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.
Afr J AIDS Res. 2021 Dec;20(4):314-323. doi: 10.2989/16085906.2021.2006727.
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.
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。
BMC Health Serv Res. 2022-4-14
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