Background
In
2010, the Uganda Ministry of Health introduced its Safe Male Circumcision (SMC)
strategy for HIV prevention with the goal of providing 4.2 million voluntary
medical male circumcisions by 2015. Fishing communities, where HIV prevalence
is approximately 3–5 times higher than the national average, have been
identified as a key population needing targeted HIV prevention services by the
National HIV Prevention Strategy. This study aimed to understand perceptions of
HIV and identify potential barriers and facilitators to SMC in fishing
communities along Lake Victoria.
Methods
We
conducted 8 focus group discussions, stratified by sex and age, with 67
purposefully sampled participants in 4 communities in Kalangala District,
Uganda.
Results
There
was universal knowledge of the availability of SMC services, but males reported
high uptake in the community while females indicated that it is low. Improved
hygiene, disease prevention, and improved sexual performance and desirability
were reported facilitators. Barriers included a perceived increase in SMC
recipients’ physiological libido, post-surgical abstinence, lost income during
convalescence, and lengthier recovery due to occupational hazards. Both males
and females reported concerns about spousal fidelity during post-SMC
abstinence. Reported misconceptions and community-held cultural beliefs include
fear that foreskins are sold after their removal, the belief that a SMC recipient’s
first sexual partner after the procedure should not be his spouse, and the
belief that vaginal fluids aid circumcision wound healing.
Conclusions
Previous outreach efforts have effectively reached these
remote communities, where availability and health benefits of SMC are widely
understood. However, community-specific intervention strategies are needed to
address the barriers identified in this study. We recommend the development of
targeted counseling, outreach, and communication strategies to address
barriers, misconceptions, and community-held beliefs. Interventions should also
incorporate female partners into the SMC decision-making process and develop
compensation strategies to address lost income during SMC recovery.
Below: Key Themes and Concepts
Full article at: http://goo.gl/jzVJ6U
By:
Paul E. Nevin, James Pfeiffer
Department of Global Health,
University of Washington Schools of Medicine and Public Health, Seattle,
Washington, United States of America
James Pfeiffer
Health Alliance International,
Seattle, Washington, United States of America
James Pfeiffer
Department of Anthropology,
University of Washington, Seattle, Washington, United States of America
Simon P. S. Kibira
Department of Community Health
and Behavioural Sciences, Makerere University School of Public Health, Kampala,
Uganda
Solomon J. Lubinga, Joseph B. Babigumira
Global Medicines Program,
Department of Global Health, University of Washington Schools of Medicine and
Public Health, Seattle, Washington, United States of America
Solomon J. Lubinga, Joseph B. Babigumira
Pharmaceutical Outcomes Research
and Policy Program, University of Washington School of Pharmacy, Seattle,
Washington, United States of America
Aggrey Mukose
Department of Epidemiology and
Biostatistics, Makerere University School of Public Health, Kampala, Uganda
More at: https://twitter.com/hiv_insight
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