Zulu Men’s Conceptions, Understanding, and Experiences of Voluntary Medical Male Circumcision in KwaZulu-Natal, South Africa

Nxumalo, Celenkosini Thembelenkosini; Mchunu, Gugu

doi:10.1177/1557988319892437

Cited by 7 publications

(6 citation statements)

References 45 publications

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“…Given the low incidence of HIV in CNC after CVCT, cost-benefit analyses preclude PrEP in this group. Similarly, given limited access and low uptake in many areas [ [72] , [73] , [74] ] men in concordant HIV- unions would be a lower programmatic priority for male circumcision compared with single men or men with HIV + spouses.…”

Section: Discussionmentioning

confidence: 99%

A cluster randomized trial to reduce HIV risk from outside partnerships in Zambian HIV-Negative couples using a novel behavioral intervention, “Strengthening Our Vows”: Study protocol and baseline data

Sharkey

Wall

Parker

et al. 2021

Contemporary Clinical Trials Communications

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Background Heterosexual couples contribute to most new HIV infections in areas of generalized HIV epidemics in sub-Saharan Africa. After Couples’ Voluntary HIV Counseling and Testing (CVCT), heterosexual concordant HIV negative couples (CNC) in cohabiting unions contribute to approximately 47% of residual new infections in couples. These infections are attributed to concurrent sexual partners, a key driver of the HIV epidemic in Zambia. Methods/design Ten Zambian government clinics in two of the largest cities were randomized in matched pairs to a Strengthening Our Vows (SOV) intervention or a Good Health Package (GHP) comparison arm. SOV addressed preventing HIV infection from concurrent partners and protecting spouses after exposures outside the relationship. GHP focused on handwashing; water chlorination; household deworming; and screening for hypertension, diabetes and schistosomiasis. CNC were referred from CVCT services in government clinics. Follow-up includes post-intervention questionnaires and outcome assessments through 60 months. Longitudinal outcomes of interest include self-report and laboratory markers of condomless sex with outside partners and reported sexual agreements. We present baseline characteristics and factors associated with study arm and reported risk using descriptive statistics. Results The mean age of men was 32 and 26 for women. On average, couples cohabited for 6 years and had 2 children. Baseline analyses demonstrated some failures of randomization by study arm which will be considered in future primary analyses of longitudinal data. An HIV/STI risk factor composite was not different in the two study arms. Almost one-quarter of couples had an HIV risk factor at baseline. Discussion In preparation for future biomedical and behavioral interventions in sub-Saharan Africa, it is critical to understand and decrease HIV risk within CNC.

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Section: Discussionmentioning

confidence: 99%

A cluster randomized trial to reduce HIV risk from outside partnerships in Zambian HIV-Negative couples using a novel behavioral intervention, “Strengthening Our Vows”: Study protocol and baseline data

Sharkey

Wall

Parker

et al. 2021

Contemporary Clinical Trials Communications

View full text Add to dashboard Cite

show abstract

“…24 , 25 , 26 Research on the socio-cultural barriers affecting uptake VMMC among men has revealed that culture and religion can act as both barriers and drivers to the acceptability of medical circumcision by men. 12 , 27 Alluding to the cultural barriers affecting VMMC among men, Nxumalo and Mchunu 28 found that cultural and religious norms were a major influences for uptake of VMMC among Zulu men in KZN, South Africa. The present study’s finding that healthcare workers’ perceptions of VMMC are influenced by cultural dynamics is significant as it highlights the deep-rooted influence of the socio-cultural context on healthcare and health service delivery.…”

Section: Discussionmentioning

confidence: 99%

Healthcare providers’ perceptions and understanding of voluntary medical male circumcision in KwaZulu-Natal, South Africa: A qualitative study

