Abstract
BackgroundAdult male surgical circumcision (MC) has been shown to reduce HIV acquisition in men and is recommended by the WHO for inclusion in comprehensive national HIV prevention programs in high prevalence settings. Only limited research to date has been conducted in countries experiencing moderate burden epidemics, where the acceptability, operational feasibility and potential epidemiological impact of MC remain unclear.MethodsA multi-method qualitative research study was conducted at four sites in Papua New Guinea (PNG), with 24 focus group discussions and 65 in-depth interviews carried out among 276 men.ResultsThe majority of men were in favour of MC being introduced for HIV prevention in PNG and considered improved genital hygiene, enhanced sexual pleasure and culturally appropriateness key factors in the acceptability of a future intervention. A minority of men were against the introduction of MC, primarily due to concerns regarding sexual risk compensation and that the intervention went against prevailing cultural and religious beliefs.ConclusionThis is one of the first community-based MC acceptability studies conducted in a moderate prevalence setting outside of Africa. Research findings from this study suggest that a future MC program for HIV prevention would be widely accepted by men in PNG.
Highlights
Adult male surgical circumcision (MC) has been shown to reduce HIV acquisition in men and is recommended by the WHO for inclusion in comprehensive national HIV prevention programs in high prevalence settings
The majority of men in the study were in favour of the Papua New Guinea (PNG) government implementing a MC program for HIV prevention among men
There were no differences in the reasons provided for or against the acceptability of MC between men who had previously undergone some form of penile modification and men who had not; and no differences in reported acceptability by geographical location
Summary
Adult male surgical circumcision (MC) has been shown to reduce HIV acquisition in men and is recommended by the WHO for inclusion in comprehensive national HIV prevention programs in high prevalence settings. Interest in MC has attracted unprecedented attention since it was shown in large-scale clinical trials in Africa to have a protective efficacy of around 60% in preventing HIV acquisition in heterosexual men [6,7,8], confirming earlier observational and ecological studies [9,10]. This led WHO and UNAIDS to recommend MC be considered an essential component of comprehensive. These findings and the attempts to scale-up MC as a result have not been accepted into HIV discourses without debate, among social scientists [16,17,18]
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