The perceptions on male circumcision as a preventive measure against HIV infection and considerations in scaling up of the services: a qualitative study among police officers in Dar es Salaam, Tanzania

Abstract

BackgroundIn recent randomized controlled trials, male circumcision has been proven to complement the available biomedical interventions in decreasing HIV transmission from infected women to uninfected men. Consequently, Tanzania is striving to scale-up safe medical male circumcision to reduce HIV transmission. However, there is a need to investigate the perceptions of male circumcision in Tanzania using specific populations. The purpose of the present study was to assess the perceptions of male circumcision in a cohort of police officers that also served as a source of volunteers for a phase I/II HIV vaccine (HIVIS-03) trial in Dar es Salaam, Tanzania.MethodsIn-depth interviews with 24 men and 10 women were conducted. Content analysis informed by the socio-ecological model was used to analyze the data.ResultsInformants perceived male circumcision as a health-promoting practice that may prevent HIV transmission and other sexually transmitted infections. They reported male circumcision promotes sexual pleasure, confidence and hygiene or sexual cleanliness. They added that it is a religious ritual and a cultural practice that enhances the recognition of manhood in the community. However, informants were concerned about the cost involved in male circumcision and cleanliness of instruments used in medical and traditional male circumcision. They also expressed confusion about the shame of undergoing circumcision at an advanced age and pain that could emanate after circumcision. The participants advocated for health policies that promote medical male circumcision at childhood, specifically along with the vaccination program.ConclusionsThe perceived benefit of male circumcision as a preventive strategy to HIV and other sexually transmitted infections is important. However, there is a need to ensure that male circumcision is conducted under hygienic conditions. Integrating male circumcision service in the routine childhood vaccination program may increase its coverage at early childhood. The findings from this investigation provide contextual understanding that may assist in scaling-up male circumcision in Tanzania.

Factors Associated with the Acceptability of Male Circumcision among Men in Jamaica

“…Risk behaviors, such as multiple sexual partners, especially among youth [27,34,43], low condom use at last sex [34] and early sexual debut (sexual initiation by the age of 14) [44,45], which are prevalent in Jamaica, underscore the need to include MC in the country’s HIV prevention program. Although MC is one of the oldest and most common of surgical procedures [46], and has been proven to be cost effective and efficacious in reducing the risk of HIV acquisition among heterosexual men [1-4], its public health importance is still highly debated in both developing and developed countries [46,47]. Some may argue that there is no need to implement MC in countries that do not meet the criteria set out by the WHO and UNAIDS for including MC in HIV prevention [1,5-9,40].…”

“…In 2007, the World Health Organization (WHO) and the United Nations Program on HIV/AIDS (UNAIDS) recommended the inclusion of male circumcision (MC) in HIV prevention programs, especially in countries with generalized heterosexual HIV epidemics, high HIV prevalence, and low prevalence of MC [1-4]. This recommendation was based on epidemiological evidence which shows that MC is effective in reducing HIV acquisition by approximately 60% among males during heterosexual sex [1,5-9].…”

Understanding and addressing socio-cultural barriers to medical male circumcision in traditionally non-circumcising rural communities in sub-Saharan Africa

“…For younger men, these included hygiene, protection from STIs, reduced pain during sex, and sexual satisfaction. The hygiene aspect of medical circumcision appears to be a widespread perceived benefit of the procedure that has been observed in other settings in Africa (Tarimo et al, 2012). Similar findings have emerged in other African countries as well amongst rural and urban populations (Francis, et al, 2012).…”

Informing the Scaling Up of Voluntary Medical Male Circumcision Efforts Through the Use of Theory of Reasoned Action: Survey Findings Among Uncircumcised Young Men in Swaziland

“…Randomized controlled trials (RCTs) in South Africa, Kenya, and Uganda have demonstrated up to 60% reduction in HIV infection rates among circumcised men compared to uncircumcised men (Auvert et al, 2005;Bailey et al, 2007;Brooks et al, 2010;Gray et al, 2007;Londish & Murray, 2008;Lukobo & Bailey, 2007;Tarimo et al, 2012;Templeton, 2010). In addition to the protective effect against heterosexual HIV transmission, VMMC may also protect against other sexually transmitted infections (STIs) such as gonorrhea and syphilis (Brooks et al, 2010).…”

“…Over the past decade, mounting evidence has indicated the potential of voluntary medical male circumcision (VMMC) to reduce the risk of HIV infection for men (Auvert et al, 2005;Bailey et al, 2007;Brooks et al, 2010;Gray et al, 2007;Londish & Murray, 2008;Lukobo & Bailey, 2007;Tarimo et al, 2012;Templeton, 2010). Randomized controlled trials (RCTs) in South Africa, Kenya, and Uganda have demonstrated up to 60% reduction in HIV infection rates among circumcised men compared to uncircumcised men (Auvert et al, 2005;Bailey et al, 2007;Brooks et al, 2010;Gray et al, 2007;Londish & Murray, 2008;Lukobo & Bailey, 2007;Tarimo et al, 2012;Templeton, 2010).…”