Academic literature on the topic 'Male circumcision – Zimbabwe'

SummaryMedical male circumcision has been recommended by the World Health Organization as part of a comprehensive approach to HIV prevention. Zimbabwe is one of the fourteen sub-Saharan countries that embarked on the Medical Male Circumcision (MMC) programme. However, the country has not yet met male circumcision targets. This paper examines the predictors of male circumcision in Zimbabwe. A cross-sectional survey was conducted on 784 men aged 15–35 years in Harare, Zimbabwe. Negative log-log logistic regression analysis was used to determine the predictors of male circumcision. The main predictors of circumcision were age, employment status, ever tested for HIV, approval of HIV testing prior to circumcision, knowledge about male circumcision and attitudes towards male circumcision. By and large, participants had good knowledge about male circumcision and viewed HIV prevention with a reasonably positive attitude. The identification of these predictors can be used to scale up the demand for male circumcision in Zimbabwe.

This study brings out circumcision dilemmas and conflicts among the Xhosa people of Lortondale area in the Matabeleland North province of Zimbabwe. The problem befell this community immediately after 2009 when Zimbabwe adopted results from Kenya, Uganda and South Africa in Orange farm that circumcision can curb HIV transmission by 60% from female to male and thus attention was given to medical circumcision, which is known as ‘smart’. Family disunity and disintegration are some of the results of conflicts, within some families whose members shunned the traditional practice. Interviews and focus group discussions were employed in gathering primary data for this study. They allowed access to first-hand information from the Xhosa people themselves. On the same note, one of the researchers has worked closely with this community for a year in other HIV/AIDS programs. This counteracted the element of secrecy associated with the subject of circumcision among the Xhosa people which a number of scholars and news reporters fail to tackle and finally produce general results. Finally, a synergy is proposed as a way that restores peace and order in the society under study.

Thesis (MPhil)--Stellenbosch University, 2013.<br>ENGLISH ABSTRACT: Background: Medical male circumcision (MMC) has emerged as one of the Human Immunodeficiency Virus (HIV) prevention methods for HIV negative men engaged in heterosexual contact. Many studies have documented its efficiency in reducing the risk of contracting HIV infection in men. Because of that, Zimbabwe like other countries in the Southern Africa region, with generalised HIV infections is finding ways to scale-up MMC in non-circumcised communities. This study searched for knowledge, perceptions and attitudes of males in Bindura urban towards MMC. Bindura is the capital city of the Mashonaland Central Province of Zimbabwe. This town has diverse people with different social backgrounds who economically depend on the surrounding mines and commercial farms. Given the enormous differences in culture, religion, social and value systems among these people it was of particular importance to understand how they perceive medical male circumcision. Methodology: The study was conducted using quantitative data collection method. Random selection was done to choose respondents and age was used to determine eligibility to the study. The qualifying age was 18-49 and a sample size of 60 was considered to be appropriate taking into consideration financial and time associated with large samples. Structured questionnaire with open-ended and closed questions were used to gather data. Likert scale was used on some questions to determine perceptions and attitudes of respondents. The questionnaires used to solicit information did not require respondent to provide his name for purposes of maintain confidentiality but contained identification number. In some cases, Chi-square test for independence was conducted to test for associations between demographic characteristics and observed responses. Comparison of responses between the age groups 18-29 and 30-49 years were also done to determine if there were some differences in representations of respondents in observed responses. Results: The study aimed to assess knowledge, perceptions and attitudes of males in Bindura urban towards MMC and barriers they were confronting in accessing MMC. Respondents showed high level of awareness about HIV/AIDS intensity in Zimbabwe. Male circumcision (MC) was perceived by the majority of respondents as important in curbing HIV infections. A