Amsterdam 2015
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| Abstract #2320 - Circumcision and TasP: Biomedical interventions | ||||
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Session: 27.3: Circumcision and TasP: Biomedical interventions (Parallel) on Thursday @ 11.30-13.00 in C001 Chaired by Catherine Adams, Fraukje Mevissen Authors: Presenting Author: Dr Eileen Moyer - University of Amsterdam, Netherlands |
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| Additional Authors: | ||||
| Aim: As part of an effort to meet ambitious male circumcision targets in Swaziland, programme implementers are increasingly focusing on adolescent boys. Whereas uptake of circumcision has been relatively modest for adult men, despite ongoing well-funded and rigorous public health campaigning, adolescents account for 75% of those who have been circumcised since the campaign began. The ethical guidelines embedded in the circumcision programme conform to international standards, requiring that informed consent/assent be obtained prior to a circumcision surgery being performed. In this paper, we examine how these ethical norms took shape in everyday practice in a Swazi context, where norms relating to adolescent autonomy and intergenerational communication, as well as consumer desires, presented challenges to the process of informed assent. | ||||
| Method / Issue: Research presented in this article draws on six focus group discussions, 11 in-depth interviews, participant observation, and 14 informal interviews with adolescent boys preparing for voluntary medical male circumcision carried out in Swaziland in 2014. | ||||
| Results / Comments: Findings suggest that parental authority overpowers adolescents’ preferences when it comes to the decision to circumcise-even for young men above the age of 18 years. Although the use of incentives, usually in the form of sporting goods, seems to increase adolescent uptake, it also threatens adolescents’ autonomy. Overall, adolescents’ understanding of the risks associated with circumcision was poor and most assumed that HIV testing was obligatory. Although knowledgeable about the 60% efficacy of VMMC, they were not clear about the efficacy of VMMC compared to other HIV prevention methods such as condoms. | ||||
| Discussion: As accordance with international ethical guidelines, policies adopted by the Swazi MOH and VMMC implementers claim to encourage respect for adolescents’ rights and respect for their decisions in the consent/assent process. Our research suggests that these ethical norms and standards are difficult to uphold in everyday practice. Realities on the ground, including generational power differences, norms of intergenerational respect, the provision of incentives, lack of information on surgical risks and HIV testing, and the pressure by clinic workers to achieve donor targets all contribute to the complexity of the assent process. | ||||
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