Female Sex Workers, Male Circumcision and HIV: A Qualitative Study of Their Understanding, Experience, and HIV Risk in Zambia

Abbott, Sharon A.; Haberland, Nicole; Mulenga, Drosin; Hewett, Paul C.

doi:10.1371/journal.pone.0053809

Cited by 17 publications

(22 citation statements)

References 21 publications

(23 reference statements)

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“…[ 60 – 63 ] Three studies each were conducted in Mozambique[ 64 – 66 ] and Nigeria. [ 67 – 69 ] Two studies each were conducted in Uganda,[ 70 , 71 ] Zambia,[ 72 , 73 ] and Zimbabwe. [ 51 , 74 ] One study each was conducted in Ghana,[ 75 ] Madagascar,[ 76 ] Swaziland,[ 77 ] and Tanzania,[ 78 ] Some studies were conducted in more than one country.…”

Section: Resultsmentioning

confidence: 99%

Risk perception and the influence on uptake and use of biomedical prevention interventions for HIV in sub-Saharan Africa: A systematic literature review

et al. 2018

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BackgroundRisk perception has been found to be a crucial factor explaining inconsistent or non-use of HIV prevention interventions. Considerations of risk need to expand beyond risk of infection to also include the personal, social, emotional, and economic risks associated with prevention intervention use.ObjectivesThis systematic review of qualitative peer-reviewed literature from sub-Saharan Africa examines perceptions of risk associated with HIV infection and HIV prevention intervention use.Data sourcesWe searched Medline, Embase, PsychInfo, Africa Wide Info, CINAHL, and Global Health for publications and screened them for relevance.Study eligibility criteriaPeer-reviewed qualitative studies published since 2003 were eligible for inclusion if they examined risk perception or uncertainty in the context of a medically regulated intervention. Only studies focusing on adults were included.Study appraisal and synthesis methodsIncluded publications were quality assessed using the Hawker method and coded thematically.Results10318 unique papers were identified, of which 29 are included. Among the themes identified, a particularly salient one was the potential of HIV prevention interventions to threaten the stability of a relationship and impact on how and when people may—or may not—choose to use prevention interventions.LimitationsThis literature review excludes grey-literature, which may have distinct valuable insights. We also excluded quantitative studies that may have challenged or triangulated our findings.Conclusions and implicationsWhen considering the risk of HIV acquisition, it is insufficient to examine biological risk in isolation from the personal, relational and economic costs associated with intervention use. This loss of emotional, physical, or material support may be perceived as more consequential than the prevention of a potential infection.

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Section: Resultsmentioning

confidence: 99%

Risk perception and the influence on uptake and use of biomedical prevention interventions for HIV in sub-Saharan Africa: A systematic literature review

et al. 2018

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“…Indeed, one of these participants reported longer complete wound healing, possibly as a result. Non-adherence to the recommended healing period has also been reported elsewhere [13,[28][29][30]. In a study by Herman-Roloff et al in Kenya, men who reported that their sexual partners were pleased with their circumcision decision were more likely to engage in sex within the healing period [30].…”

Section: Discussionmentioning

confidence: 99%

“Now that you are circumcised, you cannot have first sex with your wife”: post circumcision sexual behaviours and beliefs among men in Wakiso district, Uganda

