Umar E, Mandalazi P, Jere D, Muula A
University of Malawi, College of Medicine, Department of Community Health, Blantyre, Malawi.
University of Malawi, Kamuzu College of Nursing, Lilongwe, Malawi.
Malawi Med J. 2013 Sep;25(3):72-7.
BACKGROUND: The Malawi government has endorsed voluntary medical male circumcision (VMMC) as a biomedical strategy for HIV prevention after a decade of debating its effectiveness in the local setting. The "policy" recommends that male circumcision (MC) should be clinically based, as opposed to the alternative of traditional male circumcision (TMC). Limited finances, acceptability concerns, and the health system's limited capacity to meet demand are among the challenges threatening the mass rollout of VMMC. In terms of acceptability, the gender of clinicians conducting the operations may particularly influence health facility-based circumcision. This study explored the acceptability, by male clients, of female clinicians taking part in the circumcision procedure. METHODS: Six focus group discussions (FGDs) were conducted, with a total of 47 newly circumcised men from non-circumcising ethnic groups in Malawi participating in this study. The men had been circumcised at three health facilities in Lilongwe District in 2010. Data were audio recorded and transcribed verbatim. Data were analysed using narrative analysis. RESULTS: Participants in the FGDs indicated that they were not comfortable with women clinicians being part of the circumcising team. While few mentioned that they were not entirely opposed to female health providers' participation, arguing that their involvement was similar to male clinicians' involvement in child delivery, most of them opposed to female involvement, arguing that MC was not an illness that necessitates the involvement of clinicians regardless of their gender. Most of the participants said that it was not negotiable for females to be involved, as they could wait until an all-male clinician team could be available. Thematically, the arguments against female clinicians' involvement include sexual undertones and the influences of traditional male circumcision practices, among others. CONCLUSION: Men preferred that VMMC should be conducted by male health providers only. Traditionally, male circumcision has been a male-only affair shrouded in secrecy and rituals. Although being medical, this study strongly suggested that it may be difficult for VMMC to immediately move to a public space where female health providers can participate, even for men coming from traditionally non-circumcising backgrounds.
背景:经过十年对自愿男性包皮环切术(VMMC)在当地环境中有效性的辩论,马拉维政府已认可其作为预防艾滋病毒的生物医学策略。该“政策”建议男性包皮环切术(MC)应以临床为基础,这与传统男性包皮环切术(TMC)不同。有限的资金、对可接受性的担忧以及卫生系统满足需求的能力有限,都是威胁VMMC大规模推广的挑战。在可接受性方面,进行手术的临床医生性别可能会特别影响基于医疗机构的包皮环切术。本研究探讨了男性客户对女性临床医生参与包皮环切手术的可接受性。 方法:进行了六次焦点小组讨论(FGD),共有47名来自马拉维非包皮环切族群的新接受包皮环切术的男性参与本研究。这些男性于2010年在利隆圭区的三个医疗机构接受了包皮环切术。数据进行了音频记录并逐字转录。使用叙事分析对数据进行了分析。 结果:焦点小组讨论的参与者表示,他们对女性临床医生成为包皮环切团队的一员感到不舒服。虽然很少有人提到他们并不完全反对女性医疗服务提供者的参与,认为她们的参与类似于男性临床医生参与分娩,但大多数人反对女性参与,认为包皮环切术不是一种无论临床医生性别如何都需要其参与的疾病。大多数参与者表示女性参与是不可协商的,因为他们可以等到全是男性的临床医生团队可用。从主题上讲,反对女性临床医生参与的论点包括性暗示以及传统男性包皮环切术做法的影响等。 结论:男性更倾向于仅由男性医疗服务提供者进行VMMC。传统上,男性包皮环切术一直是男性专属事务,笼罩在秘密和仪式之中。尽管这是一种医疗行为,但本研究强烈表明,即使对于来自传统上不进行包皮环切的背景的男性,VMMC也可能难以立即进入女性医疗服务提供者可以参与的公共领域。
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