 95% CI: 0.99-9.58, p = 0.053), awareness (aOR: 3.26, 95% CI: 1.08-9.86, p = 0.037), and positive attitude towards MMC (aOR: 2.35, 95% CI: 1.30-4.25, p = 0.005) were associated with acceptability of MMC. Participants demonstrated good knowledge and acceptance of the MMC programme. Knowledge, attitude, and awareness were significant predictors of MMC acceptability.
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Affiliation(s)
- Thobani Ntshiqa
- South African Field Epidemiology Training Programme, National Institute for Communicable Disease, Sandringham, Johannesburg 2131, South Africa; (A.M.); (H.M.); (N.N.); (L.K.); (C.R.); (S.W.)
- South African National Aids Council, Pretoria 0002, South Africa
- School of Health Systems and Public Health, University of Pretoria, Pretoria 0002, South Africa
- The Aurum Institute, Johannesburg 2193, South Africa;
| | - Alfred Musekiwa
- South African Field Epidemiology Training Programme, National Institute for Communicable Disease, Sandringham, Johannesburg 2131, South Africa; (A.M.); (H.M.); (N.N.); (L.K.); (C.R.); (S.W.)
- School of Health Systems and Public Health, University of Pretoria, Pretoria 0002, South Africa
| | - Riyadh Manesen
- The Aurum Institute, Johannesburg 2193, South Africa;
- GERMS-SA, National Institute for Communicable Disease, Sandringham, Johannesburg 2131, South Africa
- Epidemiology Unit, Eastern Cape Department of Health, Bisho 5605, South Africa;
| | - Hetani Mdose
- South African Field Epidemiology Training Programme, National Institute for Communicable Disease, Sandringham, Johannesburg 2131, South Africa; (A.M.); (H.M.); (N.N.); (L.K.); (C.R.); (S.W.)
- School of Health Systems and Public Health, University of Pretoria, Pretoria 0002, South Africa
| | - Nqobile Ngoma
- South African Field Epidemiology Training Programme, National Institute for Communicable Disease, Sandringham, Johannesburg 2131, South Africa; (A.M.); (H.M.); (N.N.); (L.K.); (C.R.); (S.W.)
- School of Health Systems and Public Health, University of Pretoria, Pretoria 0002, South Africa
| | - Lazarus Kuonza
- South African Field Epidemiology Training Programme, National Institute for Communicable Disease, Sandringham, Johannesburg 2131, South Africa; (A.M.); (H.M.); (N.N.); (L.K.); (C.R.); (S.W.)
- School of Health Systems and Public Health, University of Pretoria, Pretoria 0002, South Africa
| | - Thomas Dlamini
- Epidemiology Unit, Eastern Cape Department of Health, Bisho 5605, South Africa;
| | - Carl Reddy
- South African Field Epidemiology Training Programme, National Institute for Communicable Disease, Sandringham, Johannesburg 2131, South Africa; (A.M.); (H.M.); (N.N.); (L.K.); (C.R.); (S.W.)
- School of Health Systems and Public Health, University of Pretoria, Pretoria 0002, South Africa
- TEPHINET Secretariat, The Task Force for Global Health, Decatur, GA 30030, USA
| | - Seymour Williams
- South African Field Epidemiology Training Programme, National Institute for Communicable Disease, Sandringham, Johannesburg 2131, South Africa; (A.M.); (H.M.); (N.N.); (L.K.); (C.R.); (S.W.)
