Office of Population Research, Princeton University, Princeton, NJ 08544, USA.
Sex Transm Dis. 2012 Jul;39(7):567-75. doi: 10.1097/OLQ.0b013e31824f9eaf.
This study aimed to document the clinical practices and attitudes of health care providers in South Africa and Zimbabwe on male circumcision for human immunodeficiency virus (HIV) prevention.
We conducted national surveys of physicians and nurses in both countries in 2008-2009 (N = 1444). Data on male circumcision for HIV prevention were analyzed; outcomes were patient counseling, provision of services, and desire for training. We used multivariable logistic regression to examine associations between these outcomes and clinician, practice, and attitudinal variables.
Overall, 57% of clinicians reported counseling male patients on male circumcision, 17% were offering services (49% referrals), and 61% desired training. In the multivariable analyses, provision of services was more common in South Africa (P ≤ 0.001) but desire for training higher in Zimbabwe (P ≤ 0.01). Provision of services was highest among physicians (P ≤ 0.01) and in hospital settings (P ≤ 0.001). However, nurses had greater desire for training (P ≤ 0.05) as did younger clinicians (P ≤ 0.001). Clinicians in rural and clinic settings were just as likely to express training interest. Clinician attitudes that patients would be upset due to cultural beliefs and would increase risky behaviors were associated with less counseling and service provision (P ≤ 0.05).
Many clinicians in South Africa and Zimbabwe showed willingness to integrate new HIV prevention evidence into practice and to become trained to offer the procedure to patients. Results suggest that both countries should consider involving nurses in male circumcision for HIV prevention, including those in rural areas, and should help clinicians to address cultural concerns.
本研究旨在记录南非和津巴布韦卫生保健提供者在男性割礼预防人类免疫缺陷病毒（HIV）方面的临床实践和态度。
我们于 2008-2009 年在两国对医生和护士进行了全国性调查（N=1444）。对男性割礼预防 HIV 的数据进行了分析；结果是患者咨询、服务提供和培训意愿。我们使用多变量逻辑回归来检查这些结果与临床医生、实践和态度变量之间的关联。
总体而言，57%的临床医生报告对男性患者进行了男性割礼咨询，17%提供了服务（49%的转介），61%希望接受培训。在多变量分析中，南非提供服务的情况更为常见（P≤0.001），但津巴布韦对培训的需求更高（P≤0.01）。服务的提供在医生中更为常见（P≤0.01），在医院环境中更为常见（P≤0.001）。然而，护士对培训的需求更大（P≤0.05），年轻的临床医生也是如此（P≤0.001）。在农村和诊所环境中工作的临床医生也同样有兴趣接受培训。认为患者会因文化信仰而感到不安并会增加危险行为的临床医生态度与较少的咨询和服务提供相关（P≤0.05）。
南非和津巴布韦的许多临床医生表示愿意将新的 HIV 预防证据纳入实践，并接受培训以向患者提供该程序。结果表明，这两个国家都应该考虑让护士参与男性割礼预防 HIV，包括农村地区的护士，并应帮助临床医生解决文化问题。
