Researching male circumcision for HIV prevention in Papua New Guinea: a process that incorporates science, faith and culture

Tommbe, Rachael; MacLaren, David; Redman-MacLaren, Michelle; Mafile’o, Tracie; Asugeni, Lester; McBride, William J. H.

doi:10.1186/1478-4505-11-44

Cited by 10 publications

(12 citation statements)

References 28 publications

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“…The prevalence of foreskin cutting in this study was higher than the 25.8% longitudinal cut and 3.4% circumferential cut documented in recent studies in plantation workers in the Highlands region, but similar to studies in the national capital [61-63,65]. The deliberate approach to include participants from diverse geographic locations and cultural backgrounds allowed a sample with a similar regional proportionality to the PNG population.…”

Section: Discussionsupporting

confidence: 67%

Foreskin cutting beliefs and practices and the acceptability of male circumcision for HIV prevention in Papua New Guinea

et al. 2013

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BackgroundMale circumcision (MC) reduces HIV acquisition and is a key public health intervention in settings with high HIV prevalence, heterosexual transmission and low MC rates. In Papua New Guinea (PNG), where HIV prevalence is 0.8%, there is no medical MC program for HIV prevention. There are however many different foreskin cutting practices across the country’s 800 language groups. The major form exposes the glans but does not remove the foreskin. This study aimed to describe and quantify foreskin cutting styles, practices and beliefs. It also aimed to assess the acceptability of MC for HIV prevention in PNG.MethodsCross-sectional multicentre study, at two university campuses (Madang Province and National Capital District) and at two ‘rural development’ sites (mining site Enga Province; palm-oil plantation in Oro Province). Structured questionnaires were completed by participants originating from all regions of PNG who were resident at each site for study or work.ResultsQuestionnaires were completed by 861 men and 519 women. Of men, 47% reported a longitudinal foreskin cut (cut through the dorsal surface to expose the glans but foreskin not removed); 43% reported no foreskin cut; and 10% a circumferential foreskin cut (complete removal). Frequency and type of cut varied significantly by region of origin (p < .001). Most men (72-82%) were cut between the ages of 10 – 20 years. Longitudinal cuts were most often done in a village by a friend, with circumferential cuts most often done in a clinic by a health professional. Most uncut men (71%) and longitudinal cut men (84%) stated they would remove their foreskin if it reduced the risk of HIV infection. More than 95% of uncut men and 97% of longitudinal cut men would prefer the procedure in a clinic or hospital. Most men (90%) and women (74%) stated they would remove the foreskin of their son if it reduced the risk of HIV infection.ConclusionAlthough 57% of men reported some form of foreskin cut only 10% reported the complete removal of the foreskin, the procedure on which international HIV prevention strategies are based. The acceptability of MC (complete foreskin removal) is high among men (for themselves and their sons) and women (for their sons). Potential MC services need to be responsive to the diversity of beliefs and practices and consider health system constraints. A concerted research effort to investigate the potential protective effects of longitudinal cuts for HIV acquisition is essential given the scale of longitudinal cuts in PNG.

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Section: Discussionsupporting

confidence: 67%

Foreskin cutting beliefs and practices and the acceptability of male circumcision for HIV prevention in Papua New Guinea

et al. 2013

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“…Cultural competency proficiency is not “one size fits all.” Again, it is a process, and, as such, other strategies may be needed for other populations; the literature offers a plethora of methods to start this process for other racial and ethnic groups. 40,41 …”

Section: Discussionmentioning

confidence: 99%

Enrolling Minority and Underserved Populations in Cancer Clinical Research

Wallington¹,

Dash²,

Sheppard³

et al. 2016

American Journal of Preventive Medicine

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Research suggests that community involvement is integral to solving public health problems, including involvement in clinical trials—a “gold standard.” Significant racial/ethnic disparities exist in the accrual of participants for clinical trials. Location and cultural aspects of clinical trials influence recruitment and accrual to clinical trials. It is increasingly necessary to be aware of defining characteristics such as location and culture of the populations from which research participants are enrolled. Little research has examined the effect of location and cultural competency in adapting clinical trial research for minority and underserved communities on accrual for clinical trials. Utilizing embedded community academic sites, the authors applied cultural competency frameworks to adapt clinical trial research in order to increase minority participation in nontherapeutic cancer clinical trials. This strategy resulted in successful accrual of participants to new clinical research trials, specifically targeting participation from minority and underserved communities in metropolitan Washington, DC. From 2012 to 2014, a total of 559 participants enrolled across six non-therapeutic clinical trials, representing a 62% increase in the enrollment of blacks in clinical research. Embedding cancer prevention programs and research in the community was shown to be yet another important strategy in the arsenal of approaches that can potentially enhance clinical research enrollment and capacity. The analyses showed that the capacity to acquire cultural knowledge about patients—their physical locales, cultural values, and environments in which they live—is essential to recruiting culturally and ethnically diverse population samples.

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“…As researchers, we are very committed to conducting research in an ethical manner and working in ways which are highly sensitive to the gender, social, and cultural values held by research participants [ 2 , 33 – 36 ]. These values also reflect our understanding of power held by the researcher/s and the research participants.…”

Section: Discussionmentioning

confidence: 99%

Co-interviewing across gender and culture: expanding qualitative research methods in Melanesia

et al. 2014

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BackgroundThe social and cultural positions of both researchers and research participants influence qualitative methods and study findings. In Papua New Guinea (PNG), as in other contexts, gender is a key organising characteristic and needs to be central to the design and conduct of research. The colonial history between researcher and participant is also critical to understanding potential power differences. This is particularly relevant to public health research, much of which has emerged from a positivist paradigm. This paper describes our critical reflection of flexible researcher responses enacted during qualitative research in PNG.MethodsLed by a senior male HIV researcher from PNG, a male from a PNG university and a female from an Australian university conducted qualitative interviews about faith-based responses to HIV in PNG. The two researchers planned to conduct one-on-one interviews matching gender of participants and interviewer. However, while conducting the study, four participants explicitly requested to be interviewed by both researchers. This experience led us to critically consider socially and culturally situated ways of understanding semi-structured interviewing for public health research in Melanesia.ResultsNew understandings about public health research include: (i) a challenge to the convention that the researcher holds more power than the research participant, (ii) the importance of audience in Melanesia, (iii) cultural safety can be provided when two people co-interview and (iv) the effect an esteemed leader heading the research may have on people’s willingness to participate. Researchers who occupy insider-outsider roles in PNG may provide participants new possibilities to communicate key ideas.ConclusionsOur recent experience has taught us public health research methods that are gender sensitive and culturally situated are pivotal to successful research in Melanesia. Qualitative research requires adaptability and reflexivity. Public health research methods must continue to expand to reflect the diverse worldviews of research participants. Researchers need to remain open to new possibilities for learning.

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Researching male circumcision for HIV prevention in Papua New Guinea: a process that incorporates science, faith and culture

Cited by 10 publications

References 28 publications

Foreskin cutting beliefs and practices and the acceptability of male circumcision for HIV prevention in Papua New Guinea

Foreskin cutting beliefs and practices and the acceptability of male circumcision for HIV prevention in Papua New Guinea

Enrolling Minority and Underserved Populations in Cancer Clinical Research

Co-interviewing across gender and culture: expanding qualitative research methods in Melanesia

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