Page 192 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 2 of 6 Original Research

Background immigrants from eastern and southern Africa now residing
in Leeds (UK) with regard to the role of MC or MMC as an
HIV is a major health challenge, especially in sub-Saharan HIV prevention strategy.
Africa. In 2013, more than 35 million people worldwide
2
7
were infected and 1.5 million died of HIV and AIDS. Male Materials and methods
circumcision (MC), which is the surgical removal of the
foreskin of the penis, supplements less effective strategies Study population and setting
such as abstinence, faithfulness to a partner and the A cross-sectional qualitative research approach was used for
consistent use of condoms as a means to prevent infection. 8,9,10 the evaluation of the knowledge and perceptions of male
East and southern African countries have implemented immigrants living in Leeds, the UK, and originally from
MMC as a primary prevention strategy. The widespread southern and eastern Africa. All eligible participants had
introduction of MMC followed compelling evidence of the lived in the UK for more than 2 years and had a reasonable
reduction of HIV acquisition in circumcised, uninfected and command of the English language. The study focused on
exposed men of ≥ 40%. 11 participants from this part of Africa because of the high
prevalence of HIV infection in their region of origin. 2,20
The biological plausibility and efficacy of the procedure
arises from the fact that the penile foreskin contains many Tools for data collection
CD4 receptor-bearing Langerhans cells and lymphocytes.
These cells permit viral (HIV) invasion. In addition to the Data were gathered using semi-structured interview guides.
12
removal of vulnerable tissue, circumcision assists in The responses were audio recorded, although participants
increasing the thickness (keratinisation) of residual skin, had been offered the option of having their responses hand
13
thereby reducing penile abrasions during intercourse. written in case they felt uncomfortable with recording. Each
Circumcision may reduce the incidence of genital ulcer interview took approximately 45–60 min.
disease and in this way also ‘protect’ from HIV infection. 14
Data collection
In order for rates of MC or MCC to increase, society and the Participants were purposively selected using a snowball
individual’s perceptions must be better understood. Indeed, recruitment method. Data were collected through face-to-
15
without perception, action, according to Gibson, is face researcher-guided in-depth interviews. During the
misguided and serves no purpose. The promotion of preliminary stage, an eligible person was identified. The
16
successful health strategies, for example MC and MMC, must subject was invited to participate in the study and given
influence people’s perceptions. 17
the Participant Information Sheet to read before consenting
to participate. He was then contacted and invited to an
Although the number of people diagnosed with HIV annually interview. After the interview, this person was asked if he
in the UK has been low, namely 5000 in 2001, the number of knew any potential participants from the region of Africa
those living with HIV is increasing and by the end of 2011 under study and was requested to pass on details to the
was estimated to be 96 000. Disease is not restricted to a researcher. This referral process was applied until the
1,11
geographical region or a specific population group. To reduce sample size was reached. To allow for response diversity,
or eradicate HIV from the UK, prevention strategies must participants from different age groups and nationalities
focus on the needs of key and vulnerable populations such as were contacted. The questions required the participants to
immigrants. Given the political and economic instability of define circumcision, any benefits and cultural views in
countries in Africa, the number of those seeking asylum in support of or against MC or MMC. The research questions
the UK is likely to grow. were formulated based on the study objectives, and each
interview was allocated approximately 45–60 min. Data
The World Health Organization (WHO) has identified were collected in 2 months.
14 countries in east and southern Africa with generalised
HIV epidemics and with low prevalence rates of MC. These
countries have been targeted for the scale-up of MMC Data management
programmes. In the UK, circumcision of British men is on Data were analysed using a thematic content analysis. In
1
the decline and currently stands at 15.8% of 16–44-year olds. brief, transcripts were read and re-read several times. Initial
Rates vary: high among Jewish men (98.7%), and lower codes were identified, noting repeated issues. Each code
among Hindus, Sikhs and Buddhists (9.8%). The overall was checked against the raw data, and emerging ones were
18
low rate of circumcision in the UK likely follows on directives developed into categories. The categories were grouped
from the National Health System (NHS) that recommends together into overarching themes, based on the
circumcision only if medically indicated. 19 understanding of the data. Appropriate themes were
generated and recorded. When checking the raw
The role of negative perception and its contribution to low information, a description was provided that summarised
circumcision rates is unknown. This study sought to better the theme. These transcripts were analysed manually and
understand the knowledge base and perceptions of male checked for consistency.

http://www.sajhivmed.org.za 185 Open Access