RESUMEN
Voluntary medical male circumcision (VMMC) is a global strategy for reducing female-to-male sexual transmission of HIV. Women whose partners are circumcised benefit from a reduced risk of contracting other sexually transmitted diseases; making their role in VMMC critical. The objective of our study was to identify and synthesize existing evidence related to women's role in promoting VMMC from a regional perspective. The review and selection process were guided by the Problem; Intervention; Comparison and Outcome (PICO) model, which facilitated the exclusion of irrelevant studies. The search strategy search terms for the PICO components with synonyms, related terms and specialist terms were harvested from the Medical Subject Headings (MeSH)© and Embase©. The inclusion criteria were published studies in English and relevant to women's role in VMMC for the prevention of HIV between 2007 and 2020. Four key categories emerged from the literature as follows: role of women, VMMC uptake, barriers and facilitators of VMMC. The majority of the studies concur on the importance of involving women in VMMC uptake as they have the power to negotiate with their male partners through communication and can persuade men to be circumcised, making it a joint decision. The benefits of VMMC in improving sexual pleasure and attractiveness of the penis seemed to positively convince women to influence and educate men to improve the uptake of VMMC. Women are motivated to convince men to undergo male circumcision (MC) because of the benefits associated with them such as reduction of HIV transmission and cervical cancer. There are, however, limited studies focusing on women's involvement in VMMC; hence, more research to explore this area is recommended.
Asunto(s)
Humanos , Femenino , Apoyo Social , Infecciones por VIH , Educación en Salud , Circuncisión Masculina , Transmisión de Enfermedad Infecciosa , Rol de GéneroRESUMEN
Background: Safe Male Circumcision (SMC)[1] has been widely recommended by WHO as part of a comprehensive HIV prevention strategy. However, literature pertaining to SMC amongst adolescents with a disability, and the deaf community in particular, is almost non-existent. This study sought to establish SMC prevalence, knowledge, attitude and post circumcision behaviour among adolescents with deafness in Uganda.Methods: The study was cross-sectional, used a mixed-methods approach and recruited 447 participants. 363 questionnaires were administered to adolescents of age 15 - 24 years (192 males and 171 females) from three study sites. We assessed socio-demographic variables, circumcision status, post circumcision behaviour, attitude and knowledge levels towards SMC. Qualitative data was also collected from 84 participants (m=46, f=38) using focus group discussions and key informant interviews. Quantitative data were analysed using Stata software while qualitative was thematically analysed.Results: A total of 60.9% male adolescents with deafness self-reported to be circumcised. Both male and female participants reported SMC information to be highly inaccessible (84%). Only 27.8% study participants knew about the partial protective effect of SMC against HIV, 51.8% were uncertain, while 26% thought that SMC provided full protection. Both male and female respondents had a positive attitude towards SMC (68.3%) and females were more knowledgeable (50.3%) about the partial preventive effect of SMC against HIV transmission and timeframe for the resumption of sexual activity compared to males (30.2%). Linkages were noted between SMC, social networks and key sociodemographic characteristics like ethnicity, religion and education level.Conclusion: Despite a 60.9% prevalence and general positive attitude towards SMC, study findings showed limited service access and substantial knowledge gaps in SMC efficacy, also related to high-risk behaviour after circumcision. This can largely be explained by limited targeting by HIV prevention programmes among this (deaf) category of adolescents, related barriers associated with vulnerability arising from their disability (deafness) and developmental stage (adolescence). Key actors in HIV prevention efforts should demonstrate cognizance of heightened risk among vulnerable adolescent categories through more inclusive interventions to address prevailing knowledge and service gaps. [1] This study was conducted between 2015-2016 when the commonly used term was Safe Male Circumcision (SMC) and not Voluntary Medical Male Circumcision (VMMC) as its popularly being packaged now. This manuscript has stuck to the originally used SMC acronym.
RESUMEN
To assess safety of the no-flip ShangRing male circumcision technique and to determine clinical course and safety of spontaneous detachment (i.e., allowing the device to fall off), we conducted a case series of no-flip ShangRing circumcision combined with a randomized controlled trial of removal 7 days postcircumcision versus spontaneous detachment at two health facilities in Kenya. The primary outcome was the safety of the no-flip technique based on moderate and severe adverse events (AEs) during the procedure and through 42-day follow-up. A main secondary outcome was clinical course and safety of spontaneous detachment. Two hundred and thirty males 10 years and older underwent no-flip circumcision; 114 randomized to 7-day removal and 116 to spontaneous detachment. All circumcisions were successfully completed. Overall 5.3% (6/114) of participants in the 7-day group and 1.7% (2/116) in the spontaneous group had an AE; with no differences when compared to the 3% AE rate in historical data from African studies using the original flip technique (P = 0.07 and P = 0.79, respectively). Overall 72.4% (84/116) of participants in the spontaneous group wore the ShangRing until it detached. Among the remaining (27.6%; 32/116), the ring was removed, primarily at the participants' request, due to pain or discomfort. There was no difference in AE rates (P = 0.169), visit day declared healed (P = 0.324), or satisfaction (P = 0.371) between randomization groups. The median time to detachment was 14.0 (IQR: 7-21, range: 5-35) days. The no-flip technique and spontaneous detachment are safe, effective, and acceptable to boys and men 10 years and older. Phimosis and penile adhesions do not limit successful ShangRing circumcision with the no-flip technique.
RESUMEN
To assess safety of the no-flip ShangRing male circumcision technique and to determine clinical course and safety of spontaneous detachment (i.e., allowing the device to fall off), we conducted a case series of no-flip ShangRing circumcision combined with a randomized controlled trial of removal 7 days postcircumcision versus spontaneous detachment at two health facilities in Kenya. The primary outcome was the safety of the no-flip technique based on moderate and severe adverse events (AEs) during the procedure and through 42-day follow-up. A main secondary outcome was clinical course and safety of spontaneous detachment. Two hundred and thirty males 10 years and older underwent no-flip circumcision; 114 randomized to 7-day removal and 116 to spontaneous detachment. All circumcisions were successfully completed. Overall 5.3% (6/114) of participants in the 7-day group and 1.7% (2/116) in the spontaneous group had an AE; with no differences when compared to the 3% AE rate in historical data from African studies using the original flip technique (P = 0.07 and P = 0.79, respectively). Overall 72.4% (84/116) of participants in the spontaneous group wore the ShangRing until it detached. Among the remaining (27.6%; 32/116), the ring was removed, primarily at the participants' request, due to pain or discomfort. There was no difference in AE rates (P = 0.169), visit day declared healed (P = 0.324), or satisfaction (P = 0.371) between randomization groups. The median time to detachment was 14.0 (IQR: 7-21, range: 5-35) days. The no-flip technique and spontaneous detachment are safe, effective, and acceptable to boys and men 10 years and older. Phimosis and penile adhesions do not limit successful ShangRing circumcision with the no-flip technique.