Abstract
BackgroundAlthough male circumcision (MC) is recommended as an HIV prevention option, the religious, cultural and biomedical dimensions of its feasibility, acceptability and practice in India have not been explored till date. This study explores beliefs, experiences and understanding of the community and healthcare providers (HCPs) about adult MC as an HIV prevention option in India.MethodsThis qualitative study covered 134 in-depth interviews from Belgaum, Kolkata, Meerut and Mumbai cities of India. Of these, 62 respondents were the members of circumcising (CC)/non-circumcising communities (NCC); including medically and traditionally circumcised men, parents of circumcised children, spouses of circumcised men, and religious clerics. Additionally, 58 registered healthcare providers (RHCPs) such as general and pediatric surgeons, pediatricians, skin and venereal disease specialists, general practitioners, and operation theatre nurses were interviewed. Fourteen traditional circumcisers were also interviewed. The data were coded and analyzed in QSR NUD*IST ver. 6.0. The study has not explored the participants' views about neonatal versus adult circumcision.ResultsMembers of CC/NCC, traditional circumcisers and RCHPs expressed sharp religious sensitivities around the issue of MC. Six themes emerged: Male circumcision as the religious rite; Multiple meanings of MC: MC for ‘religious identity/privilege/sacrifice’ or ‘hygiene’; MC inflicts pain and cost; Medical indications outweigh faith; Hesitation exists in accepting ‘foreign’ evidence supporting MC; and communication is the key for acceptance of MCs. Medical indications could make members of NCC accept MC following appropriate counseling. Majority of the RHCPs demanded local in-country evidence.ConclusionHCPs must educate high-risk groups regarding the preventive and therapeutic role of MC. Communities need to discuss and create new social norms about male circumcision for better societal acceptance especially among the NCC. Feasibility studies on MC as an individual specific option for the high risk groups in health care setting needs to be explored.
Highlights
The World Health Organization (WHO) has estimated that globally 30% of males aged 15 and over are circumcised, with almost 70% of these being Muslim [1]
This study has explored the views on male circumcision as a potential HIV prevention option in India
In this study, religion associated beliefs pertaining to male circumcision emerged to be critically sensitive and they could have grave implications as majority of the population in the country is non-circumcising
Summary
The World Health Organization (WHO) has estimated that globally 30% of males aged 15 and over are circumcised, with almost 70% of these being Muslim [1]. With a burden of 2.09 million people living with HIV/AIDS and an estimated. 1.16 million new infections, HIV remains a public health problem in India [8]. It has been shown that between 2000 and 2011, the male and female sex ratio of new HIV infections has remained close to 40% - 60% in favor of males in India. Increasing HIV prevalence along with increasing new HIV infection rates in the previously low prevalence states of north India [8] are an issue of concern for the health program managers. Male circumcision (MC) is recommended as an HIV prevention option, the religious, cultural and biomedical dimensions of its feasibility, acceptability and practice in India have not been explored till date. This study explores beliefs, experiences and understanding of the community and healthcare providers (HCPs) about adult MC as an HIV prevention option in India
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