Kibira

Atuyambe

Sandøy

et al. 2017

Journal of the International AIDS Society

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Introduction: Safe male circumcision is an important biomedical intervention in the comprehensive HIV prevention programmes implemented in 14 sub-Saharan African countries with high HIV prevalence. To sustain its partial protective benefit, it is important that perceived reduced HIV risk does not lead to behavioural risk compensation among circumcised men and their sexual partners. This study explored beliefs that may influence post circumcision sexual behaviours among circumcised men in a programme setting.Methods: Forty-eight in-depth interviews were conducted with newly circumcised men in Wakiso district, central Uganda. Twenty-five men seeking circumcision services at public health facilities in the district were recruited from May to June 2015 and, interviewed at baseline and after 6 months. Participants’ beliefs and sexual behaviours were compared just after circumcision and at follow up to explore changes. Data were managed using atlas.ti7 and analysed following a thematic network analysis framework.Results: Four themes following safe male circumcision emerged from this study. Beliefs related to: (1) sexual cleansing, (2) healing, (3) post SMC sexual capabilities and (4) continued HIV transmission risk. Most men maintained or adopted safer sexual behaviour; being faithful to their partner after circumcision or using condoms with extramarital partners following the knowledge that there was continued HIV risk post circumcision. The most prevalent risky belief was regarding sexual cleansing post circumcision, and as a result of this belief, some men had one off condom-less sexual intercourse with a casual partner. Some resumed sex before the recommended period due to misunderstanding of what comprised healing.Conclusions: Although most men maintained or adopted safer sexual behaviour, there were instances of risky sexual behaviour resulting from beliefs regarding the first sexual intercourse after circumcision or misunderstandings of what comprised wound healing. If not addressed, these may attenuate the safe male circumcision benefits of risk reduction for HIV.

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“…Currently, the Rwanda Zambia HIV Research Group (RZHRG) is enrolling HIV negative female sex workers (FSWs) in a longitudinal study in Zambia in preparation for a mock vaccine trial. These populations are at high risk of HIV acquisition in sub-Saharan Africa [ 26 ] where annual incidence ranges from 4-11 % for FSWs [ 27 – 30 ]. HIV prevalence among Zambian FSWs is estimated at 65-69 % [ 31 , 32 ].…”

Section: Introductionmentioning

confidence: 99%

Implementation of an electronic fingerprint-linked data collection system: a feasibility and acceptability study among Zambian female sex workers

et al. 2015

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BackgroundPatient identification within and between health services is an operational challenge in many resource-limited settings. When following HIV risk groups for service provision and in the context of vaccine trials, patient misidentification can harm patient care and bias trial outcomes. Electronic fingerprinting has been proposed to identify patients over time and link patient data between health services. The objective of this study was to determine 1) the feasibility of implementing an electronic-fingerprint linked data capture system in Zambia and 2) the acceptability of this system among a key HIV risk group: female sex workers (FSWs).MethodsWorking with Biometrac, a US-based company providing biometric-linked healthcare platforms, an electronic fingerprint-linked data capture system was developed for use by field recruiters among Zambian FSWs. We evaluated the technical feasibility of the system for use in the field in Zambia and conducted a pilot study to determine the acceptability of the system, as well as barriers to uptake, among FSWs.ResultsWe found that implementation of an electronic fingerprint-linked patient tracking and data collection system was feasible in this relatively resource-limited setting (false fingerprint matching rate of 1/1000 and false rejection rate of <1/10,000) and was acceptable among FSWs in a clinic setting (2 % refusals). However, our data indicate that less than half of FSWs are comfortable providing an electronic fingerprint when recruited while they are working. The most common reasons cited for not providing a fingerprint (lack of privacy/confidentiality issues while at work, typically at bars or lodges) could be addressed by recruiting women during less busy hours, in their own homes, in the presence of “Queen Mothers” (FSW organizers), or in the presence of a FSW that has already been fingerprinted.ConclusionsOur findings have major implications for key population research and improved health services provision. However, more work needs to be done to increase the acceptability of the electronic fingerprint-linked data capture system during field recruitment. This study indicated several potential avenues that will be explored to increase acceptability.

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Female Sex Workers, Male Circumcision and HIV: A Qualitative Study of Their Understanding, Experience, and HIV Risk in Zambia

Cited by 17 publications

References 21 publications

Risk perception and the influence on uptake and use of biomedical prevention interventions for HIV in sub-Saharan Africa: A systematic literature review

Risk perception and the influence on uptake and use of biomedical prevention interventions for HIV in sub-Saharan Africa: A systematic literature review

“Now that you are circumcised, you cannot have first sex with your wife”: post circumcision sexual behaviours and beliefs among men in Wakiso district, Uganda

Implementation of an electronic fingerprint-linked data collection system: a feasibility and acceptability study among Zambian female sex workers

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