- Centers for Disease Control and Prevention, Atlanta, GA 30328, USA
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Edossa ZK, Kumsa AT, Gebre MN. Male circumcision uptake and its predictors among sexually active men aged 15-59 years living in the highest HIV prevalence region of Ethiopia: evidence from 2016 Ethiopia demographic and health survey. BMC Public Health 2020; 20:1772. [PMID: 33228653 PMCID: PMC7684713 DOI: 10.1186/s12889-020-09918-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 11/18/2020] [Indexed: 11/18/2022] Open
Abstract
Background Pieces of evidence showed that the Gambella region of Ethiopia has remained HIV hotspot area for successive years. However, the magnitude of male circumcision uptake and its associated factors are not well studied in this region. Hence, the aim of the current study is to assess the magnitude of male circumcision uptake and its predictors among sexually active men in the region using the 2016 Ethiopian Demographic and Health Survey Data. Method Data on 868 sexually active men residing in the Gambella region were extracted from the 2016 Ethiopian Demographic and health Survey. Descriptive statistics and logistic regression were respectively used to summarize descriptive data and measure the statistical associations. Adjusted odds ratio and confidence intervals were respectively used to measure statistical associations between variables and their statistical significances. Results The current study revealed that the overall prevalence of male circumcision uptake in the Gambella region was 61.2% (95% CI: 57.96,64.44). The results of multivariable logistic regression revealed that being Muslim (AOR = 9.54, 95% CI: 6.765.13.88), being Orthodox Christian (AOR = 8.5, 95%CI: 5.00–14.45), being from Poor household (AOR = 0.11, 95%CI: 0.06, 0.22), being from medium-income household (AOR = .33, 95%CI: 0.15, 0.73), listening to radio (AOR = .29, 95%CI: .16, .54), having comprehensive HIV knowledge (AOR = .44, 95%CI: .27, .71) and ever been tested for HIV (AOR = .27, 95%CI: .16,.46) were independently associated with male circumcision uptake. Conclusion Despite all efforts made by different stakeholders to promote the provision of male circumcision in the Gambella region, its magnitude of uptake is still unacceptably low. The federal HIV prevention and Control Office and other stakeholders working on HIV prevention and control should give due emphasis to promoting HIV-related knowledge through community-based education and through religious leaders. Integrating and streamlining HIV-related education in the academic curricula, and expanding mass media coverage should also be given due consideration by the federal government and other stakeholders. The stakeholders should also give emphasis to strengthening and empowering poor sexually active men residing in the Gambella region.
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Affiliation(s)
- Zerihun Kura Edossa
- Department of Epidemiology, Jimma University, Institute of Health, Faculty of Public Health, Jimma, Ethiopia
| | - Abonesh Taye Kumsa
- Department of Nutrition and Dietetics, Jimma University, Institute of Health, Faculty of Public Health, Jimma, Ethiopia
| | - Mamo Nigatu Gebre
- Department of Epidemiology, Jimma University, Institute of Health, Faculty of Public Health, Jimma, Ethiopia.
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George C, Roberts R, Deveaux L, Brennen DFP, Read SE. "Getting to Zero New HIV Infections in the Caribbean": Knowledge and Attitudes Toward Male Circumcision Among Adolescent Males in The Bahamas. Am J Mens Health 2020; 13:1557988319872074. [PMID: 31431104 PMCID: PMC6704421 DOI: 10.1177/1557988319872074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Male circumcision (MC) plays a significant role in reducing new HIV infections, particularly in high prevalence countries. This cross-sectional study assesses the prevalence of MC and attitudes toward MC among youth aged 15-18 years in The Bahamas, a medium HIV prevalence country. The survey included 797 young men who completed a questionnaire on MC. Data analyses included chi-squared tests. The self-reported prevalence of MC among youth was 16.7% (121/759). Most of the circumcised youth were circumcised as infants, 84% (107/121) were pleased with their circumcision, and 71% would recommend it to others. For uncircumcised youth, 35% (189/533) would consider voluntary male circumcision (VMC) and 26% would recommend MC to others. In all scenarios, circumcised youth were more likely to be positive about MC. Among uncircumcised young men, being older (17-18 years compared to 15-16 years) was the only variable statistically associated with considering MC or recommending MC. After being presented with information on the benefits of MC for HIV prevention, the number of men who were positive about MC increased. Most of the young men in this cohort would consider VMC for reducing HIV incidence. Also, many stated that, if they had a male child, they would have him circumcised. The attitudes of these youth emphasize the need to provide information on HIV in addition to general health benefits of MC if there were to be a sustainable MC program within this population.
