探索安全男性包皮环切术的驱动因素：乌干达瓦基索区新接受包皮环切术男性的健康教育经历及对部分艾滋病毒防护的理解
Exploring drivers for safe male circumcision: Experiences with health education and understanding of partial HIV protection among newly circumcised men in Wakiso, Uganda.
作者信息
Kibira Simon P S, Daniel Marguerite, Atuyambe Lynn Muhimbuura, Makumbi Fredrick Edward, Sandøy Ingvild Fossgard
机构信息
Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda.
出版信息
PLoS One. 2017 Mar 31;12(3):e0175228. doi: 10.1371/journal.pone.0175228. eCollection 2017.
INTRODUCTION
About 2.5 million men have voluntarily been circumcised since Uganda started implementing the WHO recommendation to scale up safe male circumcision to reduce HIV transmission. This study sought to understand what influences men's circumcision decisions, their experiences with health education at health facilities and their knowledge of partial HIV risk reduction in Wakiso district.
METHODS
Data were collected in May and June 2015 at five public health facilities in Wakiso District. Twenty-five in-depth interviews were held with adult safe male circumcision clients. Data were analysed using thematic network analysis.
FINDINGS
Safe male circumcision decisions were mainly influenced by sexual partners, a perceived need to reduce the risk of HIV/STIs, community pressure and other benefits like hygiene. Sexual partners directly requested men to circumcise or indirectly influenced them in varied ways. Health education at facilities mainly focused on the surgical procedure, circumcision benefits especially HIV risk reduction, wound care and time to resumption of sex, with less focus on post-circumcision sexual behaviour. Five men reported no health education. All men reported that circumcision only reduces and does not eliminate HIV risk, and could mention ways it protects, although some extended the benefit to direct protection for women and prevention of other STIs. Five men thought social marketing messages were 'misleading' and feared risk compensation within the community.
CONCLUSIONS
Participants reported positive community perception about safe male circumcision campaigns, influencing men to seek services and enabling female partners to impact this decision-making process. However, there seemed to be gaps in safe male circumcision health education, although all participants correctly understood that circumcision offers only partial protection from HIV. Standard health education procedures, if followed at health facilities offering safe male circumcision, would ensure all clients are well informed, especially about post-circumcision sexual behaviour that is key to prevention of risk compensation.
引言
自乌干达开始实施世界卫生组织扩大安全男性包皮环切术以减少艾滋病毒传播的建议以来，约有250万男性自愿接受了包皮环切术。本研究旨在了解哪些因素影响男性的包皮环切术决策、他们在医疗机构接受健康教育的经历以及他们对瓦基索区部分降低艾滋病毒风险的认识。
方法
2015年5月和6月在瓦基索区的五个公共卫生机构收集数据。对25名成年安全男性包皮环切术受术者进行了深入访谈。采用主题网络分析法对数据进行分析。
结果
安全男性包皮环切术的决策主要受性伴侣、降低艾滋病毒/性传播感染风险的感知需求、社区压力以及卫生等其他益处的影响。性伴侣直接要求男性进行包皮环切术或以各种方式间接影响他们。医疗机构的健康教育主要集中在手术过程、包皮环切术的益处，尤其是降低艾滋病毒风险、伤口护理和恢复性生活的时间，而对包皮环切术后性行为的关注较少。五名男性表示没有接受健康教育。所有男性都报告说包皮环切术只能降低而不能消除艾滋病毒风险，并且能够提及它的保护方式，尽管有些人将其益处扩展到对女性的直接保护和预防其他性传播感染。五名男性认为社会营销信息“具有误导性”，并担心社区内的风险补偿。
结论
参与者报告称社区对安全男性包皮环切术运动持积极看法，这影响男性寻求服务，并使女性伴侣能够影响这一决策过程。然而，安全男性包皮环切术健康教育似乎存在差距，尽管所有参与者都正确理解包皮环切术只能提供部分艾滋病毒防护。在提供安全男性包皮环切术的医疗机构遵循标准的健康教育程序，将确保所有受术者充分了解情况，特别是关于包皮环切术后性行为，这是预防风险补偿的关键。
Zotero 插件