Reasons for the low uptake of adult male circumcision for the prevention of HIV transmission in Swaziland

Maibvise, Charles; Mavundla, Thandisizwe Redford

doi:10.2989/16085906.2014.952652

Cited by 16 publications

(23 citation statements)

References 14 publications

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“…A qualitative study in Zimbabwe found that circumcision was perceived as an ‘alien culture’ and associated with satanic rituals . In Swaziland, there is a low uptake of voluntary medical male circumcision because of fear of the operation, perceived lack of benefit of circumcision and impatience with regard to the healing time . Thus, advertising and medical promotion of voluntary medical male circumcision are essential.…”

Section: Discussionmentioning

confidence: 99%

Male circumcision for the prevention of human immunodeficiency virus (HIV) acquisition: a meta‐analysis

et al. 2018

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We aimed to assess male circumcision for the prevention of human immunodeficiency virus (HIV) acquisition in heterosexual and homosexual men using all available data. A systematic literature review was conducted searching for studies that assessed male circumcision as a method to prevent HIV acquisition in homosexual and/or heterosexual men. PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov were searched in March 2017. A random effects model was used to calculate a pooled risk ratio (RR) and its associated 95% confidence interval (CI). In total, 49 studies were included in this meta-analysis. The overall pooled RR for both homosexual and heterosexual men was 0.58 (95% CI 0.48-0.70), suggesting that circumcision was associated with a reduction in HIV risk. Circumcision was found to be protective for both homosexual and heterosexual men (RR: 0.80, 95% CI 0.69-0.92 and 0.28, 95% CI 0.14-0.59, respectively). Heterosexual men had a greater RR reduction (72% compared with 20% for homosexual men). There was significant heterogeneity among the studies (χ = 1378.34, df = 48; I = 97%). This meta-analysis shows that male circumcision was effective in reducing HIV risk for both heterosexual and homosexual men.

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Section: Discussionmentioning

confidence: 99%

Male circumcision for the prevention of human immunodeficiency virus (HIV) acquisition: a meta‐analysis

et al. 2018

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“…In Zambia, especially in the Copperbelt and Lusaka provinces, and in Swaziland, the contribution of never married men was very high, a finding that is partly explained by the low prevalence of circumcision in these countries [ 52 ]. Findings from studies investigating the determinants of uptake of voluntary medical male circumcision in these two countries should inform its scale up [ 53 – 56 ], and strategies such as early infant circumcision [ 57 , 58 ] or circumcision among adolescents through school programmes [ 59 ], which are likely to have higher acceptability, should be promoted [ 60 ]. Never married women were also disproportionately affected in Swaziland compared to their population size (see S2 Fig ), and similarly in Zambia, Gabon, the Southern province in Malawi, and Kigali City and the South province in Rwanda.…”

Section: Discussionmentioning

confidence: 99%

The Incidence Patterns Model to Estimate the Distribution of New HIV Infections in Sub-Saharan Africa: Development and Validation of a Mathematical Model

