Perspectives of Parents and Health Care Workers on Early Infant Male Circumcision Conducted Using Devices: Qualitative Findings From Harare, Zimbabwe.

Webster Mavhu,Getrude Ncube,Shamiso Fernando,Frances M Cowan,Owen Mugurungi,Karin Hatzold,Ismail Ticklay,Collin Mangenah,Kumbirai Chatora

doi:10.9745/ghsp-d-15-00200

Abstract

The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) recommend early infant male circumcision (EIMC) for prevention of HIV. Here, we present findings from a qualitative study in Zimbabwe that assessed parental and health care workers' perspectives of EIMC conducted using devices. This qualitative study was nested within a trial of EIMC devices. Between January and May 2013, we held 4 focus group discussions (FGDs) and 12 in-depth interviews with parents and 12 in-depth interviews with clinicians (7 trial clinicians and 5 non-trial clinicians). We also conducted 95 short telephone interviews with parents who had arranged to bring their sons for EIMC but then defaulted. Parents who had adopted EIMC spoke of their initial anxieties about the procedure. Additionally, they commented on both the procedure and outcome. Parents who decided against EIMC cited fear of harm, specifically the infant's death, penile injury, and excessive pain. Misperceptions about male circumcision in general and EIMC specifically were a significant barrier to EIMC adoption and were prevalent among health care workers as well as parents. In particular, the findings suggest strong parental concerns about the fate of the discarded foreskin. Parents who chose EIMC for their newborn sons felt that the procedure was safe and expressed satisfaction with the outcome. For their part, health care workers largely thought that EIMC was safe and that the outcome was aesthetically pleasing. They also felt that it would be feasible to offer wide-scale EIMC for HIV prevention in the public sector; they recommended strategies to increase EIMC uptake, in addition to highlighting a few concerns. The qualitative study enables us to better understand parental and health care workers' perspectives of EIMC conducted using devices, especially their perspectives on EIMC safety, feasibility, acceptability, and barriers. These findings will be used to design demand-generation activities that support wider adoption of EIMC.

Highlights

In order to ensure that the protective effect of male circumcision is sustained in the longer term, the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the United Nations
We interviewed in depth the 4 doctors who performed early infant male circumcision (EIMC) during the comparative trial and the 3 EIMC study nurse-midwives who assisted doctors during the trial
We interviewed in depth 5 female nurses who worked at the study clinic but were not directly involved in performing procedures or recruiting infants for the EIMC trial

Summary

Introduction

Global Health: Science and Practice 2016 | Volume 4 | Supplement 1Modeling studies conducted between 2009 and 2011 suggested that circumcising males ages 15 to 49 years to reach 80% coverage within 5 years in these countries, and maintaining this coverage thereafter, could avert 3.4 million new HIV infections within 15 years and yield treatment and care savings of US$16.5 billion.[2,3] In order to ensure that the protective effect of male circumcision is sustained in the longer term, the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the United Nations S55Parental and Health Care Workers’ Perspectives on EIMC www.ghspjournal.orgEIMC can be viewed as background population-level protection for future generations.Children’s Fund (UNICEF) recommend that early infant male circumcision (EIMC)—that is performed within the first 60 days of life—be implemented alongside VMMC.[6,7] Presuming high rates of uptake of EIMC, it will be possible to phase out the ‘‘catch-up’’ adult VMMC as circumcised infants come of age. EIMC’s impact on the HIV epidemic will take some time to realize, infant circumcision is likely to be more effective at preventing HIV acquisition than adult male circumcision, as the procedure is carried out long before the individual becomes sexually active, avoiding the risk associated with sex during the healing period.[8]. Modeling studies conducted between 2009 and 2011 suggested that circumcising males ages 15 to 49 years to reach 80% coverage within 5 years in these countries, and maintaining this coverage thereafter, could avert 3.4 million new HIV infections within 15 years and yield treatment and care savings of US$16.5 billion.[2,3] In order to ensure that the protective effect of male circumcision is sustained in the longer term, the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the United Nations S55. Parental and Health Care Workers’ Perspectives on EIMC www.ghspjournal.org. The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) recommend early infant male circumcision (EIMC) for prevention of HIV. We present findings from a qualitative study in Zimbabwe that assessed parental and health care workers’ perspectives of EIMC conducted using devices

Methods

Results

Discussion

Conclusion