Noah Taruberekera

Barriers and Motivators to Voluntary Medical Male Circumcision Uptake among Different Age Groups of Men in Zimbabwe: Results from a Mixed Methods Study

Background We conducted quantitative and qualitative studies to explore barriers and motivating factors to VMMC for HIV prevention, and to assess utilization of existing VMMC communication channels. Methods and Findings A population-based survey was conducted with 2350 respondents aged 15–49. Analysis consisted of descriptive statistics and bivariate analysis between circumcision and selected demographics. Logistic regression was used to determine predictors of male circumcision uptake compared to intention to circumcise. Focus group discussions (FGDs) were held with men purposively selected to represent a range of ethnicities. 68% and 53% of female/male respondents, respectively, had heard about VMMC for HIV prevention, mostly through the radio (71%). Among male respondents, 11.3% reported being circumcised and 49% reported willingness to undergo VMMC. Factors which men reported motivated them to undergo VMMC included HIV/STI prevention (44%), improved hygiene (26%), enhanced sexual performance (6%) and cervical cancer prevention for partner (6%). Factors that deterred men from undergoing VMMC included fear of pain (40%), not believing that they were at risk of HIV (18%), lack of partner support (6%). Additionally, there were differences in motivators and barriers by age. FGDs suggested additional barriers including fear of HIV testing, partner refusal, reluctance to abstain from sex and myths and misconceptions. Conclusions VMMC demand-creation messages need to be specifically tailored for different ages and should emphasize non-HIV prevention benefits, such as improved hygiene and sexual appeal, and need to address mens fear of pain. Promoting VMMC among women is crucial as they appear to have considerable influence over mens decision to get circumcised.

Depression and Social Stigma Among MSM in Lesotho: Implications for HIV and Sexually Transmitted Infection Prevention

Social stigma is common among men who have sex with men (MSM) across Sub-Saharan Africa, and may influence risks for HIV and sexually transmitted infections (STIs) via its association with depression. We conducted a cross-sectional study of 530 MSM in Lesotho accrued via respondent-driven sampling. Using generalized structural equation models we examined associations between stigma, social capital, and depression with condom use and testing positive for HIV/STIs. Depression was positively associated with social stigma experienced or perceived as a result of being MSM. In contrast, increasing levels of social cohesion were negatively associated with depression. Social stigma was associated with testing positive for HIV; however, this association did not appear to be mediated by depression or condom use. These data suggest a need for integrated HIV and mental health care that addresses stigma and discrimination and facilitates positive social support for MSM.

Characteristics of men who have sex with men in southern Africa who seek sex online: a cross-sectional study.

Background Use of the Internet for finding sexual partners is increasing, particularly among men who have sex with men (MSM). In particular, MSM who seek sex online are an important group to target for human immunodeficiency virus (HIV)/sexually transmitted infection (STI) interventions because they tend to have elevated levels of sexual risk behavior and because the Internet itself may serve as a promising intervention delivery mechanism. However, few studies have examined the correlates of online sexual partner seeking among MSM in sub-Saharan Africa. Objective These analyses aim to describe the prevalence of using the Internet to find new male sexual partners among MSM in two southern African countries. In addition, these analyses examine the sociodemographic characteristics, experiences of discrimination and stigma, mental health and substance use characteristics, and HIV-related knowledge, attitudes, and behaviors among MSM associated with meeting sex partners online. Methods MSM were enrolled into a cross-sectional study across two sites in Lesotho (N=530), and one in Swaziland (N=322) using respondent-driven sampling. Participants completed a survey and HIV testing. Data were analyzed using bivariate and multivariable logistic regression models to determine which factors were associated with using the Internet to meet sex partners among MSM. Results The prevalence of online sex-seeking was high, with 39.4% (209/530) of MSM in Lesotho and 43.8% (141/322) of MSM in Swaziland reporting meeting a new male sexual partner online. In the multivariable analysis, younger age (adjusted odds ratio [aOR] 0.37, 95% confidence interval [CI] 0.27-0.50 per 5 years in Lesotho; aOR 0.68, 95% CI 0.49-0.93 in Swaziland), having more than a high school education (aOR 18.2, 95% CI 7.09-46.62 in Lesotho; aOR 4.23, 95% CI 2.07-8.63 in Swaziland), feeling scared to walk around in public places (aOR 1.89, 95% CI 1.00-3.56 in Lesotho; aOR 2.06, 95% CI 1.23-3.46 in Swaziland), and higher numbers of male anal sex partners within the past 12 months (aOR 1.27, 95% CI 1.01-1.59 per 5 partners in Lesotho; aOR 2.98, 95% CI 1.51-5.89 in Swaziland) were significantly associated with meeting sex partners online in both countries. Additional country-specific associations included increasing knowledge about HIV transmission, feeling afraid to seek health care services, thinking that family members gossiped, and having a prevalent HIV infection among MSM in Lesotho. Conclusions Overall, a high proportion of MSM in Lesotho and Swaziland reported meeting male sex partners online, as in other parts of the world. The information in this study can be used to tailor interventions or to suggest modes of delivery of HIV prevention messaging to these MSM, who represent a young and highly stigmatized group. These data suggest that further research assessing the feasibility and acceptability of online interventions will be increasingly critical to addressing the HIV epidemic among MSM across sub-Saharan Africa.

