Redding Colleen A, Jones Deborah, Zulu Robert, Chitalu Ndashi, Cook Ryan, Weiss Stephen M
University of Rhode Island, 130 Flagg Rd., Kingston, RI, 02881, USA.
University of Miami Miller School of Medicine, Miami, FL, USA.
Int J Behav Med. 2015 Dec;22(6):799-806. doi: 10.1007/s12529-015-9485-z.
Dissemination and scale up of voluntary medical male circumcision (VMMC) programs is well supported by evidence that VMMC reduces HIV risk in populations with high HIV prevalence and low rates of circumcision, as is the case in Zambia.
At both individual and population levels, it is important to understand what stages of change for VMMC are associated with, especially across cultures. This study evaluated VMMC knowledge, misinformation, and stages of change for VMMC of uncircumcised men and boys (over 18 years), as well as the concurrent relationship between VMMC stages of change and sexual risk behaviors.
Uncircumcised (N = 800) adult men and boys (over 18) were screened and recruited from urban community health centers in Lusaka, Zambia, where they then completed baseline surveys assessing knowledge, attitudes, HIV risk behaviors, and stages of change for VMMC. A series of analyses explored cross-sectional relationships among these variables.
VMMC was culturally acceptable in half of the sample; younger, unmarried, and more educated men were more ready to undergo VMMC. Stage of change for VMMC was also related to knowledge, and those at greater HIV risk reported greater readiness to undergo VMMC.
Efforts to increase VMMC uptake should address the role of perceived HIV risk, risk behaviors, readiness, accurate knowledge, cultural acceptance, and understanding of the significant degree of HIV protection conferred as part of the VMMC decision making process. These results support incorporating comprehensive HIV risk reduction in VMMC promotion programs.
自愿男性包皮环切术（VMMC）项目的推广和扩大得到了充分的证据支持，即VMMC可降低艾滋病病毒（HIV）高流行率和低包皮环切率人群中的HIV感染风险，赞比亚的情况就是如此。
在个体和人群层面，了解VMMC的变化阶段与哪些因素相关非常重要，尤其是跨文化的情况。本研究评估了未接受包皮环切术的男性和男孩（18岁以上）对VMMC的知识、错误信息和变化阶段，以及VMMC变化阶段与性风险行为之间的并发关系。
从赞比亚卢萨卡的城市社区卫生中心筛选并招募了800名未接受包皮环切术的成年男性和男孩（18岁以上），他们随后完成了基线调查，评估了对VMMC的知识、态度、HIV风险行为和变化阶段。一系列分析探讨了这些变量之间的横断面关系。
在一半的样本中，VMMC在文化上是可以接受的；年龄较小、未婚且受教育程度较高的男性更愿意接受VMMC。VMMC的变化阶段也与知识有关，HIV风险较高的人表示更愿意接受VMMC。
提高VMMC接受率的努力应考虑到感知到的HIV风险、风险行为、意愿、准确知识、文化接受度以及对VMMC决策过程中所赋予的显著HIV保护程度的理解等因素的作用。这些结果支持在VMMC推广项目中纳入全面的HIV风险降低措施。