significant proposition of respondents regarded medical reasons as the most common reason why people undergo MC. However respondents demonstrated poor knowledge or understanding of other strategies that must be used in conjunction with MC. Risks associated with operation, its cost and protection of confidentiality and consideration of family concerns were considered by respondents as barriers to MMC. Availability of accurate information about MMC and easing of access to MMC services were considered to be very important facilitating factors. Religious and cultural reasons and stigma from peers and friends were considered non barriers. Statistically significant associations were only detected between MMC being motivated by medical reasons and demographic characteristics of age and marital status and also an association between education level and stigma as a barrier for MMC. The study failed to show a significant association between other observed responses and demographic characteristics.<br>AFRIKAANSE OPSOMMING: Agtergrond: Mediese manlike besnyding (MMB) het na vore gekom as een van die metodes vir die voorkoming van die oordrag van die menslike immuniteitsgebreksvirus (MIV) deur MIV-negatiewe mans betrokke by heteroseksuele kontak. Baie studies het reeds die doeltreffendheid daarvan ten opsigte van die vermindering van die risiko van MIV-infeksie by mans gedokumenteer. As gevolg daarvan is Zimbabwe, soos ander lande in die Suider-Afrika-streek met algemene MIV-infeksies, op soek na maniere om MMB by onbesnyde gemeenskappe uit te brei. Hierdie studie wou kennis, persepsies en gesindhede van manlike persone in die Bindura-stadsgebied ten opsigte MMB bepaal. Bindura is die hoofstad van die sentrale provinsie Masjonaland in Zimbabwe. Hierdie stad word bewoon deur diverse mense met verskillende maatskaplike agtergronde wat ekonomies van die omliggende myne en kommersiële plase afhanklik is. Gegewe die groot verskille in kultuur, godsdiens, maatskaplike en waardestelsels onder hierdie mense, was dit van besondere belang om te begryp hoe hulle mediese manlike besnyding verstaan. Metodologie: Die studie het van die kwantitatiewe data-insamelingsmetode gebruik gemaak. Ewekansige seleksie is gebruik om respondente te kies en ouderdom is gebruik om geskiktheid vir deelname aan die studie te bepaal. Die kwalifiserende ouderdom was 18-49 jaar en ʼn monstergrootte van 60 is geskik beskou in ag geneem finansiële beperkinge en tyd verbonde aan groot monsters. ʼn Gestruktureerde vraelys met oop en geslote vrae is gebruik om data in te samel. ʼn Likert-tipe skaal is by sommige vrae gebruik om persepsies en gesindhede van respondente te bepaal. Die vraelyste wat gebruik is om inligting te ontlok, het dit nie vir respondente nodig gemaak om hulle name te verskaf nie ten einde vertroulikheid te verseker, maar het ’n identifikasienommer bevat. In sommige gevalle is die chi-kwadraattoets vir onafhanklikheid gedoen om te toets vir verbande tussen demografiese eienskappe en response wat waargeneem is. Vergelyking van response tussen die ouderdomsgroepe 18-29 en 30-49 jaar is ook gedoen om te bepaal of daar enige verskille in verteenwoordigings van respondente in die waargenome response was. Resultate: Die studie wou kennis, persepsies en gesindhede ten opsigte van MMB by manlike persone in die Bindura-stadsgebied en hindernisse waarvoor hulle te staan kom ten einde toegang tot MMB te verkry, bepaal. Respondente het ʼn hoë vlak van bewustheid omtrent die intensiteit van MIV/VIGS in Zimbabwe getoon. Manlike besnyding (MB) is deur die meerderheid respondente as belangrik by die beperking van MIV-infeksies beskou. ʼn Beduidende aantal respondente het mediese redes gesien as die algemeensien rede waarom mense MB ondergaan. Respondente het egter swak kennis of begrip van ander strategieë wat tesame met MB gebruik moet word, getoon. Risiko’s geassosieer met die operasie, die koste daarvan en beskerming van vertroulikheid en agting vir die familie se bekommernisse is deur respondente as hindernisse met betrekking tot MMB beskou. Beskikbaarheid van akkurate inligting omtrent MMB en vergemakliking van toegang tot MMB-dienste is gesien as baie belangrike fasiliterende faktore. Godsdienstige en kulturele redes en stigmatisasie deur portuurs en vriende is nie as hindernisse beskou nie. Statisties beduidende verbande is slegs tussen MMB gemotiveer deur mediese redes en demografiese eienskappe van ouderdom en huwelikstatus bespeur en ook ʼn verband tussen opvoedingspeil en stigma as ʼn hindernis vir MMB. Die studie het nie daarin geslaag om ʼn beduidende verband tussen ander waargenome response en demografiese eienskappe aan te toon nie.