Nxumalo

Mchunu

2021

South African Family Practice

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Background: There is compelling evidence that voluntary medical male circumcision (VMMC) reduces the chances of heterosexual transmission of HIV infection. Healthcare workers are among the key influencers in terms of the scale-up of VMMC as they are often involved in mobilisation for uptake. There is a paucity of qualitative research on healthcare workers’ experiences, understanding and perceptions of VMMC; particularly in the South African rural primary healthcare context. This study was conducted to examine healthcare workers perceptions and understanding of VMMC in KwaZulu-Natal, South Africa.Methods: The study employed a qualitative approach using a phenomenographic design. A purposive sample of 15 doctors, nurses and clinical associates working in 6 different rural clinics in KwaZulu-Natal, South Africa, were interviewed in English in-depth using a semi-structured interview schedule. The interviews were audio-recorded, and transcribed. The results were analysed thematically using phenomenographic data analysis procedures.Results: Categories of description in participants’ perceptions and understanding of VMMC emerged. The findings of this study revealed that healthcare workers perceptions and understanding of VMMC were predominantly influenced by the hegemonic religious and cultural norms associated with male circumcision in KwaZulu-Natal, South Africa.Conclusion: The findings of this study suggest that tailored training to address healthcare workers misperceptions and poor understanding of VMMC is necessary to ensure that they become effective custodians for VMMC implementation.

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“…The conception of VMMC as being unnatural, unnecessary and sinful were some of the competing norms found in study, which informed the development of the present model. 28 …”

Section: Methodsmentioning

confidence: 99%

“…Similarly other studies conducted on the acceptability of medical circumcision have shown that healthcare workers (HCWs) and female partners are major influencers in terms of a man’s decision to undergo VMMC. 27 , 28 Studies exploring female partners’ role in the uptake of VMMC have revealed their view of a circumcised man being more aesthetically appealing and masculine were motivators for men to undergo medical circumcision. 29 , 30 From a healthcare perspective, it is postulated that the main barrier to the successful scale-up of VMMC in the priority countries is demand creation, so an understanding of the contextual barriers and facilitators for VMMC is crucial for demand creation.…”

Section: Introductionmentioning

confidence: 99%

The development of an explanatory model for voluntary medical male circumcision in KwaZulu-Natal, South Africa

Nxumalo

Mchunu

2021

South African Family Practice

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Background: KwaZulu-Natal (KZN) remains the epicentre of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic in South Africa. The incidence of HIV infection in KZN necessitates cost-effective strategies to curb the spread of infection. Voluntary medical male circumcision (VMMC) has been adopted as an additional biomedical preventive strategy since 2010 in line with recommendations from the World Health Organization. Despite several attempts to scale-up VMMC to reach age specific targets to achieve immediate aversion of infections, the uptake of VMMC remains sub-optimal, particularly in KZN. The purpose of this study is to describe the processes that were followed in developing, describing and evaluating an explanatory model for VMMC in KZN, South Africa.Methods: A qualitative theory-generative phenomenographic study design was used to analyse the qualitative differences in primary healthcare stakeholders’ experiences, understanding and conceptions of VMMC in KZN, South Africa. The emerging results informed the development of the VMMC explanatory model for KZN, South Africa. The model development process followed four steps, namely (1) concept analysis, (2) construction of relational statements, (3) model description and (4) model evaluation. The criteria of relevance for the target audience – applicability, clarity, user friendliness and originality of work – were used to evaluate the model.Results: The model’s central premise is that the decision to undergo VMMC is shaped by a complex interplay of factors in the context or external environment of males (the extrinsic variable), which influences specific experiences, conceptions and understanding regarding VMMC (the influential/intrinsic variables). These collectively determine men’s responses to VMMC (the outcome variable).Conclusion: The model describes the process by which contextual, extrinsic and intrinsic variables interact to determine an individual male’s response to VMMC, thus providing a guide to primary healthcare providers on care, practice and policy interventions to support the uptake of VMMC in the rural primary healthcare context of KZN, South Africa.

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Zulu Men’s Conceptions, Understanding, and Experiences of Voluntary Medical Male Circumcision in KwaZulu-Natal, South Africa

Cited by 7 publications

References 45 publications

A cluster randomized trial to reduce HIV risk from outside partnerships in Zambian HIV-Negative couples using a novel behavioral intervention, “Strengthening Our Vows”: Study protocol and baseline data

A cluster randomized trial to reduce HIV risk from outside partnerships in Zambian HIV-Negative couples using a novel behavioral intervention, “Strengthening Our Vows”: Study protocol and baseline data

Healthcare providers’ perceptions and understanding of voluntary medical male circumcision in KwaZulu-Natal, South Africa: A qualitative study

The development of an explanatory model for voluntary medical male circumcision in KwaZulu-Natal, South Africa

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