1
|
Gotye L, Nomatshila SC, Maake K, Chitha W, Mabunda SA, Nyembezi A. Acceptability of Medical Male Circumcision as an HIV Prevention Intervention among Male Learners in a South African High School. Healthcare (Basel) 2024; 12:1350. [PMID: 38998885 PMCID: PMC11241183 DOI: 10.3390/healthcare12131350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
Circumcision is a long-standing and frequently performed surgical procedure which holds significant cultural significance among AmaXhosa people in South Africa. Due to cultural reasons in some parts of Africa, the integration of medical male circumcision with traditional manhood initiation rituals still lacks acceptance. This study examined the level of knowledge and acceptance of voluntary male medical circumcision (VMMC) among young males in a selected high school in the Nyandeni District of the Eastern Cape Province, South Africa. A descriptive, quantitative, cross-sectional study was conducted, and a self-administered questionnaire was used to obtain information on sociodemographic characteristics, knowledge of VMMC, perceptions of VMMC, and circumcision practices. One hundred participants were recruited from both grades 11 and 12, and 82% of the participants indicated that they had received information about VMMC. Most of the respondents (88%) preferred traditional male circumcision (TMC), and only 12% of respondents preferred VMMC. The participants displayed a good understanding of the distinction between VMMC and TMC. However, results from the study showed that most respondents exhibited low acceptability and knowledge towards VMMC. These findings highlight the need to develop evidence-based strategies to enhance learners' knowledge and acceptance of VMMC.
Collapse
Affiliation(s)
- Lungani Gotye
- Department of Public Health, Walter Sisulu University, Mthatha 5117, South Africa; (L.G.); (S.C.N.); (W.C.); (S.A.M.); (A.N.)
| | - Sibusiso C. Nomatshila
- Department of Public Health, Walter Sisulu University, Mthatha 5117, South Africa; (L.G.); (S.C.N.); (W.C.); (S.A.M.); (A.N.)
| | - Kedibone Maake
- Department of Public Health, Walter Sisulu University, Mthatha 5117, South Africa; (L.G.); (S.C.N.); (W.C.); (S.A.M.); (A.N.)
| | - Wezile Chitha
- Department of Public Health, Walter Sisulu University, Mthatha 5117, South Africa; (L.G.); (S.C.N.); (W.C.); (S.A.M.); (A.N.)
| | - Sikhumbuzo A. Mabunda
- Department of Public Health, Walter Sisulu University, Mthatha 5117, South Africa; (L.G.); (S.C.N.); (W.C.); (S.A.M.); (A.N.)
- School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia
- George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Anam Nyembezi
- Department of Public Health, Walter Sisulu University, Mthatha 5117, South Africa; (L.G.); (S.C.N.); (W.C.); (S.A.M.); (A.N.)
| |
Collapse
|
2
|
Ashipala DO, Nhokwara TB, Joel MH. Facilitators and barriers to voluntary medical male circumcision as an HIV prevention strategy in Kavango East, Namibia. S Afr Fam Pract (2004) 2023; 65:e1-e9. [PMID: 37265134 DOI: 10.4102/safp.v65i1.5684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/19/2023] [Accepted: 03/22/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Â Voluntary medical male circumcision (VMMC) is a strategy used to try to limit new human immunodeficiency virus (HIV) infections, as it has the potential to reduce HIV and/or AIDS transmission from women to men by up to 60%. However, in spite of efforts by the Ministry of Health and Social Services, only a few men in Namibia have been circumcised. The objective of this study was to explore and describe the facilitators of, and barriers to, medical male circumcision for HIV prevention in Kavango East, Namibia. METHODS Â A qualitative, explorative, descriptive and contextual design was employed. The accessible population in this study comprised 18 health professionals who were selected for the study using a purposive sampling technique. RESULTS Â Participants reported numerous barriers to VMMC in Namibia. Barriers to VMMC included 'myths' and misconceptions attached to VMMC, age limitations, fear of pain and stigma associated with HIV, small VMMC team and long distances from health facilities. Facilitators to VMMC included family support, having experienced genital sores and genital warts or phimosis and paraphimosis. CONCLUSION Â The study revealed that a number of barriers must be overcome before VMMC before the desired number of men take advantage of VMMC. Multiple factors act as constraints to VMMC, including fear, myths and misconceptions, small VMMC teams and the long distance between clients' homes and VMMC services.Contribution:Â The study's findings can be used to develop targeted interventions and strategies that can be used by VMMC providers to address the identified barriers.
Collapse
Affiliation(s)
- Daniel O Ashipala
- Department of General Nursing Sciences, School of Nursing and Public Health, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, Rundu.
| | | | | |
Collapse
|
3
|
Risk Compensation in Voluntary Medical Male Circumcision Programs. Curr HIV/AIDS Rep 2022; 19:516-521. [PMID: 36350470 DOI: 10.1007/s11904-022-00635-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE OF REVIEW Evidence from clinical trials identified the effectiveness of voluntary medical male circumcision (VMMC) as an additional strategy to reduce the risk of HIV transmission from women to men. However, concerns about post-circumcision sexual risk compensation may hinder the scale-up of VMMC programs. We reviewed the evidence of changes in risky sexual behaviors after circumcision, including condomless sex, multiple sex partners, and early resumption of sex after surgery. RECENT FINDINGS Most clinical trial data indicate that condomless sex and multiple partners did not increase for men after circumcision, and early resumption of sex is rare. Only one post-trial surveillance reports that some circumcised men had more sex partners after surgery, but this did not offset the effect of VMMC. Conversely, qualitative studies report that a small number of circumcised men had increased risky sexual behaviors, and community-based research reports that more men resumed sex early after surgery. With the large-scale promotion and expansion of VMMC services, it may be challenging to maintain effective sexual health educations due to various restrictions. Misunderstandings of the effect of VMMC in preventing HIV infection are the main reason for increasing risky sexual behaviors after surgery. Systematic and practical sexual health counseling services should be in place on an ongoing basis to maximize the effect of VMMC.