The overall aim of the research outlined in this PhD thesis is to assess the feasibility and acceptability of early infant male circumcision (EIMC) as an HIV prevention intervention in Zimbabwe in order to inform roll out. Mathematical modelling estimates that circumcising 1.9 million Zimbabwean men aged 15-49 by 2015 could avert 42% of new HIV infections that would have otherwise occurred by 2025. Since 2009, Zimbabwe has provided voluntary medical male circumcision (VMMC) to over 300,000 adult and adolescent men. In order to ensure that the protective effect of male circumcision is sustained in the longer-term, Zimbabwe intends to roll out EIMC alongside adult MC, starting 2015. Although EIMC’s effects on HIV will take longer to realise, infant circumcision is easier, safer and cheaper than adult MC. Further, EIMC may more effectively prevent HIV acquisition as the procedure is carried out before the individual becomes sexually active, negating the risk associated with acquisition or transmission of HIV during the healing period. Since large-scale EIMC for HIV prevention, or indeed for other reasons, has never been practised in Zimbabwe or more widely in Southern Africa, there are concerns around its feasibility and acceptability. Clearly, acceptability of infant MC will have a bearing on uptake, roll out and subsequent effectiveness in preventing HIV. In Zimbabwe, there are also concerns about the feasibility of rolling out EIMC for HIV prevention within the context of existing health services, many of which are already overburdened and understaffed. The PhD research is in two phases. The first phase describes a systematic review and thematic synthesis I conducted to explore parental reasons for non-adoption of infant MC for HIV prevention in sub-Saharan Africa. Additionally, this phase qualitatively explored hypothetical acceptability of EIMC among parents and wider family as well as hypothetical feasibility and acceptability of EIMC among health-care workers. Findings from the first phase informed the design of a study to pilot EIMC roll out. The second phase was nested within a trial that assessed the feasibility, safety, acceptability and cost of rolling out EIMC using devices in Zimbabwe. It explored actual acceptability of EIMC among parents and wider family as well as actual feasibility and acceptability of EIMC among health-care workers. Findings from both phases informed recommendations for a demand generation intervention for EIMC which is currently being developed and will subsequently be tested for impact. Given that EIMC has been identified as a key HIV prevention intervention for sustaining the prevention gains anticipated through VMMC across sub-Saharan Africa, the findings of this research are likely to have broad implications for HIV prevention across the region.