Sexual identity stigma and social support among men who have sex with men in Lesotho: a qualitative analysis

Abstract Men who have sex with men (MSM) face sexual identity stigma in many settings, which can increase risk for HIV by limiting access to care. This paper examines the roles of social support, sexual identity stigma, and sexual identity disclosure among MSM in Lesotho, a lower-middle income country within South Africa. Qualitative data were collected from 23 in-depth interview and six focus group participants and content analysis was performed to extract themes. Four primary themes emerged: 1) Verbal abuse from the broader community is a major challenge faced by MSM in Lesotho, 2) participants who were open about their sexual identity experienced greater stigma but were more self-sufficient and had higher self-confidence, 3) relationships between MSM tend to be conducted in secrecy, which can be associated with unhealthy relationships between male couples and higher risk sexual practices, and 4) MSM community organisations provide significant social and emotional support. Friends and family members from outside the MSM community also offer social support, but this support cannot be utilised by MSM until the risk of disclosing their sexual identity is reduced. Greater acceptance of same-sex practices would likely result in more open, healthy relationships and greater access to social support for MSM. Résumé Les hommes qui ont des relations sexuelles avec des hommes sont souvent en butte à la stigmatisation pour leur identité sexuelle, ce qui peut accroître le risque de VIH en limitant l’accès aux soins. Cet article examine les rôles du soutien social, de la stigmatisation due à l’identité sexuelle et de la révélation de l’identité sexuelle chez les hommes qui ont des relations sexuelles avec des hommes au Lesotho, un pays à revenu faible-intermédiaire enclavé dans l’Afrique du Sud. Des données qualitatives ont été recueillies lors de 23 entretiens approfondis et une analyse de contenu et de participants de six groupes d’intérêt a été menée. Quatre thèmes principaux sont apparus: 1) les insultes verbales de la communauté élargie est un défi majeur rencontré par cette population au Lesotho, 2) les participants qui étaient ouverts sur leur identité sexuelle connaissaient une stigmatisation accrue, mais étaient plus autosuffisants et jouissaient d’une confiance en eux plus élevée, 3) les relations entre les hommes qui ont des rapports sexuels avec des hommes tendent à être conduites dans le secret, ce qui peut être associé à des relations malsaines entre couples masculins et des pratiques sexuelles à plus haut risque, et 4) les organisations communautaires de ces hommes fournissent un soutien social et psychologique important. Les amis et les membres de la famille hors de la communauté des hommes qui ont des rapports sexuels avec d’autres hommes prodiguent aussi un soutien social, mais ce soutien ne peut pas être utilisé par les intéressés tant que le risque de révélation de leur identité sexuelle ne sera pas réduit. Une plus grande acceptation des pratiques homosexuelles résulterait probablement en des relations plus saines et ouvertes et élargirait l’accès au soutien social pour les hommes qui ont des relations sexuelles avec les hommes. Resumen Los hombres que tienen sexo con hombres (HSH) enfrentan estigma relacionado con su identidad sexual en muchos entornos, lo cual puede incrementar el riesgo de contraer VIH al limitar el acceso a los servicios de salud. Este artículo examina los roles del apoyo social, el estigma relacionado con la identidad sexual y la revelación de la identidad sexual entre HSH en Lesoto, un país de ingresos bajos y medianos en Sudáfrica. Se recolectaron datos cualitativos por medio de 23 entrevistas a profundidad y seis participantes en grupos focales, y se analizó el contenido para extraer temáticas. Surgieron cuatro temáticas principales: 1) el abuso verbal de la comunidad es un gran reto que enfrentan los HSH en Lesoto, 2) los participantes que hablaron abiertamente sobre su identidad sexual sufrieron mayor estigma pero eran más autosuficientes y tenían más confianza en sí mismos, 3) las relaciones entre HSH tienden a ser llevadas a cabo en secreto, lo cual puede estar asociado con relaciones no saludables entre parejas de sexo masculino y prácticas sexuales de mayor riesgo y 4) las organizaciones comunitarias de HSH brindan considerable apoyo social y emocional. Amistades y familiares fuera de la comunidad de HSH también ofrecen apoyo social, pero este apoyo no puede ser utilizado por HSH hasta que se reduzca el riesgo de revelar su identidad sexual. Mayor aceptación de las prácticas entre personas del mismo sexo probablemente produciría relaciones saludables más abiertas y mayor acceso al apoyo social para HSH.

