Abstract
BackgroundThe World Health Organization has accepted and recommended medical male circumcision (MMC) as an HIV prevention strategy. Despite the advantages of MMC, the rate of uptake of this practice among immigrants and the general population in the United Kingdom (UK) is low, yet the procedure is provided in public and private health facilities. The role of negative perception and its contribution to low circumcision rates is unknown.ObjectivesSince immigrants are a key group that is vulnerable to HIV in the UK, this study aimed at understanding their knowledge and perceptions with regard to MMC.MethodsWe enrolled 10 participants who were purposively selected using snowball recruitment methods. Data were collected during individual in-depth interviews using semi-structured interview guides. Responses were audio recorded, transcribed and analyzed using thematic analysis. Appropriate themes were generated from the data collected.ResultsWe found that the majority looked at male circumcision (MC) as a practice to fulfill their cultural and religious obligations rather than as an HIV protection method. Few participants showed belief and certainty that MC or MMC was effective in HIV prevention hence limited knowledge. They also expressed perceived danger. This included fear of pain, complications from the procedure and possible infections when carried out through traditional means. These dangers discouraged study participants from accessing MMC.ConclusionMale circumcision is mainly practiced to fulfill cultural and religious norms, but is not seen as a credible HIV prevention strategy.
Highlights
Male circumcision (MC), which is the surgical removal of the foreskin of the penis, supplements less effective strategies such as abstinence, faithfulness to a partner and the consistent use of condoms as a means to prevent infection.[8,9,10]
A cross-sectional qualitative research approach was used for the evaluation of the knowledge and perceptions of male immigrants living in Leeds, the United Kingdom (UK), and originally from southern and eastern Africa
We explored whether participants knew MC as an HIV prevention strategy
Summary
Medical male circumcision (MMC) is a globally accepted and recommended HIV prevention strategy.[1,2] the success of this strategy depends on its uptake within the community, something consequent upon cultural acceptance, knowledge and perceptions of its effectiveness in the prevention of HIV transmission.In the United Kingdom (UK), the prevalence of HIV among immigrants, especially those from southern and eastern Africa, is higher than that of the indigenous population, namely 25 per 1000 men and 50 per 1000 women versus 2.1 per 1000 men and 1 per 1000 women, respectively.[3,4] This is partly attributed to the high prevalence rates of HIV infection in the home countries of immigrants and, as some argue, to complacency with regard to HIV prevention.[5]Behavioural change is an important instrument in the public health promotion of MMC. HIV is a major health challenge, especially in sub-Saharan Africa.[2] In 2013, more than 35 million people worldwide were infected and 1.5 million died of HIV and AIDS.[7] Male circumcision (MC), which is the surgical removal of the foreskin of the penis, supplements less effective strategies such as abstinence, faithfulness to a partner and the consistent use of condoms as a means to prevent infection.[8,9,10] East and southern African countries have implemented MMC as a primary prevention strategy. Circumcision may reduce the incidence of genital ulcer disease and in this way ‘protect’ from HIV infection.[14]
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