Barriers and Facilitators to the Uptake of Voluntary Medical Male Circumcision (VMMC) among Adolescent Boys in KwaZulu-Natal; South Africa

Epidemiological modelling has concluded that if voluntary medical male circumcision (VMMC) is scaled up in high HIV prevalence settings it would lead to a significant reduction in HIV incidence rates. Following the adoption of this evidence by the WHO; South Africa has embarked on an ambitious VMMC programme. However; South Africa still falls short of meeting VMMC targets; particularly in KwaZulu-Natal; the epicentre of the HIV/AIDS epidemic. A qualitative study was conducted in a high HIV prevalence district in KwaZulu-Natal to identify barriers and facilitators to the uptake of VMMC amongst adolescent boys. Focus group discussions with both circumcised and uncircumcised boys were conducted in 2012 and 2013. Analysis of the data was done using the framework approach and was guided by the Social Cognitive Theory focussing on both individual and interpersonal factors influencing VMMC uptake. Individual cognitive factors facilitating uptake included the belief that VMMC reduced the risk of HIV infection; led to better hygiene and improvement in sexual desirability and performance. Cognitive barriers related to the fear of HIV testing (and the subsequent result and stigmas); which preceded VMMC. Further barriers related to the pain associated with the procedure and adverse events. The need to abstain from sex during the six-week healing period was a further prohibiting factor for boys. Timing was crucial; as boys were reluctant to get circumcised when involved in sporting activities and during exam periods. Targeting adolescents for VMMC is successful when coupled with the correct messaging. Service providers need to take heed that demand creation activities need to focus on the benefits of VMMC for HIV risk reduction; as well as other non-HIV benefits. Timing of VMMC interventions needs to be considered when targeting school-going boys

The Influence of Biological Factors on Students' Sexual Behaviour at the University of KwaZulu-Natal; South Africa

Studies in South African universities reveal that the prevalence of sexual risk behaviour is very high; putting many students at high risk of HIV infection. This study explored the biological influences on students' sexual taking behaviour at the University of KwaZulu-Natal; South Africa. A qualitative approach was used; comprising a total of 80 in-depth interviews and 4 focus group discussions. These were conducted between late 2008 and early 2010. The research had equal representation of male and female students; different races; two campuses and different levels of study. Factors associated with students' sexual behaviour were identified. The data were analysed using thematic analysis; and the themes identified form the basis for discussion in this paper. Students' sexual behaviour was positively associated with the influence of a range of biological factors. Factors such as age; judgement of the health of the partner by looking at appearances; pursuit of physical beauty; sexual debut; sexual fit; and search for sexual pleasure encouraged students to engage in sexual behaviour. Most students are young and lack experience in assessing the influence of biological factors on their sexual behaviours; and need education on biological factors. This poses a big challenge to controlling students' sexual behaviour; especially if HIV and sexually transmitted diseases prevention interventions are to be successful

Applying a social-ecological lens to opinions about HIV self-testing among Kenyan truckers who declined to test: a qualitative study

HIV prevalence among truckers in Africa is high and testing rates suboptimal. With numerous African countries having approved HIV self-testing kits, more information on how to design acceptable and accessible self-testing programs for high-risk populations is necessary. We explored views about self-testing via in-depth interviews with 24 truckers participating in a randomised controlled trial who refused HIV testing. A social-ecological lens was used to guide data analysis and frame study findings. While most participants said that they would use an HIV self-test, perceived barriers and facilitators were identified at multiple levels. Many participants noted lack of time to test or obtain a self-test kit as a major barrier (intrapersonal) and varied in their views about self-testing with a partner (interpersonal). Participants offered programmatic/policy recommendations, suggesting that they preferred accessing self-test kits in settings where training could be provided. Participants believed they should be able to pick up multiple test kits at the same time and that the test kits should be free or low cost. These study findings will help guide the design of self-testing programs for truckers and other mobile populations