Piloting PrePex for Adult and Adolescent Male Circumcision in South Africa--Pain Is an Issue.

Background The World Health Organisation and the Joint United Nations Programme on HIV/AIDS have recommended the scale-up of Medical Male Circumcision (MMC) in countries with high HIV and low MMC prevalence. PrePex device circumcision is proposed as an alternate method for scaling up MMC. Objective Evaluate safety and feasibility of PrePex in South Africa. Design A multisite prospective cohort PrePex study in adults and adolescents at three MMC clinics. Participants were followed-up 8 times, up to 56 days after PrePex placement. Results In total, 398 PrePex circumcisions were performed (315 adults and 83 adolescents) their median ages were 26 (IQR: 22–30) and 16 years (IQR: 15–17), respectively. The median time for device placement across both groups was 6 minutes (IQR: 5–9) with the leading PrePex sizes being B (30%) and C (35%) for adults (18–45 years), and A (31%) and B (38%) for adolescents (14–17 years). Additional sizes (size 12–20) were rarely used, even in the younger age group. Pain of device application was minimal but that of removal was severe. However, described pain abated rapidly and almost no pain was reported 1 hour after removal. The Adverse Events rate were experienced by 2.7% (11/398) of all participants, three of which were serious (2 displacements and 1 self-removal requiring prompt surgery). None of the Adverse Events required hospitalization. The majority of participants returned to work within a day of device placement. Conclusion Our study shows that PrePex is a safe MMC method, for males 14 years and above. PrePex circumcision had a similar adverse event rate to that reported for surgical MMC, but device removal caused high levels of pain, which subsided rapidly.

Are women more likely to self-test? A short report from an acceptability study of the HIV self-testing kit in South Africa.

ABSTRACT This study assessed the acceptability of, as well as the facilitators of and barriers to the HIV self-testing kit in the Gauteng province, South Africa. An exploratory qualitative cross-sectional study was conducted using focus group discussions (FGDs) among a sample of 118 respondents selected from the Braamfontein and Soweto areas of Johannesburg. Sixteen FGDs were conducted in order to assess the acceptability of the HIV self-testing kit. Respondent groups were segmented according to area (Soweto or Braamfontein), gender (male or female), age (20–34 and 35–49 years of age) and HIV testing status (have previously tested for HIV or have never tested for HIV) in order to achieve maximum variability. The main advantage identified was that the self-testing kit allows for privacy and confidentiality with regard to HIV status, and does not require a visit to a health facility – two of the main barriers to current HIV counselling and testing uptake. However, respondents, predominantly males, were concerned about the lack of counselling involved, which they thought could lead to suicide ideation among testers. The HIV self-testing kit was found to be acceptable among the majority of respondents. However, there is still a need for follow-up services for self-testers. The idea of a hotline for telephonic counselling within the self-testing model seemed to be favourable among many respondents and is an alternative to traditional face-to-face counselling, although some respondents felt that this was not sufficient.

Evaluating the cost of adult voluntary medical male circumcision in a mixed (surgical and PrePex) site compared to a hypothetical PrePex-only site in South Africa

Background Several circumcision devices have been evaluated for a safe and simplified male circumcision among adults. The PrePex device was prequalified for voluntary male medical circumcision (VMMC) in May 2013 by the World Health Organization and is expected to simplify the procedure safely while reducing cost. South Africa is scaling up VMMC. Objective To evaluate the overall unit cost of VMMC at a mixed site vs. a hypothetical PrePex-only site in South Africa. Design We evaluated the overall unit cost of VMMC at a mixed site where PrePex VMMC procedure was added to routine forceps-guided scalpel-based VMMC in Soweto, South Africa. We abstracted costs and then modeled these costs for a hypothetical PrePex-only site, at which 9,600 PrePex circumcisions per year could be done. We examined cost drivers and modeled costs, varying the price of the PrePex device. The healthcare system perspective was used. Results In both sites, the main contributors of cost were personnel and consumables. If 10% of all VMMC were by PrePex at the mixed site, the overall costs of the surgical method and PrePex were similar – US

Perceptions of the PrePex Device Among Men Who Received or Refused PrePex Circumcision and People Accompanying Them.

59.62 and

Safety and Efficacy of the PrePex Male Circumcision Device: Results From Pilot Implementation Studies in Mozambique, South Africa, and Zambia

59.53, respectively. At the hypothetical PrePex-only site, the unit cost was US

HIV risks and needs related to the Sustainable Development Goals among female sex workers who were commercially sexually exploited as children in Lesotho

51.10 with PrePex circumcisions having markedly lower personnel and biohazardous waste management costs. In sensitivity analysis with the cost of PrePex kit reduced to US