Price Jessica E, Phiri Lyson, Mulenga Drosin, Hewett Paul C, Topp Stephanie M, Shiliya Nicholas, Hatzold Karin
Population Council, Zambia Office, Lusaka, Zambia.
Population Council, HIV and PGY Divisions, New York, New York, United States of America.
PLoS One. 2014 Nov 6;9(11):e111602. doi: 10.1371/journal.pone.0111602. eCollection 2014.
As an HIV prevention strategy, the scale-up of voluntary medical male circumcision (VMMC) is underway in 14 countries in Africa. For prevention impact, these countries must perform millions of circumcisions in adolescent and adult men before 2015. Although acceptability of VMMC in the region is well documented and service delivery efforts have proven successful, countries remain behind in meeting circumcision targets. A better understanding of men's VMMC-seeking behaviors and experiences is needed to improve communication and interventions to accelerate uptake. To this end, we conducted semi-structured interviews with 40 clients waiting for surgical circumcision at clinics in Zambia. Based on Stages of Change behavioral theory, men were asked to recount how they learned about adult circumcision, why they decided it was right for them, what they feared most, how they overcame their fears, and the steps they took to make it to the clinic that day. Thematic analysis across all cases allowed us to identify key behavior change triggers while within-case analysis elucidated variants of one predominant behavior change pattern. Major stages included: awareness and critical belief adjustment, norming pressures and personalization of advantages, a period of fear management and finally VMMC-seeking. Qualitative comparative analysis of ever-married and never-married men revealed important similarities and differences between the two groups. Unprompted, 17 of the men described one to four failed prior attempts to become circumcised. Experienced more frequently by older men, failed VMMC attempts were often due to service-side barriers. Findings highlight intervention opportunities to increase VMMC uptake. Reaching uncircumcised men via close male friends and female sex partners and tailoring messages to stage-specific concerns and needs would help accelerate men's movement through the behavior change process. Expanding service access is also needed to meet current demand. Improving clinic efficiencies and introducing time-saving procedures and advance scheduling options should be considered.
作为一项艾滋病预防策略，非洲14个国家正在扩大自愿男性包皮环切术（VMMC）的实施规模。为了实现预防效果，这些国家必须在2015年前为数百万青少年和成年男性实施包皮环切术。尽管该地区对VMMC的接受程度已有充分记录，且服务提供工作已证明取得成功，但各国在实现包皮环切术目标方面仍落后。需要更好地了解男性寻求VMMC的行为和经历，以改善沟通和干预措施，加速接受率。为此，我们在赞比亚的诊所对40名等待手术包皮环切术的患者进行了半结构化访谈。基于行为改变阶段理论，我们要求男性讲述他们如何了解到成人包皮环切术，为什么认为这对他们合适，他们最害怕什么，如何克服恐惧，以及当天他们为前来诊所所采取的步骤。对所有案例进行主题分析使我们能够识别关键的行为改变触发因素，而案例内分析则阐明了一种主要行为改变模式的变体。主要阶段包括：认知和关键信念调整、规范压力和优势的个性化、恐惧管理期以及最终寻求VMMC。对已婚和未婚男性的定性比较分析揭示了两组之间重要的异同点。在未受提示的情况下，17名男性描述了之前一到四次包皮环切术尝试失败的经历。VMMC尝试失败在老年男性中更为常见，往往是由于服务方面的障碍。研究结果突出了增加VMMC接受率的干预机会。通过亲密男性朋友和女性性伴侣接触未割包皮的男性，并根据特定阶段的担忧和需求量身定制信息，将有助于加速男性在行为改变过程中的进展。还需要扩大服务可及性以满足当前需求。应考虑提高诊所效率，引入节省时间的程序和提前预约选项。
