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Mweemba O, Rodriguez VJ, Jones DL, Desgraves JF, Msimuko R, Mofya R, Kalebaila SK, Musonda-Chisangano MM, Mulavu M, Zulu R, Dunleavy VO, Bowa K, Weiss SM. Factors influencing neonatal male circumcision uptake among expecting couples in Zambia: formative findings. AIDS Care 2024; 36:528-535. [PMID: 37408444 DOI: 10.1080/09540121.2023.2223900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/06/2023] [Indexed: 07/07/2023]
Abstract
Male circumcision is a protective HIV prevention strategy. However, uncircumcised Zambian men are reluctant to undergo voluntary medical male circumcision (VMMC). Tailored interventions are necessary to stimulate the uptake of early infant male circumcision (EIMC) and VMMC in Zambia. This feasibility study presents the formative process of utilising the PRECEDE framework in the development of a family-centred EIMC/VMMC intervention, Like Father Like Son, and its application in an existing VMMC intervention, Spear & Shield. We found that fear of the pain associated with EIMC procedures, foreskin disposal, beliefs in children's autonomy and rights, and men's dominance in health decision-making were factors affecting EIMC uptake. Perceived benefits for infants included improved hygiene, protection from HIV infection, and faster recovery. Reinforcing factors included female partners and fathers' MC status. The availability and access to EIMC services and information, skill and experience of health workers, and engagement and belief in traditional circumcision practices were factors enabling EIMC uptake. These individual, interpersonal, and structural factors positively and negatively influencing EIMC uptake in the Zambian clinic context were integrated into the intervention for expecting parents. Feedback from community advisory boards suggested the process was effective in developing a culturally tailored and acceptable EIMC/VMMC promotion intervention.
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Affiliation(s)
- Oliver Mweemba
- Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jelisah Faith Desgraves
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Richard Msimuko
- University Teaching Hospital, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Rodgers Mofya
- University Teaching Hospital, School of Medicine, University of Zambia, Lusaka, Zambia
| | | | | | - Mataanana Mulavu
- Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Robert Zulu
- University Teaching Hospital, Lusaka, Zambia
- School of Medicine, University of Zambia, Lusaka, Zambia
| | - Victoria Orrego Dunleavy
- Department of Communication Studies, School of Communication, University of Miami, Miami, FL, USA
| | - Kasonde Bowa
- The School of Medicine and Health Sciences, University of Lusaka, Lusaka, Zambia
| | - Stephen M Weiss
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
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Weiss SM, Bowa K, Zulu R, Rodriguez VJ, Cook RR, Jones DL. Dissemination and implementation of an evidence-based voluntary medical male circumcision program: The Spear & Shield program. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002065. [PMID: 38295087 PMCID: PMC10830021 DOI: 10.1371/journal.pgph.0002065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 12/19/2023] [Indexed: 02/02/2024]
Abstract
Despite compelling evidence linking voluntary medical male circumcision (VMMC) with 60-70% HIV risk reduction in sub-Saharan Africa, Zambian men have been especially reluctant to undergo VMMC. The Government of Zambia set targets for VMMC uptake and promoted community-level interventions. Spear & Shield (S&S) is an innovative, evidence-based, service program promoting VMMC uptake while ensuring both VMMC supply and demand. This study assessed the large-scale provincial rollout of the program (S&S2) utilizing the RE-AIM model for translating interventions into the community. The S&S2 study was conducted between November 2015 and December 2020, and sequentially rolled out over four Zambian provinces in 96 clinics; 24 observation clinics received VMMC training only. Local clinic healthcare workers were trained to conduct the VMMC procedure and HIV counselors were trained to lead S&S group sessions. Using the RE-AIM model, primary outcomes were: Reach, the number, proportion, and representativeness of S&S attendees; Effectiveness, the impact of S&S2 on VMMC uptake; Adoption, the number, proportion, and representativeness of clinics implementing S&S2; Implementation, fidelity to the S&S intervention manual; and Maintenance, the extent to which S&S2 became an element of standard care within community clinics. Initially, n = 109 clinics were recruited; 96 were sustained and randomized for activation (Adoption). A total of 45,630 clinic patients (n = 23,236 men and n = 22,394 women) volunteered to attend the S&S sessions (Reach). The S&S2 program ran over 2,866 clinic-months (Implementation). Although the study did not target individual-level VMMCs, ~58,301 additional VMMCs were conducted at the clinic level (Effectiveness). Fidelity to the S&S intervention by group leaders ranged from 42%-95%. Sustainability of the program was operationalized as the number of CHCs initially activated that sustained the program. Intervention delivery ended, however, when study funding ceased (Maintenance). The S&S2 program successfully utilized the RE-AIM model to achieve study goals for implementation and dissemination in four Zambian provinces. Innovative VMMC programs such as S&S2 can improve the uptake of VMMC, one of the most effective strategies in the HIV prevention arsenal.
