Barriers and facilitators to the uptake of voluntary medical male circumcision (VMMC) among adolescent boys in KwaZulu-Natal, South Africa
Barriers and facilitators to the uptake of voluntary medical male circumcision (VMMC) among adolescent boys in KwaZulu-Natal, South Africa
复制标题
DOI：
10.2989/16085906.2014.943253
复制
发表时间：
2014-01-01
影响因子：
1.2
通讯作者：
Govender, Kaymarlin
中科院分区：
文献类型：
--
作者：
George, Gavin;Strauss, Michael;Govender, Kaymarlin
流行病学模型得出的结论是，如果在艾滋病毒高流行地区扩大自愿医疗男性包皮环切术 (VMMC)，将导致艾滋病毒发病率显着降低。在世界卫生组织采纳这一证据后，南非开始实施一项雄心勃勃的 VMMC 计划。然而，南非仍未能实现 VMMC 目标，特别是在艾滋病毒/艾滋病流行中心夸祖鲁-纳塔尔省。在夸祖鲁-纳塔尔省的艾滋病毒高发区进行了一项定性研究，以确定青春期男孩接受 VMMC 的障碍和促进因素。 2012 年和 2013 年对接受包皮环切和未包皮环切的男孩进行了焦点小组讨论。数据分析是使用框架方法进行的，并以社会认知理论为指导，重点关注影响 VMMC 吸收的个人和人际因素。促进采用的个人认知因素包括相信 VMMC 降低了 HIV 感染的风险，导致更好的卫生习惯以及性欲和性能力的改善。认知障碍与对 HIV 检测（以及随后的结果和耻辱）的恐惧有关，这发生在 VMMC 之前。与手术相关的疼痛和不良事件相关的进一步障碍。对于男孩来说，在六周的康复期间需要禁欲是另一个阻碍因素。时机至关重要，因为男孩在参加体育活动和考试期间不愿意接受包皮环切术。当与正确的信息相结合时，以青少年为目标进行 VMMC 是成功的。服务提供商需要注意，需求创造活动需要关注 VMMC 对降低 HIV 风险的益处以及其他非 HIV 益处。针对正在上学的男孩时，需要考虑 VMMC 干预的时机。
Epidemiological modelling has concluded that if voluntary medical male circumcision (VMMC) is scaled up in high HIV prevalence settings it would lead to a significant reduction in HIV incidence rates. Following the adoption of this evidence by the WHO, South Africa has embarked on an ambitious VMMC programme. However, South Africa still falls short of meeting VMMC targets, particularly in KwaZulu-Natal, the epicentre of the HIV/AIDS epidemic. A qualitative study was conducted in a high HIV prevalence district in KwaZulu-Natal to identify barriers and facilitators to the uptake of VMMC amongst adolescent boys. Focus group discussions with both circumcised and uncircumcised boys were conducted in 2012 and 2013. Analysis of the data was done using the framework approach and was guided by the Social Cognitive Theory focussing on both individual and interpersonal factors influencing VMMC uptake. Individual cognitive factors facilitating uptake included the belief that VMMC reduced the risk of HIV infection, led to better hygiene and improvement in sexual desirability and performance. Cognitive barriers related to the fear of HIV testing (and the subsequent result and stigmas), which preceded VMMC. Further barriers related to the pain associated with the procedure and adverse events. The need to abstain from sex during the six-week healing period was a further prohibiting factor for boys. Timing was crucial, as boys were reluctant to get circumcised when involved in sporting activities and during exam periods. Targeting adolescents for VMMC is successful when coupled with the correct messaging. Service providers need to take heed that demand creation activities need to focus on the benefits of VMMC for HIV risk reduction, as well as other non-HIV benefits. Timing of VMMC interventions needs to be considered when targeting school-going boys.