ArticleHIV/AIDS (Auckland, N.Z.)2018
Modifying the health system to maximize voluntary medical male circumcision uptake: a qualitative study in Botswana.
Article in HIV/AIDS (Auckland, N.Z.), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.
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Who cites it
5 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Service delivery interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review.PloS one · 2020Pooled it
- Barriers and Facilitators to, and Experience of, Voluntary Medical Male Circumcision Among Men Who Have Sex with Men in China: A Mixed-Methods Study.Archives of sexual behavior · 2023Trial
- Trial
- Identifying "What Matters Most" to Men in Botswana to Promote Resistance to HIV-Related Stigma.Qualitative health research · 2021Article
- Factors Associated with Low Uptake of Voluntary Medical Male Circumcision as HIV-Prevention Strategy among Men Aged 18-49 Years from Nyanza District, Rwanda.HIV/AIDS (Auckland, N.Z.) · 2021Article
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Authors and funding
8 authors.
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Abstract
backgroundIn 2007, the World Health Organization and the Joint United Nations Programme on HIV/AIDS endorsed voluntary medical male circumcision (VMMC) as an add-on HIV-prevention strategy. Similar to many other sub-Saharan countries, VMMC uptake in Botswana has been low; as of February 2016, only 42.7% of the program target had been achieved. Previous work has examined how individual-level factors, such as knowledge and attitudes, influence the update of VMMC. This paper examines how factors related to the health system can be leveraged to maximize uptake of circumcision services, with a focus on demand creation, access to services, and service delivery.
methodsTwenty-seven focus group discussions with 238 participants were conducted in four communities in Botswana among men (stratified by circumcision status and age), women (stratified by age), and community leaders. A semi-structured guide was used by a trained same-gender interviewer to facilitate discussions, which were audio recorded, transcribed, translated to English, and analyzed using an inductive analytic approach.
resultsParticipants felt demand creation activities utilizing age- and gender-appropriate mobilizers and community leaders were more effective than mass media campaigns. Participants felt improved access to VMMC clinics would facilitate service uptake, as would designated men's clinics with male-friendly providers for VMMC service delivery. Additionally, providing comprehensive pre-procedure counseling and education, outlining the benefits and disadvantages of the surgical procedure, and explaining the differences between the surgical and non-surgical procedures, were suggested by participants to increase understanding and uptake of VMMC.
conclusionCultural acceptability of circumcision services can be improved by engaging age- and gender-appropriate community mobilizers. Involving influential community leaders, providing a forum for men to discuss health issues, and bringing services closer to people can increase VMMC utilization. Service delivery can be improved by communicating the pros and cons of the procedure to the clients for informed decision-making.
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