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Affiliation(s)
- Stephen M. Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Kasonde Bowa
- Clinical Sciences Department University of Lusaka, Lusaka, Zambia
| | - Robert Zulu
- Ministry of Health, Provincial Health Office, Ndola, Copperbelt, Zambia
- Department of Health Promotion and Education, University of Zambia, School of Public Health, Lusaka, Zambia
| | - Violeta J. Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- Department of Psychology, University of Georgia, Athens, Georgia, United States of America
| | - Ryan R. Cook
- Medicine, General Internal Medicine, and Geriatrics, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Deborah L. Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
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Weiss SM, Rodriguez VJ, Cook RR, Bowa K, Zulu R, Mweemba O, Kamboyi R, Castro J, Dunleavy VO, Alcaide ML, Jones DL. Increasing early infant male circumcision uptake in Zambia: Like father like son. PLoS One 2023; 18:e0289819. [PMID: 37561707 PMCID: PMC10414584 DOI: 10.1371/journal.pone.0289819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/27/2023] [Indexed: 08/12/2023] Open
Abstract
Voluntary Medical Male Circumcision (VMMC) is an effective strategy for HIV prevention in areas with high prevalence of, and risk for, HIV. More than 361,000 male neonates are born each year in Zambia, many of whom could be eligible for Early-Infant Medical Circumcision (EIMC). Building on successful implementation strategies utilized in our Spear & Shield program, this pilot study, "Like Father, Like Son" (LFLS), evaluated the feasibility and acceptability of offering combined EIMC and VMMC services and couple-level behavioral interventions. A total of N = 702 pregnant women and their male partners (n = 351 couples) were recruited and enrolled. Couples were assessed twice pre-birth, 2 weeks post birth, and 6 months post birth. Expectant mothers were an average of 15.05 weeks pregnant (SD = 8.83). Thirty-nine pregnancies did not result in a live birth (11%), 14 couples withdrew from the study or were lost to follow-up prior to delivery (4%), and 148 babies were born female (42%), leaving 150 couples with a male infant in the analytic sample (43%). The LFLS study achieved significantly higher EIMC rates (35%) in comparison with previously observed EIMC study rates in Zambia (11%), and significantly higher than hypothetical comparison rates up to 30%. Relative to baseline rates, odds of VMMC among couples' older sons increased by 31% at post-intervention and by 90% at two-weeks following birth. Overall, this pilot study found the LFLS intervention to be feasible, acceptable, and effective in doubling the rate of EIMC in comparison with a previous longitudinal study in Zambia. Future research should consider a family-centric approach to promotion of male circumcision for infants and adolescents. LFLS may be effective in promoting father-son "bonding" by MC status; a bond that may be a bridge to increase both EIMC and VMMC uptake in newborns and couples' older sons and is a novel leverage point for promotion of this HIV prevention strategy.
