Factors influencing neonatal male circumcision uptake among expecting couples in Zambia: formative findings

ABSTRACT

Male circumcision is a protective HIV prevention strategy. However, uncircumcised Zambian men are reluctant to undergo voluntary medical male circumcision (VMMC). Tailored interventions are necessary to stimulate the uptake of early infant male circumcision (EIMC) and VMMC in Zambia. This feasibility study presents the formative process of utilising the PRECEDE framework in the development of a family-centred EIMC/VMMC intervention, Like Father Like Son, and its application in an existing VMMC intervention, Spear & Shield. We found that fear of the pain associated with EIMC procedures, foreskin disposal, beliefs in children’s autonomy and rights, and men’s dominance in health decision-making were factors affecting EIMC uptake. Perceived benefits for infants included improved hygiene, protection from HIV infection, and faster recovery. Reinforcing factors included female partners and fathers’ MC status. The availability and access to EIMC services and information, skill and experience of health workers, and engagement and belief in traditional circumcision practices were factors enabling EIMC uptake. These individual, interpersonal, and structural factors positively and negatively influencing EIMC uptake in the Zambian clinic context were integrated into the intervention for expecting parents. Feedback from community advisory boards suggested the process was effective in developing a culturally tailored and acceptable EIMC/VMMC promotion intervention.

KEYWORDS:

• Circumcision
• paediatrics
• HIV prevention
• Africa

Acknowledgements

Oliver Mweemba played a major role in the conceptualisation and design of the study, collected the data, carried out the initial analyses, drafted the initial manuscript, and reviewed and revised the manuscript. Deborah Jones, Robert Zulu, Kasonde Bowa and Stephen Weiss also significantly contributed to the conceptualisation and design of the study, coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content. Violeta J. Rodriguez and Jelisah Faith Desgraves drafted the initial manuscript and reviewed and revised the manuscript. Mr. Richard Msimuko, Mr. Rogers Mofya, Ms. Sharon Kayula Kalebaila, Ms. Mirriam Mwaba Musonda, Mr. Mataanana Mulavu collected data and reviewed and revised the manuscript. Victoria Orrego reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was funded by National Institutes of Health/National Institute of Mental Health (NIH/NIMH) (R34MH121111) with support from the University of Miami Miller School of Medicine Center for AIDS Research funded by NIH/National Institute of Allergy and Infectious Diseases (NIAID) (P30AI073961). VJR’s work on this manuscript was partially supported by a Ford Foundation Fellowship, administered by the National Academies of Sciences, Engineering, and Medicine (NASEM). The funding agency had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.