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Affiliation(s)
- Clemon George
- 1 University of Ontario Institute of Technology, Oshawa, ON, Canada.,5 Faculty of Medical Sciences, The University of the West Indies, Cave Hill, Barbados
| | - Robin Roberts
- 2 UWI School of Clinical Medicine and Research, Nassau, Bahamas
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Lubogo M, Anguzu R, Wanzira H, Shour AR, Mukose AD, Nyabigambo A, Tumwesigye NM. Utilization of safe male circumcision among adult men in a fishing community in rural Uganda. Afr Health Sci 2019; 19:2645-2653. [PMID: 32127837 PMCID: PMC7040272 DOI: 10.4314/ahs.v19i3.40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background In Uganda, most-at-riskpopulations(MARPs) such as fishing communities remain vulnerable to preventable HIV acquisition. Safe Male Circumcision (SMC) has been incorporated into Uganda's HIV prevention strategies. This study aimed at determining SMC utilization and associated factors among adult men in a rural fishing community in Uganda. Methods A cross-sectional study was conducted in a rural fishing village in central Uganda. Stratified random sampling of 369 fishermen aged 18–54 yearswas used according to their occupational category; fish monger, boat crew and general merchandise. The dependent variable wasutilization of SMC.A forward fitting multivariable logistic regression model was fitted with variables significant at p≤0.05 controlling for confounding and effect modification. Results Respondents'mean(SD) age was 30.0(9.3) years. Only8.4%hadSMC and among non-circumcised men, 84.9% had adequate knowledge of SMC benefits while 79.3% did not know were SMC services were offered. Peer support(AOR0.17;95%-CI0.05–0.60) and perceived procedural safety (AOR6.8;95%CI2.16–21.17) were independently associated with SMC utilization. Conclusion In this rural fishing community, SMC utilization was low. These findings underscore the need to inform HIV preventionstrategies inthecontextof peer support and perceptionsheld by rural dwelling men.
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Affiliation(s)
- Mutaawe Lubogo
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Uganda
| | - Ronald Anguzu
- Institute of Health and Equity, Medical College of Wisconsin, US
| | | | - Abdul R Shour
- Institute of Health and Equity, Medical College of Wisconsin, US
| | - Aggrey D Mukose
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Uganda
| | - Agnes Nyabigambo
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University, Uganda
| | - Nazarius M Tumwesigye
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Uganda
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Morris BJ, Wamai RG, Henebeng EB, Tobian AAR, Klausner JD, Banerjee J, Hankins CA. Estimation of country-specific and global prevalence of male circumcision. Popul Health Metr 2016; 14:4. [PMID: 26933388 PMCID: PMC4772313 DOI: 10.1186/s12963-016-0073-5] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 02/12/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Male circumcision (MC) status and genital infection risk are interlinked and MC is now part of HIV prevention programs worldwide. Current MC prevalence is not known for all countries globally. Our aim was to provide estimates for country-specific and global MC prevalence. METHODS MC prevalence data were obtained by searches in PubMed, Demographic and Health Surveys, AIDS Indicator Surveys, and Behavioural Surveillance Surveys. Male age was ≥15 years in most surveys. Where no data were available, the population proportion whose religious faith or culture requires MC was used. The total number of circumcised males in each country and territory was calculated using figures for total males from (i) 2015 US Central Intelligence Agency (CIA) data for sex ratio and total population in all 237 countries and territories globally and (ii) 2015 United Nations (UN) figures for males aged 15-64 years. RESULTS The estimated percentage of circumcised males in each country and territory varies considerably. Based on (i) and (ii) above, global MC prevalence was 38.7 % (95 % confidence interval [CI]: 33.4, 43.9) and 36.7 % (95 % CI: 31.4, 42.0). Approximately half of circumcisions were for religious and cultural reasons. For countries lacking data we assumed 99.9 % of Muslims and Jews were circumcised. If actual prevalence in religious groups was lower, then MC prevalence in those countries would be lower. On the other hand, we assumed a minimum prevalence of 0.1 % related to MC for medical reasons. This may be too low, thereby underestimating MC prevalence in some countries. CONCLUSIONS The present study provides the most accurate estimate to date of MC prevalence in each country and territory in the world. We estimate that 37-39 % of men globally are circumcised. Considering the health benefits of MC, these data may help guide efforts aimed at the use of voluntary, safe medical MC in disease prevention programs in various countries.
