A culture-congruent male-circumcision model for HIV-infection prevention

Abstract

Research studies have revealed that male circumcision (MC) reduces the transmission of HIV infection from infected women to circumcised men by up to 60% (UNAIDS 2007:2), hence the adoption of MC as an HIV-infection prevention strategy by the United Nations (WHO 2007:2). Botswana, a sub-Saharan African (SSA) country, has HIV as a leading health and developmental challenge. The government adopted male circumcision as one of the strategies to combat the infection. Apparently, not all tribes in Botswana practise male circumcision as part of their culture. The purpose of this study was to develop and describe a model for HIV-infection prevention using MC. Three theory-generating research objectives were used to develop the model, namely to explore and describe perceptions of men regarding the use of MC, to develop and describe a model for MC service delivery, and to develop and describe guidelines for service providers to facilitate delivery of MC. A theory-generating research design which is qualitative, exploratory, descriptive, and contextual was used to develop the model in three phases.

Phase 1 involved concept identification, concept definition, and concept classification. Data was collected using focus group discussions and individual in-depth interviews among 38 men aged 18-49 years and analysed according to recommendations made by Tesch (1990), as cited in Creswell (2009:186). Four themes emerged in the study, namely perceived effects on values, perceived source and provision of information, perceived knowledge of benefits of male circumcision, and perceived risks of male circumcision. The concept of “culture congruence” was derived from the themes as the main concept for the development of a “culture-congruent MC model for HIV prevention”.

Phase 2 involved a description of the structure and the process of the model, by organising the concepts in relation to one another. The model was also evaluated.

Phase 3 of the model involved the development of guidelines to support health service providers to provide MC services in a culture-congruent way in preventing HIV infection.

Recommendations made were incorporation of transcultural health care instruction in nursing and medicine curricula, research on secondary audiences, such as women, and application of a culture-congruent MC model among diverse cultures.