Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Clin Infect Dis. 2018 Apr 3;66(suppl_3):S198-S204. doi: 10.1093/cid/cix1036.
The majority of individuals who seek voluntary medical male circumcision (VMMC) services in sub-Saharan Africa are adolescents (ages 10-19 years). However, adolescents who obtain VMMC services report receiving little information on human immunodeficiency virus (HIV) prevention and care. In this study, we assessed the perceptions of VMMC facility managers and providers about current training content and their perspectives on age-appropriate adolescent counseling.
Semistructured in-depth interviews were conducted with 33 VMMC providers in Tanzania (n = 12), South Africa (n = 9), and Zimbabwe (n = 12) and with 4 key informant facility managers in each country (total 12). Two coders independently coded the data thematically using a 2-step process and Atlas.ti qualitative coding software.
Providers and facility managers discussed limitations with current VMMC training, noting the need for adolescent-specific guidelines and counseling skills. Providers expressed hesitation in communicating complete sexual health information-including HIV testing, HIV prevention, proper condom usage, the importance of knowing a partner's HIV status, and abstinence from sex or masturbation during wound healing-with younger males (aged <15 years) and/or those assumed to be sexually inexperienced. Many providers revealed that they did not assess adolescent clients' sexual experience and deemed sexual topics to be irrelevant or inappropriate. Providers preferred counseling younger adolescents with their parents or guardians present, typically focusing primarily on wound care and procedural information.
Lack of training for working with adolescents influences the type of information communicated. Preconceptions hinder counseling that supports comprehensive HIV preventive behaviors and complete wound care information, particularly for younger adolescents.
在撒哈拉以南非洲，大多数寻求自愿男性包皮环切术（VMMC）服务的人是青少年（10-19 岁）。然而，接受 VMMC 服务的青少年报告说，他们很少收到有关艾滋病毒（HIV）预防和护理的信息。在这项研究中，我们评估了 VMMC 设施经理和提供者对当前培训内容的看法，以及他们对适合青少年的咨询的看法。
在坦桑尼亚（n=12）、南非（n=9）和津巴布韦（n=12）对 33 名 VMMC 提供者进行了半结构式深入访谈，并对每个国家的 4 名关键信息提供者进行了访谈（共 12 名）。两名编目员使用两步法和 Atlas.ti 定性编目软件，独立对数据进行主题编码。
提供者和设施管理人员讨论了当前 VMMC 培训的局限性，指出需要青少年专用指南和咨询技能。提供者表示在与年龄较小的男性（<15 岁）和/或那些被认为没有性经验的男性沟通完整的性健康信息（包括 HIV 检测、HIV 预防、正确使用避孕套、了解伴侣 HIV 状况的重要性以及在伤口愈合期间禁欲或自慰）时犹豫不决。许多提供者表示，他们没有评估青少年客户的性经验，并认为性话题无关或不适当。提供者更喜欢在青少年父母或监护人在场的情况下对年龄较小的青少年进行咨询，通常主要关注伤口护理和程序信息。
缺乏与青少年合作的培训会影响沟通的信息类型。成见阻碍了支持全面预防 HIV 行为和完整伤口护理信息的咨询，尤其是对年龄较小的青少年。
