Age Differences in Perceptions of and Motivations for Voluntary Medical Male Circumcision Among Adolescents in South Africa, Tanzania, and Zimbabwe.
Age Differences in Perceptions of and Motivations for Voluntary Medical Male Circumcision Among Adolescents in South Africa, Tanzania, and Zimbabwe.
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DOI：
10.1093/cid/cix951
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发表时间：
2018-04-03
期刊：
影响因子：
--
通讯作者：
Tobian AAR
中科院分区：
文献类型：
--
作者：
Patel EU;Kaufman MR;Dam KH;Van Lith LM;Hatzold K;Marcell AV;Mavhu W;Kahabuka C;Mahlasela L;Njeuhmeli E;Seifert Ahanda K;Ncube G;Lija G;Bonnecwe C;Tobian AAR
世界卫生组织（世卫组织）和联合国艾滋病毒/艾滋病联合规划署（艾滋病规划署）制定了一个快速通道目标，即到2021年，在优先环境中，在10-29岁的男孩和男性中实现90%的自愿医疗男性包皮环切术（VMMC）覆盖率。我们的目的是确定青少年中VMMC摄取的年龄特异性促进因素。年轻（10-14岁; n = 967）和老年（15-19岁; n = 559）男性青少年完成结构化的采访VMMC的看法和动机，在接受VMMC咨询服务提供网站在南非，坦桑尼亚和津巴布韦。调整后的患病率（aPR）估计使用多变量修改泊松回归模型广义估计方程和稳健的标准误。大多数青少年报告了对VMMC的强烈愿望。与年龄较大的青少年相比，年龄较小的青少年不太可能提到预防人类免疫缺陷病毒（艾滋病毒）或其他性传播感染（aPR，0.77; 95%置信区间[CI]，0.66 - 0.91）和卫生原因（aPR，0.55; 95%CI，0.39 - 0.77）作为他们接受VMMC的动机，但更有可能报告受到他人建议的激励（aPR，1.88; 95% CI，1.54-2.29）。虽然大多数青少年认为接受VMMC是一种规范行为，但年轻的青少年不太可能感知到更高的描述性规范（aPR，0.79; .71-.89），强制性规范（aPR，0.86; 95%CI，.73-1.00）或未行包皮环切术的预期耻辱（aPR，0.79; 95%CI，.68-.90）。与年龄较大的青少年相比，年龄较小的青少年也不太可能正确引用VMMC为男性和男孩提供部分艾滋病毒保护（aPR，0.73; 95% CI，0.65 - 0.82）。不考虑年龄，青少年对VMMC的主要担忧是疼痛（aPR，0.95; 95% CI，0.87 -1.04）。在年轻的青少年中，对疼痛的恐惧与VMMC的欲望呈负相关（aPR，0.89; 95%CI，0.83 - 0.96）。为产生对VMMC的可持续需求，必须考虑特定于企业的战略。方案工作应考虑建立在VMMC周围的社会规范基础上，并旨在减轻对疼痛的恐惧。
The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have set a Fast-Track goal to achieve 90% coverage of voluntary medical male circumcision (VMMC) among boys and men aged 10–29 years in priority settings by 2021. We aimed to identify age-specific facilitators of VMMC uptake among adolescents. Younger (aged 10–14 years; n = 967) and older (aged 15–19 years; n = 559) male adolescents completed structured interviews about perceptions of and motivations for VMMC before receiving VMMC counseling at 14 service provision sites across South Africa, Tanzania, and Zimbabwe. Adjusted prevalence ratios (aPRs) were estimated using multivariable modified Poisson regression models with generalized estimating equations and robust standard errors. The majority of adolescents reported a strong desire for VMMC. Compared with older adolescents, younger adolescents were less likely to cite protection against human immunodeficiency virus (HIV) or other sexually transmitted infections (aPR, 0.77; 95% confidence interval [CI], .66–.91) and hygienic reasons (aPR, 0.55; 95% CI, .39–.77) as their motivation to undergo VMMC but were more likely to report being motivated by advice from others (aPR, 1.88; 95% CI, 1.54–2.29). Although most adolescents believed that undergoing VMMC was a normative behavior, younger adolescents were less likely to perceive higher descriptive norms (aPR, 0.79; .71–.89), injunctive norms (aPR, 0.86; 95% CI, .73–1.00), or anticipated stigma for being uncircumcised (aPR, 0.79; 95% CI, .68–.90). Younger adolescents were also less likely than older adolescents to correctly cite that VMMC offers men and boys partial HIV protection (aPR, 0.73; 95% CI, .65–.82). Irrespective of age, adolescents’ main concern about undergoing VMMC was pain (aPR, 0.95; 95% CI, .87–1.04). Among younger adolescents, fear of pain was negatively associated with desire for VMMC (aPR, 0.89; 95% CI, .83–.96). Age-specific strategies are important to consider to generate sustainable demand for VMMC. Programmatic efforts should consider building on the social norms surrounding VMMC and aim to alleviate fears about pain.
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影响因子：
11.8
作者：
Njeuhmeli, Emmanuel;Opuni, Marjorie;Kripke, Katharine
通讯作者：
Kripke, Katharine
DOI：
10.1097/qai.0000000000000179
发表时间：
2014-07-01
影响因子：
3.6
作者：
Njeuhmeli, Emmanuel;Hatzold, Karin;Kasedde, Susan
通讯作者：
Kasedde, Susan
影响因子：
3.6
作者：
DeHart, DD;Birkimer, JC
通讯作者：
Birkimer, JC
影响因子：
4.4
作者：
Jayeoba, Oluwemimo;Dryden-Peterson, Scott;Lockman, Shahin
通讯作者：
Lockman, Shahin
DOI：
10.1056/nejmoa1702150
发表时间：
2017-11-30
期刊：
The New England journal of medicine
影响因子：
--
作者：
Grabowski MK;Serwadda DM;Gray RH;Nakigozi G;Kigozi G;Kagaayi J;Ssekubugu R;Nalugoda F;Lessler J;Lutalo T;Galiwango RM;Makumbi F;Kong X;Kabatesi D;Alamo ST;Wiersma S;Sewankambo NK;Tobian AAR;Laeyendecker O;Quinn TC;Reynolds SJ;Wawer MJ;Chang LW;Rakai Health Sciences Program
通讯作者：
Rakai Health Sciences Program