Abstract
BackgroundIn recent randomized controlled trials, male circumcision has been proven to complement the available biomedical interventions in decreasing HIV transmission from infected women to uninfected men. Consequently, Tanzania is striving to scale-up safe medical male circumcision to reduce HIV transmission. However, there is a need to investigate the perceptions of male circumcision in Tanzania using specific populations. The purpose of the present study was to assess the perceptions of male circumcision in a cohort of police officers that also served as a source of volunteers for a phase I/II HIV vaccine (HIVIS-03) trial in Dar es Salaam, Tanzania.MethodsIn-depth interviews with 24 men and 10 women were conducted. Content analysis informed by the socio-ecological model was used to analyze the data.ResultsInformants perceived male circumcision as a health-promoting practice that may prevent HIV transmission and other sexually transmitted infections. They reported male circumcision promotes sexual pleasure, confidence and hygiene or sexual cleanliness. They added that it is a religious ritual and a cultural practice that enhances the recognition of manhood in the community. However, informants were concerned about the cost involved in male circumcision and cleanliness of instruments used in medical and traditional male circumcision. They also expressed confusion about the shame of undergoing circumcision at an advanced age and pain that could emanate after circumcision. The participants advocated for health policies that promote medical male circumcision at childhood, specifically along with the vaccination program.ConclusionsThe perceived benefit of male circumcision as a preventive strategy to HIV and other sexually transmitted infections is important. However, there is a need to ensure that male circumcision is conducted under hygienic conditions. Integrating male circumcision service in the routine childhood vaccination program may increase its coverage at early childhood. The findings from this investigation provide contextual understanding that may assist in scaling-up male circumcision in Tanzania.
Highlights
In recent randomized controlled trials, male circumcision has been proven to complement the available biomedical interventions in decreasing HIV transmission from infected women to uninfected men
The police officers in Dar es Salaam have been involved in HIV-related studies since 1994, and experience shows that they voluntarily consent to participate in HIV-related studies [21]
Informants’ characteristics A total of 24 men and 10 women participated in the study, and their mean age was 34 and 33 years respectively
Summary
In recent randomized controlled trials, male circumcision has been proven to complement the available biomedical interventions in decreasing HIV transmission from infected women to uninfected men. Tanzania is striving to scale-up safe medical male circumcision to reduce HIV transmission. Three randomized controlled trials in African countries have demonstrated that medical male circumcision reduces the risk of acquiring sexually transmitted infections (STIs), including HIV, from infected women to uninfected men by about 60% [2,3,4]. WHO and UNAIDS have widely recommended the scaling up of male circumcision activities in countries and regions with heterosexual epidemics with high HIV and low male circumcision prevalence [1,8]. One of the potential challenges in adopting male circumcision in African communities as an HIV intervention strategy may be the lack of awareness that it could minimize risks of HIV transmission
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