Thesis (MPhil (Industrial Psychology. Africa Centre for HIV/AIDS Management))--University of Stellenbosch, 2011.<br>ENGLISH ABSTRACT: This study sought to establish the level of knowledge of people on the medical benefits of male circumcision, especially the protective effect against HIV, with the aim of gathering baseline information on the subject for future health promotion programmes. A cross-section survey was conducted at Border Timbers Limited forest management units with 220 respondents that were conveniently selected into the study, and of these 49% were males and the reminder females. The data were collected using two questionnaires; one for females and the other for males. The data was analyzed using an Epi Info programme. The findings showed that, there was little knowledge on the benefits of male circumcision as they scored an average score of three out of eight, and 66% scored less than 50%. Striking was that that females were more knowledgeable than their male counterparts. Less than 20% knew of the protective effect of male circumcision against HIV. Fifty eight percent of the respondents had negative perceptions of the procedure, and 55% of the respondents were of the opinion that, male circumcision should be stopped with as little as twenty percent of the uncircumcised men willing to be circumcised. Under a third of the total respondents (26.7%) expressed their willingness to circumcise their male children. Medically conducted circumcision was preferred by 95% of the respondents over traditionally conducted circumcision. Based on the above; the study concluded that, raising people's knowledge on benefits of male circumcision would help in changing people's perceptions and increase the acceptability of the procedure. It is recommended that the government together with the private sector urgently need to carry awareness campaigns to raise workplace on how male circumcision can reduce chances of getting HIV. Furthermore, traditional circumcision practice should be encouraged and the practitioners trained to carry the procedure in a safe way. Further studies are recommended to assess the impact of stigma on the already circumcised in order to effectively plan and overcome societal barriers for the recommended strategies to make an impact.<br>AFRIKAANSE OPSOMMING: Hierdie studie poog om die vlak van kennis van mense rakende die mediese voordele van manlike besnyding te vestig, veral die voorkomende effek teen MIV met die doel om basislyn inligting oor die onderwerp van toekomstige gesondheidsbevoordelings programme te bevorder. 'n Proefopname is uitgevoer by die Border Timbers Beperk bosbestuur eenhede met 220 respondente wat gerieflik gekies is, waarvan 49% mans en die res vroue is. Data is ingesamel met behulp van twee vraelyste vir vrouens en mans onderskeidelik. Die data was ontleed deur gebruik te maak van die Epi Info program. Die bevindinge het getoon dat daar min kennis oor die voordele van manlike besnyding is, aangesien 'n gemiddelde telling van drie uit agt behaal is en 66% respondente het minder as 50% behaal. Wat opvallend was, is dat vroue meer kennis as hul manlike eweknieë oor die onderwerp gehad het. Minder as 20% het geweet van die beskermende effek van manlike besnyding teen MIV. Agt en vyftig persent van die respondente het negatiewe persepsies oor die proses en 55% van die respondente was van mening dat manlike besnyding gestop moet word en so min as twintig persent van die onbesnyde mans is bereid om besny te word. Minder as 'n derde van die totale respondente (26,7%) was bereid om hul manlike kinders te besny. Medies uitgevoerde besnyding was verkies deur 95% van die respondente teenoor tradisionele besnyding. Gegrond op bogenoemde, het hierdie studie bevind dat die verhoging van mense se kennis oor die voordele van manlike besnyding sal help om mense se persepsies asook die verhoging van aanvaarbaarheid van die proses te verander. Daar word aanbeveel dat die regering, tesame met die privaatsektor dringend bewusmakingsveldtogte moet uitvoer om die werksplek op te voed oor hoe manlike besnyding die kanse om MIV te verminder. Verder moet tradisionele besnydingspraktyke aangemoedig word en praktisyne moet opgelei word om die prosedure op „n veilige manier uit te voer. Verdere studies word aanbeveel om die impak van stigma op die reeds besnydes te assesseer om doeltreffend te beplan en om maatskaplike hindernisse te oorkom vir die aanbevole strategieë om 'n impak te maak.

Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2007.<br>Title from electronic title page (viewed Dec. 18, 2007). "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Epidemiology, School of Public Health." Discipline: Epidemiology; Department/School: Public Health.

