Voluntary medical male circumcision (VMMC) has been recommended for the prevention of HIV transmission, particularly in sub-Saharan Africa. Uptake of the campaign has been relatively poor, particularly in traditionally non-circumcising regions. This study evaluates the knowledge, attitudes and practices of medical male circumcision (MC) of 104 community members exposed to promotional campaigns for VMMC for five years. Results show that 93% of participants have heard of circumcision and 72% have heard of some health benefit from the practice. However, detailed knowledge of the relationship with HIV infection is lacking: 12.2% mistakenly believed you could not get HIV after being circumcised, while 75.5% believe that a circumcised man is still susceptible and another 12.2% do not know of any relationship between HIV and MC. There are significant barriers to the uptake of the practice, including misperceptions and fear of complications commonly attributed to traditional, non-medical circumcision. However, 88.8% of participants believe circumcision is an acceptable practice, and community-specific promotional campaigns may increase uptake of the service.

Background & objectivesThe benefits of long-term adherence to antiretroviral treatment (ART) are countered by interruptions in care or disengagement from care. Healthcare workers (HCWs) play an important role in patient engagement and negative or authoritarian attitudes can drive patients to disengage. However, little is known about HCW perspectives on disengagement. We explored HCWs’ perspectives on ART disengagement in Khayelitsha, a peri-urban area in South Africa with a high HIV burden.MethodSemi-structured interviews were conducted in English with 30 HCWs in a primary care HIV clinic to explore their perspectives of patients who disengage from ART. Participants included doctors, nurses, counsellors, social workers, data clerks, security guards, and allied health professionals. The interview guide included questions that asked HCWs to give examples of patients who interrupt treatment, their perceptions of people who disengage from care and their feelings when dealing with a patient who is returning to care. All transcripts were audio-recorded, transcribed, and analysed using an inductive thematic analysis approach.ResultsMost staff were knowledgeable about the complexities of disengagement and highlighted potential barriers to sustaining adherence on ART, including mental health challenges and non-disclosure to family and partners. Participants expressed empathy for patients who interrupted treatment, particularly when discussing potential barriers to continued engagement in care. However, many also expressed feelings of anger and frustration towards these patients, partly because they reported these patients increase workload. Some staff, mainly those taking chronic medication themselves, perceived that patient who disengage from ART do not take adequate responsibility for their health.ConclusionLifelong engagement with HIV care is influenced by many factors, including HCW interactions. Findings from this study show that staff had contradictory feelings towards disengaged patients, experiencing both empathy and anger. This understanding could contribute to the development of more nuanced interventions to support staff and encourage true person-centred care, to improve patient outcomes.