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Affiliation(s)
- Brian J Morris
- />School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, NSW 2006 Australia
| | - Richard G Wamai
- />Department of African-American Studies, Northeastern University, Boston, MA 02115 USA
| | | | - Aaron AR Tobian
- />Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD 21287 USA
| | - Jeffrey D Klausner
- />Division of Infectious Diseases and Program in Global Health, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90095 USA
| | - Joya Banerjee
- />Jhpiego, an affiliate of Johns Hopkins University, Washington, DC 20009 USA
| | - Catherine A Hankins
- />Department of Global Health, Academic Medical Centre and Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, 1105 AZ The Netherlands
- />Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
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Zamawe COF, Kusamula F. What are the social and individual factors that are associated with undergoing male circumcision as an HIV prevention strategy? A mixed methods study in Malawi. Int Health 2015; 8:170-8. [PMID: 26503362 DOI: 10.1093/inthealth/ihv061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 07/31/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is compelling evidence that medical male circumcision (MMC) decreases transmission of HIV. Nevertheless, the uptake of MMC is generally very low. Understanding the characteristics of individuals who choose MMC could inform future strategies for scaling-up MMC. The main objective of this study was to explore the social and individual characteristics of men that are associated with the uptake of circumcision as an HIV prevention strategy. METHODS A mixed-methods study, comprising a cross-sectional survey and an exploratory qualitative study, was conducted in Malawi. A total number of 1644 men, of at least 18 years old, participated in this study. A multistage sampling approach was used in the survey while convenience sampling was adopted in the qualitative study. Descriptive statistics, bivariate analyses and multivariable logistic regression were performed to analyze the cross-sectional data and thematic content approach to analyze the qualitative data. RESULTS Individuals who chose MMC were more likely to be unemployed (AOR=1.65; 95% CI: 1.30-2.11), to be married (AOR=3.16; 95% CI: 2.21-4.52) and to have had exposure to MMC promotions (AOR=1.81; 95% CI: 1.41-2.33). They were also more likely to reside in rural areas (AOR=1.85; 95% CI: 1.44-2.38), to perceive themselves as more vulnerable to HIV (AOR=1.60; 95% CI: 1.19-2.15) and to be more knowledgeable about the benefits of MMC (AOR=1.51; 95% CI: 1.16-1.97). CONCLUSIONS The findings suggest that men who had certain social and individual characteristics (for example better knowledge of the benefits of MMC, greater perceived vulnerability to HIV, married and unemployed) were more likely to choose circumcision as a prevention strategy for HIV than those who lacked those characteristics. Strategies for increasing MMC take-up should recognize the current social/individual landscape of MMC uptake and ensure that deliberate efforts targeting marginalized categories of men are available.
