Barcelona 2013
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| Abstract #589 - E-Posters English | ||||
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Session: 50.127: E-Posters English (Poster) on Sunday in Chaired by Authors: Presenting Author: Ms. Kayla Down - Battelle Memorial Research Institute, United States |
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| Additional Authors: Dr. Jordi Casabona, Sra Cristina Sanclemente, Dra. Anna Esteve, Dra. Victoria Gonzalez, Grupo HIVITS TS, | ||||
| Aim: As the final step in an assessment of a non-surgical device for voluntary male medical circumcision (VMMC) procedures in Zimbabwe, a field implementation trial was conducted to evaluate both clinical and psychosocial implications of VMMC implementation in district hospitals. Of the 603 men enrolled in the device study, half were randomly selected to participate in the psychosocial component (n=301), alongside 121 female partners of the men undergoing device circumcisions. Participants were over 18 years old and resided in Harare, Kadoma and Mutare. The majority of males and females in the study were Shona (94% male; 91% female), Christian (91% males; 98% females) with similar years of education (Mean 12.5 years male; Mean 11.8 years female). | ||||
| Method / Issue: The psychosocial component for men and their female partners assessed 11 outcomes: 1) Demographics; 2) VMMC experience, particularly in conversations and information resources; 3) Direct and indirect attitudes toward VMMC; 4) Social norms regarding circumcision; 5) Activities of daily living; 6) Experiences post-procedure; 7) Satisfaction with process and results of the circumcision; 8) Sexual history and current sexual activities; 9) Attitudes toward sex; 10) Attitudes toward condom use with different partners; and 11) Perception of HIV risk over lifetime. Outcomes for both groups measured males? perspectives and experiences with device circumcisions, and the female partner?s perspective of her male partner?s procedure and the implications of it. By evaluating these aspects, we could effectively measure attitudes, norms and personal agency in addition to the effects of their circumcisions on activities of daily living prior to the procedure and at 2-weeks and 3 months post-procedure. | ||||
| Results / Comments: Overall satisfaction ratings post-VMMC procedure were high for both men and women. Male attitudes towards VMMC were more positive than female attitudes. One of the largest differences between males and their female partners came from the discrete behavioral beliefs regarding pain associated with the procedure and healing process. Least consistent were the thoughts about men being tempted or intending to have sex with more than one partner after the healing took place. A significant difference between males and females also came at the 90-day post-procedure survey regarding beliefs around potential or perceived complications. More women disagreed with the statements ?it did not heal properly and caused disfigurement?, ?the nurse made a mistake and caused him to be disfigured?, ?he had too much bleeding?, ?it got infected and swollen?, and ?it meant having to wait too long to have sex?. The proportion of women strongly disagreeing with the aforementioned statements increased about thirty percent, likely driven by low initial expectations and the impact of experience over anticipated effects. The other nine outcomes also showed divergent results between men and women, particularly surrounding risk compensation and abstaining from sex for the designated period of time. | ||||
| Discussion: Psychosocial data from both males and females clearly indicate positive effects from these circumcisions, showing the potential for increasing capacity for circumcisions using devices in Ministry of Health clinics. However, without evidence-based demand creation going hand-in-hand with scaled-up efforts, planned target numbers will not be achieved. | ||||
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