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AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/caic20
Male circumcision for HIV prevention in India: emerging viewpoints and practices of health care providers a
a
b
c
d
Anju Sinha , Nomita Chandhiok , Seema Sahay , Sibnath Deb , Shalini Bharat , Abhilasha e
f
b
b
b
Gupta , Sripad Bhatt , Vidisha Kanthe , Bijesh Kumar , Neelam Joglekar , Ramesh b
Paranjape & Sanjay Mehendale
Click for updates
g
a
Indian Council of Medical Research, New Delhi, India
b
National AIDS Research Institute, Pune, India
c
Pondicherry University, Puducherry, India
d
Tata Institute of Social Sciences, Mumbai, India
e
LLRM Medical College, Meerut, India
f
Regional Medical Research Institute, Belgaum, India
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National Institute of Epidemiology, Chennai, India Published online: 22 May 2015.
To cite this article: Anju Sinha, Nomita Chandhiok, Seema Sahay, Sibnath Deb, Shalini Bharat, Abhilasha Gupta, Sripad Bhatt, Vidisha Kanthe, Bijesh Kumar, Neelam Joglekar, Ramesh Paranjape & Sanjay Mehendale (2015): Male circumcision for HIV prevention in India: emerging viewpoints and practices of health care providers, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, DOI: 10.1080/09540121.2015.1039957 To link to this article: http://dx.doi.org/10.1080/09540121.2015.1039957
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
AIDS Care, 2015 http://dx.doi.org/10.1080/09540121.2015.1039957
Male circumcision for HIV prevention in India: emerging viewpoints and practices of health care providers Anju Sinhaa*, Nomita Chandhioka, Seema Sahayb, Sibnath Debc, Shalini Bharatd, Abhilasha Guptae, Sripad Bhattf, Vidisha Kantheb, Bijesh Kumarb, Neelam Joglekarb, Ramesh Paranjapeb and Sanjay Mehendaleg a
Indian Council of Medical Research, New Delhi, India; bNational AIDS Research Institute, Pune, India; cPondicherry University, Puducherry, India; dTata Institute of Social Sciences, Mumbai, India; eLLRM Medical College, Meerut, India; fRegional Medical Research Institute, Belgaum, India; gNational Institute of Epidemiology, Chennai, India
Downloaded by [New York University] at 08:18 26 May 2015
(Received 21 August 2014; accepted 6 April 2015) A compelling case for promoting male circumcision (MC) as an intervention for reducing the risk of heterosexually acquired HIV infection was made by dissemination of the results of three studies in Africa. The WHO/UNAIDS recommendation for MC for countries like India, where the epidemic in concentrated in high-risk groups, advocates MC for specific population groups such as men at higher risk for HIV acquisition. A multicentre qualitative study was conducted in four geographically distinct districts (Belgaum, Kolkata, Meerut and Mumbai) in India during June 2009 to June 2011. Two categories of health care providers: Registered Healthcare Providers (RHCPs) and traditional circumcisers were interviewed by trained research staff who had received master’s level education using interview guides with probes and open-ended questions. Respondents were selected using purposive sampling. A comparative analysis of the perspectives of the RHCP vs. traditional circumcisers is presented. Representatives of both categories of providers expressed the need for Indian data on MC. Providers feared that promoting circumcision might jeopardize/ undermine the progress already made in the field of condom promotion. Reservation was expressed regarding its adoption by Hindus. Behavioural disinhibition was perceived as an important limitation. A contrast in the practice of circumcision was apparent between the traditional and the trained providers. MC should be mentioned as a part of comprehensive HIV prevention services in India that includes HIV counselling and testing, condom distribution and diagnosis and treatment of sexually transmitted infections. It should become an issue of informed personal choice rather than ethnic identity. Keywords: perspectives; health care providers; male circumcision; practices; prevention; India
Introduction The Indian HIV/AIDS control programme is making considerable progress, with an overall reduction of 57% in annual new infections among adults from 274,000 in 2000 to 116,000 in 2011(National AIDS Control Organization, 2013). A compelling case for promoting male circumcision (MC) as an intervention was made by three African studies (Auvert et al., 2005; Bailey et al., 2007; Gray et al., 2007). The WHO/UNAIDS recommendation for MC for countries like India, with concentrated HIV epidemic, indicates benefit from the intervention (WHO/ UNAIDS, 2007). The prevalence of MC in India is
AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/caic20
Male circumcision for HIV prevention in India: emerging viewpoints and practices of health care providers a
a
b
c
d
Anju Sinha , Nomita Chandhiok , Seema Sahay , Sibnath Deb , Shalini Bharat , Abhilasha e
f
b
b
b
Gupta , Sripad Bhatt , Vidisha Kanthe , Bijesh Kumar , Neelam Joglekar , Ramesh b
Paranjape & Sanjay Mehendale
Click for updates
g
a
Indian Council of Medical Research, New Delhi, India
b
National AIDS Research Institute, Pune, India
c
Pondicherry University, Puducherry, India
d
Tata Institute of Social Sciences, Mumbai, India
e
LLRM Medical College, Meerut, India
f
Regional Medical Research Institute, Belgaum, India
g
National Institute of Epidemiology, Chennai, India Published online: 22 May 2015.