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Affiliation(s)
- Stephen M. Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Violeta J. Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- Department of Psychology, University of Georgia, Athens, Georgia, United States of America
| | - Ryan R. Cook
- Medicine, General Internal Medicine, and Geriatrics, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Kasonde Bowa
- University of Lusaka School of Medicine, Lusaka, Zambia
| | - Robert Zulu
- University of Zambia School of Medicine, Lusaka, Zambia
| | - Oliver Mweemba
- Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia
| | | | - Jose Castro
- Division of Infectious Diseases, Dept. of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | | | - Maria L. Alcaide
- Division of Infectious Diseases, Dept. of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Deborah L. Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
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Bowa K, Rodriguez VJ, Malik FS, Knight J, Cristofari N, Parrish MS, Jones DL, Zulu R, Weiss SM. Dissemination of the Spear & Shield Project using a Training of Trainers Model: A reflection on challenges and successes. Transl Behav Med 2022; 12:622-629. [PMID: 35312766 PMCID: PMC9154251 DOI: 10.1093/tbm/ibac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Several large-scale clinical trials have conclusively demonstrated that voluntary medical male circumcision (VMMC) could provide a 50%-70% reduction in HIV acquisition, but willingness to undergo VMMC has been lowest in Zambia compared to other countries in eastern and southern Africa. This manuscript describes training for "task-shifting" among local healthcare workers at Community Health Centers (CHCs) applying state of the art strategies (e.g., Training of Trainers, i.e., ToT, and Training of Facilitators, ToF) to provide novel clinical services. Staff at 96 CHCs from four Provinces in Zambia were sequentially trained to provide the Spear & Shield intervention. A total of 45,630 men (n = 23,236) and women (n = 22,394) volunteered to participate in the S&S intervention service program when offered in the CHCs. Group session (total = 5313 sessions; 2,736 men's and 2,582 women's sessions) were conducted over 4.5 years. Remarkably, both men and women's groups achieved 97% retention. Of these, 256 sessions recorded from 128 group leaders were assessed and scored for intervention fidelity; fidelity was 80%-90% among the majority of clinics. S&S program sustainment exceeded expectations among 85% of clinics (82/96) in all provinces across the duration of the study. Of note, attendance in the S&S program was encouraged by CHC staff, but no financial incentives were provided to those attending S&S. This study examined the effectiveness of the ToT/ToF model in dissemination of the S&S program, which proved to be feasible even in resource-limited settings. Benefits and challenges are discussed.
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Affiliation(s)
- Kasonde Bowa
- School of Medicine and Health Sciences, University of Lusaka, Lusaka, Zambia
| | - Violeta J Rodriguez
- Department of Psychology, University of Georgia, Athens, GA,USA
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Fayeza S Malik
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Jennifer Knight
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Nicholas Cristofari
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Manasi S Parrish
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Correspondence to: DL Jones,
| | - Robert Zulu
- Ministry of Health, Provincial Health Office, Ndola, Copperbelt,Zambia
- Department of Health Promotion and Education, University of Zambia, School of Public Health, Lusaka, Zambia
| | - Stephen M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Cristofari NV, Rodriguez VJ, Jones DL, Weiss SM. Understanding barriers and facilitators to voluntary medical male circumcision and Spear and Shield uptake in Zambian community health centers. Transl Behav Med 2022; 12:613-621. [PMID: 35195269 PMCID: PMC9154239 DOI: 10.1093/tbm/ibac007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Voluntary medical male circumcision (VMMC) has been an effective method for reducing the risk of HIV transmission by 50%-70% in Eastern and Southern Africa. The Spear and Shield (S&S) program is a community health center (CHC)-based biobehavioral VMMC HIV prevention intervention that increased VMMC uptake in male CHC attendees in Lusaka, Zambia. Qualitative data organized using the Consolidated Framework for Implementation Research (CFIR) has been used to characterize factors that may impact S&S/VMMC implementation. This manuscript uses the CFIR to examine S&S implementation across 96 CHCs in four Zambian provinces using a mixed-methods approach to (a) quantify successful S&S implementation; (b) understand how CFIR domains might provide insight into the degree of implemental success; (c) identify major themes among least and most successful CHCs; and (d) help guide future prevention efforts and policy related to VMMC promotion in the Zambian CHC context. In contrast with CFIR quantitative analyses, 12 major qualitative themes associated with the least and most successful CHCs provided unique insight into S&S and VMMC implementation and guidance for future implementation studies. Themes included lack of resources (staff, space, transportation) for the former and strong staff relationships and active community engagement for the latter. The CFIR framework appears extremely useful for the identification of qualitative themes related to intervention implementation, and reduction of qualitative data for quantitative analyses may sacrifice more nuanced information. Consideration of CFIR themes may be useful to inform HIV prevention strategies in Zambia and similar contexts.
