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障碍、益处与行为:赞比亚男性人群中基于人群样本的自愿男性割礼观念。

Barriers, benefits, and behaviour: Voluntary medical male circumcision ideation in a population-based sample of Zambian men.

机构信息

Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.

Office of Family Planning and Reproductive Health, United States Agency for International Development, Washington DC, USA.

出版信息

Afr J AIDS Res. 2021 Dec;20(4):314-323. doi: 10.2989/16085906.2021.2006727.


DOI:10.2989/16085906.2021.2006727
PMID:34905454
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8994851/
Abstract

Reaching ambitious voluntary medical male circumcision (VMMC) coverage targets requires a deeper understanding of the multifaceted processes shaping men's willingness to access VMMC. Guided by the Ideation Model for Health Communication, this population-based study identifies correlates of Zambian men's future VMMC intentions. Multistage cluster sampling was used to identify households with adult men in 14 districts. Multivariable Poisson regression with robust standard errors modelled associations of future VMMC intent with ideational factors (e.g. perceived benefits and barriers) and sexual behaviours respectively. Forty per cent (40%) of uncircumcised men ( = 1 204) expressed future VMMC intentions. In multivariable analysis, VMMC intent was associated with secondary education or higher (Adjusted Prevalence Ratio [APR] 1.30, 95% Confidence Interval [95% CI]: 1.02-1.66), perceiving VMMC to increase sexual satisfaction (APR 1.45, 95% CI: 1.11-1.89), reporting distance to services as a barrier to VMMC uptake (APR = 0.54, 95% CI: 1.27-1.87), unprotected last sex (APR 1.54, 95% CI: 1.11-2.14), and ≥ 2 sexual partners in the past 12 months (APR 1.45, 95% CI: 1.05-1.99). Being aged ≥ 45 years (vs 18-24 years: APR 0.23, 95% CI: 0.13-0.40) and perceiving that circumcision: (1) is unimportant (APR 0.71, 95% CI: 0.51-0.98); (2) is incompatible with local customs (APR 0.41, 95% CI: 0.18-0.94); or (3) reduces sexual satisfaction (APR 0.10, 95% CI: 0.02-0.62) were inversely associated with future VMMC intent. Demand-creation efforts must confront salient cognitive and social barriers to VMMC uptake, including concerns around incompatibility with local customs. Simultaneously, promotional efforts should emphasise relevant VMMC benefits beyond HIV prevention that resonate with men (e.g. penile hygiene) without reinforcing harmful gender norms.

摘要

为了实现雄心勃勃的自愿男性包皮环切(VMMC)覆盖目标,我们需要更深入地了解影响男性接受 VMMC 的各种因素。本研究以健康传播理念模型为指导,旨在确定赞比亚男性未来 VMMC 意愿的相关因素。采用多阶段聚类抽样方法,在 14 个区识别出有成年男性的家庭。采用多变量泊松回归模型,使用稳健标准差分别对未来 VMMC 意愿与观念因素(如感知益处和障碍)和性行为进行关联分析。40%(40%)的未割礼男性(n=1204)表示未来有 VMMC 意愿。在多变量分析中,VMMC 意愿与中学或以上教育程度(调整后流行率比[APR]1.30,95%置信区间[95%CI]:1.02-1.66)、认为 VMMC 可以增加性满意度(APR 1.45,95%CI:1.11-1.89)、报告服务距离是 VMMC 采用的障碍(APR=0.54,95%CI:1.27-1.87)、最近一次性行为无保护(APR 1.54,95%CI:1.11-2.14)和过去 12 个月内有≥2 个性伴侣(APR 1.45,95%CI:1.05-1.99)有关。年龄≥45 岁(vs.18-24 岁:APR 0.23,95%CI:0.13-0.40)和认为包皮环切:(1)不重要(APR 0.71,95%CI:0.51-0.98);(2)与当地习俗不兼容(APR 0.41,95%CI:0.18-0.94);或(3)降低性满意度(APR 0.10,95%CI:0.02-0.62)与未来 VMMC 意愿呈负相关。需求创造工作必须应对 VMMC 采用的明显认知和社会障碍,包括对与当地习俗不兼容的担忧。同时,宣传工作应强调 VMMC 除了预防 HIV 之外的相关益处,这些益处与男性相关(例如阴茎卫生),而不会强化有害的性别规范。

相似文献

[1]
Barriers, benefits, and behaviour: Voluntary medical male circumcision ideation in a population-based sample of Zambian men.

