Sahay Seema, Nagarajan Karikalan, Mehendale Sanjay, Deb Sibnath, Gupta Abhilasha, Bharat Shalini, Bhatt Shripad, Kumar Athokpam Bijesh, Kanthe Vidisha, Sinha Anju, Chandhiok Nomita
National AIDS Research Institute, Pune, India.
National Institute of Epidemiology, Chennai, India.
PLoS One. 2014 Mar 10;9(3):e91213. doi: 10.1371/journal.pone.0091213. eCollection 2014.
Although male circumcision (MC) is recommended as an HIV prevention option, the religious, cultural and biomedical dimensions of its feasibility, acceptability and practice in India have not been explored till date. This study explores beliefs, experiences and understanding of the community and healthcare providers (HCPs) about adult MC as an HIV prevention option in India.
This qualitative study covered 134 in-depth interviews from Belgaum, Kolkata, Meerut and Mumbai cities of India. Of these, 62 respondents were the members of circumcising (CC)/non-circumcising communities (NCC); including medically and traditionally circumcised men, parents of circumcised children, spouses of circumcised men, and religious clerics. Additionally, 58 registered healthcare providers (RHCPs) such as general and pediatric surgeons, pediatricians, skin and venereal disease specialists, general practitioners, and operation theatre nurses were interviewed. Fourteen traditional circumcisers were also interviewed. The data were coded and analyzed in QSR NUD*IST ver. 6.0. The study has not explored the participants' views about neonatal versus adult circumcision.
Members of CC/NCC, traditional circumcisers and RCHPs expressed sharp religious sensitivities around the issue of MC. Six themes emerged: Male circumcision as the religious rite; Multiple meanings of MC: MC for 'religious identity/privilege/sacrifice' or 'hygiene'; MC inflicts pain and cost; Medical indications outweigh faith; Hesitation exists in accepting 'foreign' evidence supporting MC; and communication is the key for acceptance of MCs. Medical indications could make members of NCC accept MC following appropriate counseling. Majority of the RHCPs demanded local in-country evidence.
HCPs must educate high-risk groups regarding the preventive and therapeutic role of MC. Communities need to discuss and create new social norms about male circumcision for better societal acceptance especially among the NCC. Feasibility studies on MC as an individual specific option for the high risk groups in health care setting needs to be explored.
尽管男性包皮环切术被推荐作为一种预防艾滋病病毒的方法，但在印度，其可行性、可接受性及实施过程中涉及的宗教、文化和生物医学层面，至今尚未得到探究。本研究探讨了印度社区及医疗服务提供者（HCPs）对于成年男性包皮环切术作为预防艾滋病病毒方法的看法、经历和理解。
这项定性研究涵盖了来自印度贝尔高姆、加尔各答、密拉特和孟买市的134次深度访谈。其中，62名受访者是施行包皮环切术的社区（CC）/不施行包皮环切术的社区（NCC）的成员，包括接受过医学和传统包皮环切术的男性、接受过包皮环切术儿童的父母、接受过包皮环切术男性的配偶以及宗教神职人员。此外，还采访了58名注册医疗服务提供者（RHCPs），如普通外科和儿科外科医生、儿科医生、皮肤性病专科医生、全科医生以及手术室护士。还采访了14名传统包皮环切师。数据在QSR NUD*IST 6.0版本中进行编码和分析。该研究未探讨参与者对新生儿包皮环切术与成年男性包皮环切术的看法。
CC/NCC的成员、传统包皮环切师和注册医疗服务提供者在男性包皮环切术问题上表现出强烈的宗教敏感性。出现了六个主题：男性包皮环切术作为宗教仪式；男性包皮环切术的多重含义：为“宗教身份/特权/牺牲”或“卫生”而进行的男性包皮环切术；男性包皮环切术带来痛苦和费用；医学指征超过信仰；在接受支持男性包皮环切术的“国外”证据方面存在犹豫；沟通是接受男性包皮环切术的关键。医学指征可以使NCC的成员在接受适当咨询后接受男性包皮环切术。大多数注册医疗服务提供者要求有本国的本地证据。
医疗服务提供者必须就男性包皮环切术预防和治疗作用对高危人群进行教育。社区需要讨论并制定关于男性包皮环切术的新社会规范，以提高社会接受度，特别是在NCC中。需要探索将男性包皮环切术作为医疗环境中针对高危人群的个体特定选择的可行性研究。