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Affiliation(s)
- Nicholas V Cristofari
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL 33146, USA
| | - Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Psychology, University of Georgia, Athens, GA 30602, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Stephen M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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Tumina MS, Yona S, Waluyo A. The experiences of women from <em>Atoin Meto</em> tribe who performed <em>Sifon</em> ritual in the context of HIV/AIDS transmission. J Public Health Res 2021; 10. [PMID: 34060742 PMCID: PMC9309712 DOI: 10.4081/jphr.2021.2337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 12/03/2022] Open
Abstract
Background Sifon is a sexual intercourse ritual after male circumcision
from the Atoin Meto tribe that contributed to HIV/AIDS
transmission. Ritual Sifon may put at risk for HIV
infection and also the sexual transmisson diseases. Doing ritual
Sifon as a culture, without using protection during
intercourse becomes one way to get HIV infection from infected men. Few
study explore this phenomenon among women who becomes Sifon
women. Therefore, the aim of this study is to explore the experience of
Sifon women in the context of HIV/AIDS
transmission. Design and Methods The data was collected from March 2020 to July 2020. This study used a
phenomenological approach with a purposive sampling technique. Inclusion
criteria: the women from Atoin Meto tribe aged above
eighteen years old who have been Sifon women for at least
six months. The participants were recruited through traditional healers in
Nekbaun village of Kupang District and Timor Tengah Selatan District. The
data was analysed by Collaizi method. Results Thirteen women were interviewed and we found four themes: lack of knowledge
about HIV/AIDS transmission, unaware became Sifon women,
women experienced of STDs, using traditional medicine to treat STDs (Timor
medicine). Conclusions The interpretation of Sifonwomen's experiences that
performed Sifon rituals indicated that
Sifon is a risk factor for transmitting HIV/AIDS.
Preventive and promotional educational programs with cultural approach are
needed to reduce the risk of HIV/AIDS transmission.
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Affiliation(s)
- Maria Syelvrida Tumina
- Postgraduate Programme of Medical Surgical Nursing, Faculty of Nursing, Universitas Indonesia, Depok, West Java.
| | - Sri Yona
- Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Indonesia, Depok, West Java.
| | - Agung Waluyo
- Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Indonesia, Depok, West Java.
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Nnaji CA, Wiysonge CS, Okeibunor JC, Malinga T, Adamu AA, Tumusiime P, Karamagi H. Implementation research approaches to promoting universal health coverage in Africa: a scoping review. BMC Health Serv Res 2021; 21:414. [PMID: 33941178 PMCID: PMC8094606 DOI: 10.1186/s12913-021-06449-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/27/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Implementation research has emerged as part of evidence-based decision-making efforts to plug current gaps in the translation of research evidence into health policy and practice. While there has been a growing number of initiatives promoting the uptake of implementation research in Africa, its role and effectiveness remain unclear, particularly in the context of universal health coverage (UHC). Hence, this scoping review aimed to identify and characterise the use of implementation research initiatives for assessing UHC-related interventions or programmes in Africa. METHODS The review protocol was developed based on the methodological framework proposed by Arksey and O'Malley, as enhanced by the Joanna Briggs Institute. The review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). MEDLINE, Scopus and the Cochrane Library were searched. The search also included a hand search of relevant grey literature and reference lists. Literature sources involving the application of implementation research in the context of UHC in Africa were eligible for inclusion. RESULTS The database search yielded 2153 records. We identified 12 additional records from hand search of reference lists. After the removal of duplicates, we had 2051 unique records, of which 26 studies were included in the review. Implementation research was used within ten distinct UHC-related contexts, including HIV; maternal and child health; voluntary male medical circumcision; healthcare financing; immunisation; healthcare data quality; malaria diagnosis; primary healthcare quality improvement; surgery and typhoid fever control. The consolidated framework for implementation research (CFIR) was the most frequently used framework. Qualitative and mixed-methods study designs were the commonest methods used. Implementation research was mostly used to guide post-implementation evaluation of health programmes and the contextualisation of findings to improve future implementation outcomes. The most commonly reported contextual facilitators were political support, funding, sustained collaboration and effective programme leadership. Reported barriers included inadequate human and other resources; lack of incentives; perception of implementation as additional work burden; and socio-cultural barriers. CONCLUSIONS This review demonstrates that implementation research can be used to achieve UHC-related outcomes in Africa. It has identified important facilitators and barriers to the use of implementation research for promoting UHC in the region.
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Affiliation(s)
- Chukwudi A Nnaji
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Joseph C Okeibunor
- Health Systems and Services Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Thobile Malinga
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Abdu A Adamu
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Prosper Tumusiime
- Health Systems and Services Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Humphrey Karamagi
- Health Systems and Services Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo
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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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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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