Reasons for the low uptake of adult male circumcision for the prevention of HIV transmission in Swaziland

Swaziland is currently experiencing the worst impact of HIV and AIDS of any country in the world. In an effort to curb further spread of the virus; the country adopted mass male circumcision (MC) as recommended by the World Health Organization in 2007. Despite intense campaigns to promote the procedure over the past three years; the uptake of circumcision remains very low for reasons that are not very clear. The purpose of this study was to explore the reasons for the low uptake of MC in Swaziland despite the massive national MC campaigns. A qualitative research design was used; in which all men who were targeted by the mass MC campaign were eligible. Participants were identified as they came for sexual and reproductive health services at the Family Life Association of Swaziland (FLAS) Clinic; Mbabane. In-depth; individual face-to-face unstructured interviews were conducted to elicit the reasons why men were not going for circumcision. A total of 17 men were interviewed. Results showed that these reasons include fear of the procedure and the possible outcome; perception of no significant benefit of the procedure; impatience about waiting for the procedure or the healing process; religious/cultural beliefs; and worries about the fate of the foreskin. These reasons were attributed to misconceptions and lack of accurate and specific information about some aspects of the circumcision strategy of HIV preventions. Physiological changes and economic activities associated with adulthood were also found to be hindrances to MC uptake. The study recommended that a comprehensive description of the procedure and more precise facts and scientific bases of the MC strategy be incorporated and emphasised in the MC campaigns. Involvement of religious leaders will also facilitate clarification of religious or cultural misunderstandings or misconceptions. A focus on neonatal MC would also help

Factors infuencing the use of voluntary counselling and testing by university students

The study explored the factors influencing the use of voluntary counselling and testing (VCT) by university students. This was done by undertaking an exploratory and descriptive qualitative study. Data were collected using focus group discussions (FGDs) and field notes. Thematic analysis was done. The study revealed several factors and challenges regarding the uptake of VCT services by university students. Among the factors are: knowing one's HIV status; illness; pregnancy; blood donation; getting a reward; influence of significant others; media; awareness campaigns; compulsion; getting a job; curiosity; being positive role model; and the attitude of the health care provider. And among the challenges these include: HIV/AIDS-related stigma and discrimination; fear; low perception of risk to HIV infection; lack of student friendly VCT services; shortage of resources; inaccessibility of VCT services; long waiting period for test results; negative perceptions about VCT; pre-test counselling and ignorance