AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #282 - Behavioral issues surrounding male circumcision roll-out
Authors: Presenting Author: Dr. Daniel Montaño - Battelle
Additional Authors: Dr. Danuta Kasprzyk, Dr. Dirk Taljaard, Dr. Vincent Mutabazi, Dr. Shannon Hader,
Aim: Results of three RCTs led the Zimbabwe Ministry of Health and Child Welfare (MOHCW) to develop and prepare to roll out a male circumcision (MC) program as part of the national HIV prevention strategy. Critical to the success of this program is research to determine factors affecting MC uptake motivation among several key groups, while maintaining other successful HIV prevention strategies.
Method / Issue: The Integrated Behavioral Model (IBM) is used as the framework to investigate environmental (capacity, structure, culture) and individual (attitude, normative, personal agency) factors influencing MC uptake motivation among seven key groups in Zimbabwe: policy makers, health care providers, young adult men, young adult women, expectant parents, and adolescent boys and their parents. A qualitative interview phase (N=321) was first conducted with each group to identify salient issues relevant to each model construct with respect to adoption of MC. Qualitative results were used to design quantitative surveys, one for each group. We are currently administering the questionnaires to representative samples of each study group with a goal of surveying a total of 7,460 respondents in both urban and rural areas and among the two main ethnic groups (Shona and Ndebele). After we document the prevalence of the issues raised by interviewees, we will use survey results to design messages to motivate MC adoption for each study group.
Results / Comments: The qualitative phase identified a wide range of positive and negative beliefs about MC for each study group, with many common beliefs as well as beliefs unique to each group. Results for this presentation focus on two important issues for roll-out: 1) concern about risk compensation (RC), 2) where and by whom MC is preferred. All study groups expressed concern about risk compensation (RC) after MC, with statements such as: ‘I might be tempted to behave badly’ (male), ‘they may grow up to be notorious’ (parent of adolescent), and ‘would lead him to be tempted to have other partners’ (adult woman). Quantitative surveys provide belief prevalence. Results to date indicate that 30% to 70% of respondents agree that there is potential for increased behavioral risk to occur after MC. For all study groups, high proportions (85% to 95%) indicated that provision of MC in local (including rural) clinics would make recommendation/provision (clinicians) and receipt (men, boys) of MC easier than MC provision in dedicated centers or city clinics/hospitals.
Discussion: Follow-up of men in the three RCT studies suggest little RC, however these men received frequent counseling and testing which is unlikely to be sustainable in MC program roll-out. Our survey results clearly indicate that all study groups express concern that MC will lead to risk compensation. With MC roll-out it will be critical to ensure that safe sex messages are conveyed and received, and follow-up with men should be carried out to determine whether RC occurs. Preference for MC provision in local clinics has important implications for clinician training and for developing MC provision strategies to obtain high uptake.
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