Cultural competence: a framework for promoting voluntary medical male circumcision among VaRemba communities in Zimbabwe

Abstract

Almost a decade after the formal introduction of voluntary medical male circumcision (VMMC) as an important technology for HIV prevention, its implementation is still fraught with acceptability challenges. This is especially true among ethnic groups where male circumcision is conducted as a rite of passage into adulthood. In this article we question why VMMC is being met with resistance despite widespread awareness of its promise to reduce HIV incidence in a culturally circumcising community in Zimbabwe. In-depth and key informant interviews were conducted with selected VaRemba initiation graduates and surgeons respectively in Mposi area in Mberengwa to explore why VMMC has not been readily accepted in their community. Findings suggest that male circumcision among VaRemba is not only the removal of prepuce but comprises a secretive and rich curriculum rooted in their culture and identity. Such a conceptualisation renders some social and programmatic impediments for VMMC uptake. To scale up VMMC uptake among VaRemba, we argue for a reorganisation and adaptation of VMMC services in a culturally competent way that accounts for local conceptions of circumcision and respect for the cultural beliefs and practices of VaRemba communities.

Indigenous Health Systems and Adolescent Sexual Health in Umguza and Mberengwa Districts of Zimbabwe: Community Key Stakeholders’ Perspectives

“…8,9 In Zimbabwe, there are two recognised HSs: the indigenous health system (IHS), which is run by traditional healers, herbalists, traditional attendants, community leaders, and community members. 10 The IHS is readily accessible to community members, particularly those marginalised, therefore commanding a considerable proportion of users in different districts. [10][11][12] The second system is a modernised HS run by trained personnel such as nurses, doctors, and many more who would go through formal training in their line of work.…”

“…10 The IHS is readily accessible to community members, particularly those marginalised, therefore commanding a considerable proportion of users in different districts. [10][11][12] The second system is a modernised HS run by trained personnel such as nurses, doctors, and many more who would go through formal training in their line of work. 11,12 The 2 systems are regulated by boards such as the Health Services Board (HSB) and the Zimbabwe National Traditional Healers Association (ZINATHA).…”

Health System Strategies and Adolescent Sexual Health: Systematic review using Rodgers Concept Analysis Framework

“…Adolescent utilisation of SH care services in low and middle income countries remains low despite quite a number of strategies that have been implemented to create demand for these services [1,6]. Most countries find it very challenging to provide comprehensive and integrated HSs to cater for adolescents' SH issues [7,8]. Demand and utilisation of modern health care services by adolescents still remains low despite this huge investment in these services [1,6].…”

Incorporating Voluntary Medical Male Circumcision Into Traditional Circumcision Contexts: Experiences of a Local Consortium in Zimbabwe Collaborating With an Ethnic Group

“…Among the VaRemba, initiation camps are held every 1 to 2 years to complete the rites of passage from boyhood to manhood. In these camps, experienced traditional circumcisers typically perform male circumcision with the help of the community elders 12 . The initiation camp is traditionally held in the winter after the harvest season when the community can ensure enough food for the gathering.…”

“…The consortium aimed to maintain VaRemba traditional male circumcision ceremonies but with MoHCC-trained, VaRemba health care workers performing the actual male circumcision procedure, according to national male circumcision guidelines. Culturally appropriate education and mobilization efforts would facilitate success, 12 , 15 taking care to ensure active VaRemba participation and leadership at all stages of planning, implementation, and dissemination 16 – 19 . At the core, rather than demanding modern VMMC, this collaborative approach would promote cultural competency and sensitivity among MoHCC and ZAZIC partners 12 with the aim of forming a long-term, mutually beneficial partnership focused on future VMMC scale-up in the area.…”