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Affiliation(s)
- Collins O F Zamawe
- Blantyre International University, Community Health Department, Private Bag 98, Blantyre, Malawi Parent and Child Health Initiative (PACHI), Research Centre, P.O. Box 31686, Lilongwe, Malawi
| | - Fatsani Kusamula
- Parent and Child Health Initiative (PACHI), Research Centre, P.O. Box 31686, Lilongwe, Malawi
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Brito MO, Lerebours L, Volquez C, Basora E, Khosla S, Lantigua F, Flete R, Rosario R, Rodriguez LA, Fernandez M, Donastorg Y, Bailey RC. A Clinical Trial to Introduce Voluntary Medical Male Circumcision for HIV Prevention in Areas of High Prevalence in the Dominican Republic. PLoS One 2015; 10:e0137376. [PMID: 26367187 PMCID: PMC4569265 DOI: 10.1371/journal.pone.0137376] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 08/17/2015] [Indexed: 11/19/2022] Open
Abstract
Background Voluntary Medical Male Circumcision (VMMC) is an effective strategy to reduce the risk of HIV infection. Studies conducted in the Dominican Republic (DR) suggest that acceptability of VMMC among men may be as high as 67%. The goal of this clinical trial was to assess the acceptability, uptake and safety for VMMC services in two areas of high HIV prevalence in the country. Methods This was a single-arm, non-randomized, pragmatic clinical trial. Study personnel received background information about the risks and benefits of VMMC and practical training on the surgical technique. A native speaking research assistant administered a questionnaire of demographics, sexual practices and knowledge about VMMC. One week after the surgery, participants returned for wound inspection and to answer questions about their post-surgical experience. Results 539 men consented for the study. Fifty seven were excluded from participation for medical or anatomical reasons and 28 decided not to have the procedure after providing consent. A total of 454 men were circumcised using the Forceps Guided Method Under Local Anesthesia. The rate of adverse events (AE) was 4.4% (20% moderate, 80% mild). There were no serious AEs and all complications resolved promptly with treatment. Eighty eight percent of clients reported being “very satisfied” and 12% were “somewhat satisfied” with the outcome at the one-week postoperative visit. Conclusions Recruitment and uptake were satisfactory. Client satisfaction with VMMC was high and the rate of AEs was low. Roll out of VMMC in targeted areas of the DR is feasible and should be considered. Trial Registration ClinicalTrials.gov NCT02337179
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Affiliation(s)
- Maximo O. Brito
- University of Illinois at Chicago, Chicago, Illinois, United States of America
- * E-mail:
| | | | - Claudio Volquez
- HIV Vaccine Trials Unit, Instituto Dermatologico y Cirugia De Piel, Santo Domingo, Dominican Republic
| | | | - Shaveta Khosla
- University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Flavia Lantigua
- HIV Vaccine Trials Unit, Instituto Dermatologico y Cirugia De Piel, Santo Domingo, Dominican Republic
| | - Roberto Flete
- HIV Vaccine Trials Unit, Instituto Dermatologico y Cirugia De Piel, Santo Domingo, Dominican Republic
| | | | - Luis A. Rodriguez
- HIV Vaccine Trials Unit, Instituto Dermatologico y Cirugia De Piel, Santo Domingo, Dominican Republic
| | - Mathius Fernandez
- HIV Vaccine Trials Unit, Instituto Dermatologico y Cirugia De Piel, Santo Domingo, Dominican Republic
| | - Yeycy Donastorg
- HIV Vaccine Trials Unit, Instituto Dermatologico y Cirugia De Piel, Santo Domingo, Dominican Republic
| | - Robert C. Bailey
- University of Illinois at Chicago, Chicago, Illinois, United States of America
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Figueroa JP. Review of HIV in the Caribbean: significant progress and outstanding challenges. Curr HIV/AIDS Rep 2015; 11:158-67. [PMID: 24623473 DOI: 10.1007/s11904-014-0199-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This paper reviews the recent literature on HIV in the Caribbean and discusses the challenges faced. HIV incidence in the Caribbean has declined by 49 % in the past decade, coverage of persons living with HIV among those eligible for antiretroviral treatment as per national guidelines was 70 % in 2012, and some countries are meeting the target of virtual elimination of mother-to-child transmission. HIV prevalence in the Caribbean is 1 % with features of both a generalized and concentrated HIV epidemic. HIV prevalence among female sex workers has declined but remains unacceptably high among men who have sex with men. Social and cultural factors, gender norms, and strong stigma associated with HIV and homosexuality contribute to the continued spread of HIV. Caribbean countries and their partners have invested significant resources, creative effort and impressive research in strengthening the HIV response nationally and regionally. However, in order to control the HIV epidemic, leaders at all levels, and the people, must address fundamental structural barriers in society that deny marginalized persons their rights, undermine public health goals, and impede universal access to HIV prevention, treatment, and care.