Afr J AIDS Res. 2021-12

[2]
Age Differences in Perceptions of and Motivations for Voluntary Medical Male Circumcision Among Adolescents in South Africa, Tanzania, and Zimbabwe.

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[3]
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[4]
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[5]
Impact of Counseling Received by Adolescents Undergoing Voluntary Medical Male Circumcision on Knowledge and Sexual Intentions.

Clin Infect Dis. 2018-4-3

[6]
Evidence that promotion of male circumcision did not lead to sexual risk compensation in prioritized Sub-Saharan countries.

PLoS One. 2017-4-25

[7]
Women's support for voluntary medical male circumcision in fishing communities on the shores of Lake Victoria, Uganda.

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[8]
Barriers and facilitators to the uptake of voluntary medical male circumcision (VMMC) among adolescent boys in KwaZulu-Natal, South Africa.

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[9]
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[10]
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引用本文的文献

[1]
Exploring joint decision-making and family dynamics to identify barriers and enablers for early adolescent medical circumcision (EAMC) uptake in Zambia for HIV prevention: An innovative methodology.

PLoS One. 2025-4-29

[2]
Deficits and opportunities, pivots and shifts for scaling-up voluntary medical male circumcision in Uganda: a qualitative reflexive thematic analysis study.

BMC Public Health. 2024-8-16

[3]
Male circumcision uptake and misperceived norms about male circumcision: Cross-sectional, population-based study in rural Uganda.

J Glob Health. 2023-12-20

[4]
Effectiveness of an intervention to increase uptake of voluntary medical male circumcision among men with sexually transmitted infections in Malawi: a preinterventional and postinterventional study.

BMJ Open. 2023-10-3

[5]
The impact of community-based, peer-led sexual and reproductive health services on knowledge of HIV status among adolescents and young people aged 15 to 24 in Lusaka, Zambia: The Yathu Yathu cluster-randomised trial.

PLoS Med. 2023-4

[6]
Factors Beyond Compensation Associated with Uptake of Voluntary Medical Male Circumcision in Zambia.

AIDS Behav. 2023-6

[7]
Community Mobilization is Associated with HIV Testing Behaviors and Their Psychosocial Antecedents Among Zambian Adults: Results from a Population-Based Study.

AIDS Behav. 2023-5

[8]
Communicative appeals and messaging frames in visual media for HIV pre-exposure prophylaxis promotion to cisgender and transgender women.

Cult Health Sex. 2023-8

本文引用的文献

[1]
Impact of male circumcision on risk of HIV infection in men in a changing epidemic context - systematic review and meta-analysis.

J Int AIDS Soc. 2020-6

[2]
Promoting male circumcision as HIV prevention in sub-Saharan Africa: An evaluation of the ethical and pragmatic considerations of adopting a demand creation approach.

Glob Public Health. 2020-9

[3]
Voluntary medical male circumcision and sexual practices among sexually active circumcised men in Mzuzu, Malawi: a cross-sectional study.

BMC Public Health. 2020-2-11

[4]
Economic compensation interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review and meta-analysis.

PLoS One. 2020-1-15

[5]
Service delivery interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review.

PLoS One. 2020-1-13

[6]
Masculine gender norms, male circumcision, and men's engagement with health care in the Dominican Republic.

Glob Public Health. 2020-5

[7]
Circumcision to prevent HIV and other sexually transmitted infections in men who have sex with men: a systematic review and meta-analysis of global data.

Lancet Glob Health. 2019-4

[8]
"To speak or not to speak": A qualitative analysis on the attitude and willingness of women to start conversations about voluntary medical male circumcision with their partners in a peri-urban area, South Africa.

PLoS One. 2019-1-25

[9]
Knowledge on voluntary medical male circumcision in a low uptake setting in northern Uganda.

BMC Public Health. 2018-11-20

[10]
Exploring the roots of antagony in the safe male circumcision partnership in Botswana.

PLoS One. 2018-9-20

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