et al. 2016

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BackgroundProgrammatic planning in HIV requires estimates of the distribution of new HIV infections according to identifiable characteristics of individuals. In sub-Saharan Africa, robust routine data sources and historical epidemiological observations are available to inform and validate such estimates.Methods and FindingsWe developed a predictive model, the Incidence Patterns Model (IPM), representing populations according to factors that have been demonstrated to be strongly associated with HIV acquisition risk: gender, marital/sexual activity status, geographic location, “key populations” based on risk behaviours (sex work, injecting drug use, and male-to-male sex), HIV and ART status within married or cohabiting unions, and circumcision status. The IPM estimates the distribution of new infections acquired by group based on these factors within a Bayesian framework accounting for regional prior information on demographic and epidemiological characteristics from trials or observational studies. We validated and trained the model against direct observations of HIV incidence by group in seven rounds of cohort data from four studies (“sites”) conducted in Manicaland, Zimbabwe; Rakai, Uganda; Karonga, Malawi; and Kisesa, Tanzania. The IPM performed well, with the projections’ credible intervals for the proportion of new infections per group overlapping the data’s confidence intervals for all groups in all rounds of data. In terms of geographical distribution, the projections’ credible intervals overlapped the confidence intervals for four out of seven rounds, which were used as proxies for administrative divisions in a country. We assessed model performance after internal training (within one site) and external training (between sites) by comparing mean posterior log-likelihoods and used the best model to estimate the distribution of HIV incidence in six countries (Gabon, Kenya, Malawi, Rwanda, Swaziland, and Zambia) in the region. We subsequently inferred the potential contribution of each group to transmission using a simple model that builds on the results from the IPM and makes further assumptions about sexual mixing patterns and transmission rates. In all countries except Swaziland, individuals in unions were the single group contributing to the largest proportion of new infections acquired (39%–77%), followed by never married women and men. Female sex workers accounted for a large proportion of new infections (5%–16%) compared to their population size. Individuals in unions were also the single largest contributor to the proportion of infections transmitted (35%–62%), followed by key populations and previously married men and women. Swaziland exhibited different incidence patterns, with never married men and women accounting for over 65% of new infections acquired and also contributing to a large proportion of infections transmitted (up to 56%). Between- and within-country variations indicated different incidence patterns in specific settings.ConclusionsIt is possible to reliably predict the distribution of ...

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“…In a similar situation in Swaziland, male circumcision recipients were incentivized to undergo the procedure with spice packets and promotional items from a spice company. This led to a rumor that foreskins were an ingredient in the spice mixture [ 40 ]. It is difficult to know if these misconceptions might be a consequence of misinterpreted incentivization practices or international, Internet-based anti-circumcision campaigns.…”

Section: Discussionmentioning

confidence: 99%

Perceptions of HIV and Safe Male Circumcision in High HIV Prevalence Fishing Communities on Lake Victoria, Uganda

et al. 2015

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BackgroundIn 2010, the Uganda Ministry of Health introduced its Safe Male Circumcision (SMC) strategy for HIV prevention with the goal of providing 4.2 million voluntary medical male circumcisions by 2015. Fishing communities, where HIV prevalence is approximately 3–5 times higher than the national average, have been identified as a key population needing targeted HIV prevention services by the National HIV Prevention Strategy. This study aimed to understand perceptions of HIV and identify potential barriers and facilitators to SMC in fishing communities along Lake Victoria.MethodsWe conducted 8 focus group discussions, stratified by sex and age, with 67 purposefully sampled participants in 4 communities in Kalangala District, Uganda.ResultsThere was universal knowledge of the availability of SMC services, but males reported high uptake in the community while females indicated that it is low. Improved hygiene, disease prevention, and improved sexual performance and desirability were reported facilitators. Barriers included a perceived increase in SMC recipients’ physiological libido, post-surgical abstinence, lost income during convalescence, and lengthier recovery due to occupational hazards. Both males and females reported concerns about spousal fidelity during post-SMC abstinence. Reported misconceptions and community-held cultural beliefs include fear that foreskins are sold after their removal, the belief that a SMC recipient’s first sexual partner after the procedure should not be his spouse, and the belief that vaginal fluids aid circumcision wound healing.ConclusionsPrevious outreach efforts have effectively reached these remote communities, where availability and health benefits of SMC are widely understood. However, community-specific intervention strategies are needed to address the barriers identified in this study. We recommend the development of targeted counseling, outreach, and communication strategies to address barriers, misconceptions, and community-held beliefs. Interventions should also incorporate female partners into the SMC decision-making process and develop compensation strategies to address lost income during SMC recovery.

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Reasons for the low uptake of adult male circumcision for the prevention of HIV transmission in Swaziland

Cited by 16 publications

References 14 publications

Male circumcision for the prevention of human immunodeficiency virus (HIV) acquisition: a meta‐analysis

Male circumcision for the prevention of human immunodeficiency virus (HIV) acquisition: a meta‐analysis

The Incidence Patterns Model to Estimate the Distribution of New HIV Infections in Sub-Saharan Africa: Development and Validation of a Mathematical Model

Perceptions of HIV and Safe Male Circumcision in High HIV Prevalence Fishing Communities on Lake Victoria, Uganda

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