To cite this article: Anju Sinha, Nomita Chandhiok, Seema Sahay, Sibnath Deb, Shalini Bharat, Abhilasha Gupta, Sripad Bhatt, Vidisha Kanthe, Bijesh Kumar, Neelam Joglekar, Ramesh Paranjape & Sanjay Mehendale (2015): Male circumcision for HIV prevention in India: emerging viewpoints and practices of health care providers, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, DOI: 10.1080/09540121.2015.1039957 To link to this article: http://dx.doi.org/10.1080/09540121.2015.1039957
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
AIDS Care, 2015 http://dx.doi.org/10.1080/09540121.2015.1039957
Male circumcision for HIV prevention in India: emerging viewpoints and practices of health care providers Anju Sinhaa*, Nomita Chandhioka, Seema Sahayb, Sibnath Debc, Shalini Bharatd, Abhilasha Guptae, Sripad Bhattf, Vidisha Kantheb, Bijesh Kumarb, Neelam Joglekarb, Ramesh Paranjapeb and Sanjay Mehendaleg a
Indian Council of Medical Research, New Delhi, India; bNational AIDS Research Institute, Pune, India; cPondicherry University, Puducherry, India; dTata Institute of Social Sciences, Mumbai, India; eLLRM Medical College, Meerut, India; fRegional Medical Research Institute, Belgaum, India; gNational Institute of Epidemiology, Chennai, India
Downloaded by [New York University] at 08:18 26 May 2015
(Received 21 August 2014; accepted 6 April 2015) A compelling case for promoting male circumcision (MC) as an intervention for reducing the risk of heterosexually acquired HIV infection was made by dissemination of the results of three studies in Africa. The WHO/UNAIDS recommendation for MC for countries like India, where the epidemic in concentrated in high-risk groups, advocates MC for specific population groups such as men at higher risk for HIV acquisition. A multicentre qualitative study was conducted in four geographically distinct districts (Belgaum, Kolkata, Meerut and Mumbai) in India during June 2009 to June 2011. Two categories of health care providers: Registered Healthcare Providers (RHCPs) and traditional circumcisers were interviewed by trained research staff who had received master’s level education using interview guides with probes and open-ended questions. Respondents were selected using purposive sampling. A comparative analysis of the perspectives of the RHCP vs. traditional circumcisers is presented. Representatives of both categories of providers expressed the need for Indian data on MC. Providers feared that promoting circumcision might jeopardize/ undermine the progress already made in the field of condom promotion. Reservation was expressed regarding its adoption by Hindus. Behavioural disinhibition was perceived as an important limitation. A contrast in the practice of circumcision was apparent between the traditional and the trained providers. MC should be mentioned as a part of comprehensive HIV prevention services in India that includes HIV counselling and testing, condom distribution and diagnosis and treatment of sexually transmitted infections. It should become an issue of informed personal choice rather than ethnic identity. Keywords: perspectives; health care providers; male circumcision; practices; prevention; India
Introduction The Indian HIV/AIDS control programme is making considerable progress, with an overall reduction of 57% in annual new infections among adults from 274,000 in 2000 to 116,000 in 2011(National AIDS Control Organization, 2013). A compelling case for promoting male circumcision (MC) as an intervention was made by three African studies (Auvert et al., 2005; Bailey et al., 2007; Gray et al., 2007). The WHO/UNAIDS recommendation for MC for countries like India, with concentrated HIV epidemic, indicates benefit from the intervention (WHO/ UNAIDS, 2007). The prevalence of MC in India is
