National Institute for Medical Research, Mwanza, Tanzania.
BMC Public Health. 2011 Jun 28;11:506. doi: 10.1186/1471-2458-11-506.
Male circumcision (MC) has been shown to be effective against heterosexual acquisition of HIV infection and is being scaled up as an additional strategy against HIV in several countries of Africa. However, the policy environment (whether to formulate new specific policy on MC or adapts the existing ones); and the role of various stakeholders in the MC scale up process in Tanzania was unclear. We conducted this study as part of a situation analysis to understand the attitudes of policy makers and other key community and health authority decision makers towards MC, policy and regulatory environment, and the readiness of a health system to accommodate scaling up of MC services.
We conducted 36 key informants' interviews with a broad range of informants including civil servants, religious leaders, cultural and traditional gatekeepers and other potential informants. Study informants were selected at the national level, regional, district and community levels to represent both traditionally circumcising and non-circumcising communities.
Study informants had positive attitudes and strong beliefs towards MC. Key informants in traditionally non-circumcising districts were willing to take their sons for medically performed MC. Religious leaders and traditional gatekeepers supported MC as it has been enshrined in their holy scripts and traditional customs respectively. Civil servants highlighted the need for existence of enabling policy and regulatory environment in the form of laws, regulations and guidelines that will ensure voluntary accessibility, acceptability, quality and safety for those in need of MC services. Majority of informants urged the government to make improvements in the health system at all levels to ensure availability of adequate trained personnel, infrastructure, equipment, and supplies for MC scale up, and insisted on the involvement of different MC stakeholders as key components in effective roll out of medically performed MC programme in the country.
Findings from the situation analysis in Tanzania have shown that despite the absence of a specific policy on MC, basic elements of enabling policy environment at national, regional, district and community levels are in place for the implementation of MC scale up programme.
男性割礼（MC）已被证明能有效预防异性间感染艾滋病毒，并且正在非洲的几个国家被扩大作为预防艾滋病毒的另一种策略。然而，坦桑尼亚在政策环境（是否制定新的关于 MC 的具体政策或调整现有的政策）；以及在 MC 扩大规模过程中各利益攸关方的作用方面尚不清楚。我们进行了这项研究，作为情况分析的一部分，以了解决策者和其他主要社区和卫生当局决策者对 MC、政策和监管环境的态度，以及卫生系统对 MC 服务扩大规模的准备情况。
我们对包括公务员、宗教领袖、文化和传统守门人在内的广泛信息提供者进行了 36 次关键知情者访谈。研究信息提供者是在国家、地区、地区和社区各级挑选的，以代表传统上进行割礼和不进行割礼的社区。
研究信息提供者对 MC 持有积极的态度和强烈的信念。在传统上不进行割礼的地区，公务员愿意带他们的儿子去接受医学上的 MC。宗教领袖和传统的看门人支持 MC，因为它在他们的圣典和传统习俗中都有规定。公务员强调需要有一个有利的政策和监管环境，以法律、法规和准则的形式存在，以确保有需要的人能够自愿获得 MC 服务的可及性、可接受性、质量和安全性。大多数信息提供者敦促政府改进各级卫生系统，以确保有足够的经过培训的人员、基础设施、设备和 MC 扩大规模所需的用品，并且坚持让不同的 MC 利益攸关方作为有效推出国家医学割礼方案的关键组成部分参与。
坦桑尼亚的情况分析结果表明，尽管没有关于 MC 的具体政策，但在国家、地区、地区和社区各级实施 MC 扩大规模方案的有利政策环境的基本要素已经到位。