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Affiliation(s)
- J Peter Figueroa
- Department of Community Health and Psychiatry, University of the West Indies, Mona, Kingston 7, Jamaica,
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Walcott MM, Ehiri J, Kempf MC, Funkhouser E, Bakhoya M, Aung M, Zhang K, Jolly PE. Gender Norms and Family Planning Practices Among Men in Western Jamaica. Am J Mens Health 2014; 9:307-16. [PMID: 25077729 DOI: 10.1177/1557988314543792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The objective of this study was to identify the association between gender norms and family planning practices among men in Western Jamaica. A cross-sectional survey of 549 men aged 19 to 54 years attending or visiting four government-operated hospitals was conducted in 2011. Logistic regression models were used to identify factors associated with taking steps to prevent unwanted pregnancy, intention to have a large family size (three or more children), and fathering children with multiple women. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated from the models. Reduced odds for taking steps to prevent unwanted pregnancy among men with moderate (AOR = 0.5; 95% CI = 0.3-0.8) and high (AOR = 0.3; 95% CI = 0.1-0.6) support for inequitable gender norms was observed. Desiring large family size was associated with moderate (AOR = 2.0; 95% CI = 1.3-2.5) and high (AOR = 2.6; 95% CI = 1.5-4.3) support for macho scores. For men with two or more children (41%), there were increased odds of fathering children with multiple women among those who had moderate (AOR = 2.1; 95% CI = 1.0-4.4) and high (AOR = 2.4; 95% CI = 1.1-5.6) support for masculinity norms. Support for inequitable gender norms was associated with reduced odds of taking steps to prevent unwanted pregnancy, while support for masculinity norms was associated with desiring a large family size and fathering children with multiple women. These findings highlight the importance of including men and gender norms in family planning programs in Jamaica.
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Affiliation(s)
| | | | | | | | | | - Maung Aung
- Cornwall Regional Hospital, St James, Jamaica
| | - Kui Zhang
- University of Alabama at Birmingham, AL, USA
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Walcott MM, Funkhouser E, Aung M, Kempf MC, Ehiri J, Zhang K, Bakhoya M, Hickman D, Jolly PE. Gender norms and sexual behaviours among men in western Jamaica. Sex Health 2014; 11:42-51. [PMID: 24618497 DOI: 10.1071/sh13099] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 01/22/2014] [Indexed: 11/23/2022]
Abstract
UNLABELLED Objectives Gender norms, especially among men, can reduce the effectiveness of HIV prevention programs. We sought to assess the association between attitudes towards gender norms and risky sexual behaviours, and identify sociodemographic factors that predict gender-inequitable and masculinity norms among men in western Jamaica. METHODS A cross-sectional, survey of 549 men aged 19-54 years was conducted. Attitudes towards gender norms were measured using the Gender Equitable Men and Macho scales. Logistic regression and general linear models were used to assess associations between gender norms and multiple sexual partners, and to identify the associated sociodemographic factors. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) are presented. RESULTS Fifty-four percent of the participants (mean age=32.4 years) reported multiple sex partners and 22% reported unprotected sex with non-regular partner in the past 12 months. Men with moderate (AOR=2.2; 95% CI=1.4-3.3) and high (AOR=4.2; 95% CI=2.0-8.5) support for inequitable gender norms, and moderate (AOR=1.7; 95% CI=1.1-2.7) and high (AOR=2.5; 95% CI=1.5-4.3) support for masculinity norms were more likely to report multiple sex partners. Similarly, men with moderate (AOR=2.4; 95% CI=1.3-4.3) and high (AOR=2.5; 95% CI=1.2-5.2) support for inequitable gender norms were more likely to report unprotected sex with a nonregular partner. CONCLUSION A high proportion of Jamaican men engage in risky sexual behaviours. These results highlight the need for behaviour change interventions addressing gender norms targeting Jamaican men.
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Affiliation(s)
- Melonie M Walcott
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Ellen Funkhouser
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Maung Aung
- Western Regional Health Authority, Cornwall Regional Hospital, Montego Bay, PO Box 9000, St James, Jamaica
| | - Mirjam C Kempf
- Department of Family/Child Health and Caregiving and Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - John Ehiri
- Division of Health Promotion Sciences, University of Arizona, Tucson, AZ 85724, USA
| | - Kui Zhang
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Marion Bakhoya
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Deborah Hickman
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Pauline E Jolly
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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