Collapse
|
4
|
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
Collapse
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
| |
Collapse
|
5
|
Ssensamba JT, Nakafeero M, Musana H, Amollo M, Ssennyonjo A, Kiwanuka SN. Primary care provider notions on instituting community-based geriatric support in Uganda. BMC Geriatr 2022; 22:258. [PMID: 35351013 PMCID: PMC8962536 DOI: 10.1186/s12877-022-02897-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Understanding of the most economical and sustainable models of providing geriatric care to Africa’s rising ageing population is critical. In Uganda, the number of old adults (60 years and above) continues to rise against absence of policies and guidelines, and models for providing care to this critical population. Our study explored public primary health care provider views on how best community-based geriatric support (CBGS) could be instituted as an adaptable model for delivering geriatric care in Uganda’s resource-limited primary public health care settings. Methods We interviewed 20 key informants from four districts of Bukomansimbi, Kalungu, Rakai, and Lwengo in Southern Central Uganda. Respondents were leads (in-charges) of public primary health units that had spent at least 6 months at the fore said facilities. All interviews were audio-recorded, transcribed verbatim, and analysed based on Hsieh and Shannon’s approach to conventional manifest content analysis. Results During analysis, four themes emerged: 1) Structures to leverage for CBGS, 2) How to promote CBGS, 3) Who should be involved in CBGS, and 4) What activities need to be leveraged to advance CBGS? The majority of the respondents viewed using the existing village health team and local leadership structures as key to the successful institutionalization of CBGS; leveraging community education and sensitization using radio, television, and engaging health workers, family relatives, and neighbors. Health outreach activities were mentioned as one of the avenues that could be leveraged to provide CBGS. Conclusion Provider notions pointed to CBGS as a viable model for instituting geriatric care in Uganda’s public primary healthcare system. However, this requires policymakers to leverage existing village health team and local governance structures, conduct community education and sensitization about CBGS, and bring onboard health workers, family relatives, and neighbors. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02897-9.
Collapse
Affiliation(s)
- Jude Thaddeus Ssensamba
- Division of Infectious Diseases and Geriatric Health, Center for Innovations in Health Africa, Kampala, Uganda. .,Health Care Programmes, VIVES University of Applied Sciences, Kortrijk, Belgium. .,School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Mary Nakafeero
- Division of Infectious Diseases and Geriatric Health, Center for Innovations in Health Africa, Kampala, Uganda.,School of Public Health, Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Hellen Musana
- Division of Infectious Diseases and Geriatric Health, Center for Innovations in Health Africa, Kampala, Uganda.,School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mathew Amollo
- School of Public Health, Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Aloysius Ssennyonjo
- School of Public Health, Department of Health Policy and Planning, Makerere University College of Health Sciences, Kampala, Uganda
| | - Suzanne N Kiwanuka
- School of Public Health, Department of Health Policy and Planning, Makerere University College of Health Sciences, Kampala, Uganda
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
"Now that you are circumcised, you cannot have first sex with your wife": post circumcision sexual behaviours and beliefs among men in Wakiso district, Uganda. J Int AIDS Soc 2017; 20:21498. [PMID: 28605174 PMCID: PMC5515054 DOI: 10.7448/ias.20.1.21498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Introduction: Safe male circumcision is an important biomedical intervention in the comprehensive HIV prevention programmes implemented in 14 sub-Saharan African countries with high HIV prevalence. To sustain its partial protective benefit, it is important that perceived reduced HIV risk does not lead to behavioural risk compensation among circumcised men and their sexual partners. This study explored beliefs that may influence post circumcision sexual behaviours among circumcised men in a programme setting. Methods: Forty-eight in-depth interviews were conducted with newly circumcised men in Wakiso district, central Uganda. Twenty-five men seeking circumcision services at public health facilities in the district were recruited from May to June 2015 and, interviewed at baseline and after 6 months. Participants’ beliefs and sexual behaviours were compared just after circumcision and at follow up to explore changes. Data were managed using atlas.ti7 and analysed following a thematic network analysis framework. Results: Four themes following safe male circumcision emerged from this study. Beliefs related to: (1) sexual cleansing, (2) healing, (3) post SMC sexual capabilities and (4) continued HIV transmission risk. Most men maintained or adopted safer sexual behaviour; being faithful to their partner after circumcision or using condoms with extramarital partners following the knowledge that there was continued HIV risk post circumcision. The most prevalent risky belief was regarding sexual cleansing post circumcision, and as a result of this belief, some men had one off condom-less sexual intercourse with a casual partner. Some resumed sex before the recommended period due to misunderstanding of what comprised healing. Conclusions: Although most men maintained or adopted safer sexual behaviour, there were instances of risky sexual behaviour resulting from beliefs regarding the first sexual intercourse after circumcision or misunderstandings of what comprised wound healing. If not addressed, these may attenuate the safe male circumcision benefits of risk reduction for HIV.
Collapse
|