IDENTIFYING BARRIERS AND EFFECTIVE COMMUNITY INTERVENTIONS TO VOLUNTARY MEDICAL MALE CIRCUMCISION IN THE ZAMBEZI Region

ABSTRACT

Voluntary Medical Male Circumcision (VMMC) is basically the surgical removal of foreskin of the penis. This is done for many reasons. However, cultural, religious and medical reasons are the most paramount for Male Circumcision (MC) around the world today. Needless to say, since the three randomized controlled trials on male circumcision in Kenya, Uganda and South Africa proved that VMMC can reduce the HIV transmission by at least 60%, this has become the main reason for MC, especially in sub-Saharan Africa (Woambe, 2003). VMMC has also proved to protect both men and women against diseases and infections among others: Sexually Transmitted Infections (STIs), cervical cancer and penile cancer. Subsequent to these realizations, the World Health Organization (WHO) and the United Nations Programme on HIV/AIDS (UNAIDS) recommended VMMC to 14 countries in Eastern and Southern Africa (including Namibia) with high Human Immunodeficiency Virus (HIV) prevalence rates and low MC prevalence rates, as an additional HIV prevention strategy (Woambe, 2003).

However, since the roll out of VMMC services in these countries, fewer men have heed the call to go for VMMC as the achieved number of circumcised men at the country and regional levels is not promising any significant realization that would have a positive health impact on the population, especially in relation to the HIV pandemic. Nearly all these countries could not reach the set targets, Namibia included. Despite numerous interventions to scale up VMMC in priority countries, the MC prevalence rates are still low. For example, Namibia as a country set the target of 330 128 men to

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be circumcised by 2016, however the numbers are not promising. Therefore, the objectives of this study were to identify barriers and the most effective community interventions in scaling up VMMC in the Zambezi Region. This study utilized a qualitative approach. Since the study dealt with a sensitive cultural topic of male circumcision, the most appropriate research design was ethnography (Adams, 2012), in particular ‘compressed ethnography’ (Rowsell, 2011).

The data collection techniques that were used in this study included: focused group discussions (FGDs), in-depth interviews (IDIs) and VMMC modified client forms to collect detailed views about barriers and the most effective community interventions from study participants. A total number of 89 participants (about 58%) out of 153 targeted population took part in the study which included: circumcised men, uncircumcised men, women, traditional leaders, church leaders, VMMC providers and VMMC promoters. The research was conducted in three locations: Katima Mulilo, Bukalo and Sibbinda. Data was collected over a period of two months. This was done as follows: modified client forms with prospective VMMC clients: n=23, focus group discussions (FGDs): n=8 with 49 participants and in-depth interviews (IDIs): n=17.

The majority of the study participants identified the main barriers to VMMC in the Zambezi Region as: fear of pain, fear of needles, fear of surgical complications and fear of taking an HIV test. The other additional barriers included: cultural barrier, religious beliefs, lack of adequate information, women staffs at VMMC sites, cost, abstinence from sex for 42 days after VMMC procedure, stigmatization, lack of parental consent, age limit and distance to VMMC facilities. The study also revealed

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that the barriers to VMMC can be addressed by strengthening the already existing educational advocacy approaches. The study further found out that the motivating factors associated with the scaling up of VMMC in the Zambezi Region are mainly: the prevention of disease, penile hygiene, peer-to-peer influence and social recognition. In addition, the most repeatedly mentioned effective community interventions in scaling up VMMC in the Zambezi Region were: community mobilization, peer-to-peer influence, radio and television, and posters and leaflets. Additionally, the use of influential persons such as artists and the use of women were found to be vital players in encouraging more men to sign up for VMMC.