Zimbabwe is one of the priority countries nominated by the World Health Organisation and the Joint United Nations Programme on HIV and AIDS to adopt and implement voluntary medical male circumcision (VMMC) because of its high rate of HIV prevalence and its low level of male circumcision. VMMC, which was introduced in Zimbabwe in 2009, is a new HIV prevention method which reportedly offers partial protection of about 60 percent for circumcised males with respect to contracting HIV through sexual relations. The other key prevention method, namely the use of condoms consistently and correctly, has a protection rate of up to 95 percent. As a result, because of only partial protection, medically-circumcised men are encouraged to use condoms to decrease the chances of HIV infection. Concerns though have been raised about the possibility of risk compensation by circumcised males by way of increases in unsafe or risky sexual practices subsequent to circumcision and arising from perceptions of reduced risk through VMMC. This compensation may take the form of condom use aversion including when involved with concurrent sexual partners. If risk compensation does take place, this would lead to increases in HIV transmissions affecting not only the circumcised men but their sexual partners as well. The supposed effectiveness of VMMC as a HIV prevention method has been subjected to significant criticism and, as yet, no significant study has been undertaken in Zimbabwe on the relationship between VMMC, condom use, concurrent sexual partners and risk compensation. Based on a study of twenty-five medically-circumcised males in Harare, the capital of Zimbabwe, this thesis seeks to understand and explain the relationship between voluntary medical male circumcision and risky sexual practices with particular reference to condom use amongst men engaged in concurrent sexual partnerships. While the thesis finds evidence of risky sexual practices subsequent to circumcision, risk compensation does not seem to be particularly prevalent.

Text in English<br>Many African countries including Zimbabwe have scaled up and included male circumcision in their comprehensive HIV Prevention package. However, the impact of male circumcision on male sexual function and satisfaction has remained controversial. The main purpose of the study was to investigate the impact of male circumcision on sexual function and satisfaction in Harare, Zimbabwe. A quantitative study was carried out amongst a sample of 169 circumcised men using a questionnaire. The results showed that circumcision has a positive effect on both male sexual function and satisfaction. It was concluded that undergoing voluntary medical male circumcision have a high degree of satisfaction with the procedure and its consequences in terms of sexual function and satisfaction. It was recommended that men are educated about these findings so as to clear myths and misconceptions around circumcision.<br>Health Studies<br>M.P.H.

A research submitted to the faculty of health science (School of Public Health), University of the Witwatersrand, in partial fulfilment of the requirements for the Degree of Masters in Public Health in the field of Social and Behaviour Change Communication. October 2017.<br>Introduction Zimbabwe is lagging behind on its target to scale up Voluntary Medical Male Circumcision (VMMC). The engagement of female partners in VMMC demand creation is important as they can play an important role in their male partners’ decision to uptake VMMC. Exploring women’s perceptions and experiences will help to better understand factors behind low uptake of VMMC in Zimbabwe as efforts are being made to scale up VMMC for HIV prevention. The aim of the study was to explore female partners’ underlying perceptions and experiences of having their partners undergo medical male circumcision in order to inform the development of promotional messages on the basis of women’s experiences with VMMC. Methods The study was conducted in Mbare, an urban high density suburb in the southern district of Harare utilising qualitative methodology. Individual in-depth interviews were conducted using an in-depth interview guide. Through purposive sampling a total of twenty female partners of medically circumcised men attending antenatal clinic between February and May 2016 were recruited. Interviews were audio recorded and transcripts were analysed using content analysis. Results The results show that women were knowledgeable about VMMC. The perception towards medical male circumcision was linked to the perceived benefits of VMMC. The main role that women played was encouraging their male partners. The perception of women towards VMMC was generally good. The perceived benefits of having a circumcised partner were Fine Mazambara 872453 iv reduced risk of HIV and STIs, improved sexual experience, improved hygiene, improved sexual communication, no need to use condoms and improvement of the relationship. The risk perception towards HIV and STIs was decreased after the male partner’s VMMC and fear of risk compensation was reported. Women had misconceptions about adverse events of circumcision and the age at which men can be circumcised. Mass media was the main source of VMMC information for women. VMMC was understood to offer direct protection from HIV for women and circumcised men were understood to being conferred full protection from HIV and STIs. Conclusions Women have knowledge on VMMC although their knowledge on adverse events associated with circumcision, age at which men can be circumcised, indirect protection for women, and partial protection for men can be improved. The perceptions of women towards VMMC were influenced by the perceived benefits of having a circumcised partner. The main perceived benefits of having a VMMC client as a male partner is reduced risk of HIV and STIs and improved sexual experience. Targeted health messages directed at women should therefore aim at increasing women’s knowledge of VMMC, include improved sexual experience and take gender issues into consideration.<br>LG2018

MAAS<br>Centre for African Studies<br>Zimbabwe launched the Voluntary medical male circumcision programme (VMMC) in November 2009, with the primary aim of curbing sexual transmitted infections (STI’s). In 2010, the district of Mazowe managed to adopt voluntary medical male circumcision programme to curb sexual transmitted infections. It is of concern that the voluntary medical male circumcision programme has been below expectations in Mazowe district. Hence, the aim of the study was to explore the effectiveness of the voluntary medical male circumcision programme among secondary school learners in Mazowe district. Furthermore, the primary goals of the study were firstly check the levels of understanding about the voluntary medical male circumcision programme among secondary school learners in Mazowe district. Secondly, explore the reasons behind the low rate of the voluntary medical male circumcision programme among secondary school learners. Thirdly, investigate whether cultural beliefs influence the learners’ choice. Lastly, recommend possible ways of improving the uptake of the voluntary medical male circumcision programme among secondary school learners in Mazowe district. A qualitative research method used in the study. Also, un-structured interviews and focused group discussions. The researcher conducted interviews using purposeful sampling method on three secondary schools in Mazowe district, Zimbabwe and about forty respondents participated in the study. The study adopted a planned behaviour and person/client centered approaches. The thesis’s conclusions deduced that most of the male respondents are not ready or willing to receive circumcision due to fear of being screened for HIV/AIDS, the cost of the procedure, pain, bleeding, to mention but a few. Furthermore, the researcher identified that in the Shona culture, medical male circumcision is rarely unknown. In addition, the Ministry of Health and Child Welfare must introduce new ways of circumcision to avoid bleeding, pain and must remove the screening of the HIV testing procedure before one is circumcise. Therefore, by these outcomes the Ministry of Child and Health Care Centre will try to find strategies in which they can scale the programme, since the study highlighted that most males are not going for circumcision, hence their lives are in predicament. More so, the study recommends v that researchers must obtain consent and ethical clearance from different relevant place so that data there will not be harm to respondents. Also, there is a need to look for policies in which the government will use to assess strategies to scale the programme, since it is of paramount importance to test the VMMC programme about the impact that it is giving to the community and to find out whether it is helpful or not. More so, in terms of future researchers, there is a need to reconnoiter barriers that hinders males from circumcised. Hence, fourth, this will motivate number of District schools to bring awareness towards males to take part in the programme and prevent males from being susceptible to the infections as recommended by the WHO in 2007. In addition, decentralizing the programme to the community, stakeholders would be able to work hand in hand with the District to make sure that the rate of the VMMC is up and those males take part in the programme willingly. Hence, this will create an efficacy of the programme since all stakeholders and the community will scale up the programme since the priority of all sides will be to scale the programme. Furthermore, clearing misconceptions associated with male learners (witchcraft, pain, bleeding, and religion, to mention but the few), providing them with right mentality about the good side of the programme. In addition, there is a need for the Ministry of Health and Child Welfare to amend new polices that allows free male circumcision, especially in public hospitals, hence, through these amendments, males might be willing to get the services. Lastly but not least, the Department of Education in Zimbabwe must set up tight mechanism for assessment for the programme, especially at secondary and high schools. This will in turn, develop an effective assessment system to see how effective the programme is in the districts. Finally, it is of paramount importance that the National HIV/AIDS council collaborates with the Ministry of Health and Child Welfare in decentralizing the service of the VMMC, since some respondents were concerned that the distance to the service centers were a hindrance for circumcision.<br>NRF