A study of KAP of circumcirsed men towards safe sex in Manakayabe District in Swaziland

Vambe, Debrah (2013-03)

Thesis (MPhil)--Stellenbosch University, 2013.

Thesis

ENGLISH ABSTRACT: World Health Organisation (WHO) and UNAIDS named male circumcision as a key intervention in halting the spread of HIV in Africa. Several countries in sub-Saharan Africa with low levels of male circumcision (MC) and high HIV prevalence are scaling up MC services, Swaziland being one of them. Despite the circumcisions done in Swaziland it seems there is no significant decrease in HIV prevalence which might be due to various reasons. One of the reasons noted was the behaviour of men after circumcision because of the belief of total of immunity. This has led to an increase in high risk behaviour, increased promiscuity, multiple partners, more unsafe sex and failure to use condoms, thereby defeating the own stated purpose. Objectives: 1) To identify the knowledge, attitude and practices (KAP) of circumcised men towards safe sex. 2) To establish the existing knowledge of the relationship between circumcision and HIV prevention. 3) To establish whether men in Swaziland take part in riskier sexual behaviour after or before being circumcised. 4) To make recommendations for the counseling programme. Methodology: A cross-sectional analytical study whereby both qualitative and quantitative methods of data collection was used. Simple random sampling was used to select circumcised men from Mankayane hospital, Mankayane and Holy Rosary high schools and a total of 90(60 adults and 30 teenagers) filled in self- administered questionnaires and also took part in focus group discussions. Purposive sampling was used to choose the MC Counsellors and in-depth interviews were done to complement the information on knowledge, attitudes and practices of men towards safe sex before, during and after circumcision. An observation checklist was also used to check what they included in their counselling sessions. Results: The responses solicited from the men who participated in this study show that there is basic knowledge with regards to safe sex and the value of MC in the prevention of HIV. The pattern in the data however shows that those that were the most recent to undergo medical circumcision had the most varied opinions on the extent to which MC protect one from HIV. There was mixed attitude towards safe sex after circumcision, some wanting to maximise their satisfaction without using protection. The data also points to a pattern were the men have a high relationship turnover and this was more discernible among the teenagers who suggest that the relationships are not built on commitment but possible experimentation. While the study did not have control that tracked uncircumcised men for comparative purposes, the findings point to inconsistent use of condoms among men which heightens the risk of HIV transmission. The results point to a well-structured programme of counseling followed by MC counselors. Conclusion: The study was able to satisfy the aim and objectives. The research process was designed to collect the necessary data and be analysed in a manner that answered the research question. The research target population and subsequent sample represented the geographical scope of the study. The research tools were designed to be easy for the respondents to use. The distribution and collection method was designed to give the respondents less hassle as possible. This had a positive impact on the response rate, which increased the validity of the data collected. Both the literature review and primary research findings affirm that MC without behaviour change is not the panacea for prevention of HIV.

AFRIKAANSE OPSOMMING: Die Wêreldgesondheidsorganisasie (WGO) en UNAIDS het manlike besnydenis as ’n belangrike intervensie uitgewys om die verspreiding van MIV in Afrika te stuit. Verskeie lande in Afrika suid van die Sahara met lae vlakke van manlike besnydenis (MB) en hoë vlakke van MIV is tans besig om MB-dienste uit te brei, en Swaziland is geen uitsondering nie. Ondanks die besnydenis wat in Swaziland gedoen word, blyk daar egter geen beduidende afname in MIV te wees nie. Dít kan aan verskillende redes toegeskryf word. Een daarvan is mans se gedrag ná besnyding vanweë hul oortuiging dat hul geheel en al immuun is. Dit het tot ’n toename in hoërisikogedrag, meer promiskuïteit, veelvuldige bedmaats, meer onveilige seks en ’n gebrek aan kondoomgebruik gelei, wat uiteraard die doel verydel. Oogmerke: 1) Om besnyde mans se kennis, houdings en praktyke met betrekking tot veilige seks te bepaal. 2) Om bestaande kennis oor die verband tussen besnydenis en MIV-voorkoming te bepaal. 3) Om vas te stel of mans in Swaziland voor of ná besnyding geneig is tot meer riskante seksuele gedrag. 4) Om aanbevelings te doen vir die MB-beradingsprogram. Metodologie: ’n Deursnee- analitiese studiebenadering met sowel kwalitatiewe as kwantitatiewe datainsamelingsmetodes is gevolg. Met behulp van eenvoudige ewekansige steekproefneming is mans van Mankayane-hospitaal en tienerseuns van Mankayane- en Holy Rosary-hoërskool gekies. Altesaam 90 respondente (60 volwassenes en 30 tieners) het vraelyste op hul eie ingevul en ook aan fokusgroepbesprekings deelgeneem. Doelbewuste steekproefneming is gebruik om ’n groep MB-beraders te kies, met wie daar diepteonderhoude gevoer is om die inligting oor mans se kennis, houdings en praktyke met betrekking tot veilige seks voor, gedurende en ná besnyding aan te vul. ’n Waarnemingskontrolelys is ook gebruik om af te merk wat die beraders by hul beradingsessies insluit. Resultate: Die antwoorde van die mans wat aan hierdie studie deelgeneem het, toon basiese kennis met betrekking tot veilige seks en die waarde van MB in die voorkoming van MIV. Die patroon in die data toon egter dat diegene wat mees onlangs mediese besnydenis ondergaan het, die mees uiteenlopende menings het oor die mate waarin MB jou teen MIV beskerm. Daar is ’n gemengde houding oor veilige seks ná besnyding: Party mans jaag eenvoudig so veel moontlik bevrediging na, sonder enige beskerming. Die data dui ook op ’n patroon van ’n hoë verhoudingsomset onder die respondente. Dít was veral waarneembaar onder die tieners, wat te kenne gee dat hul verhoudings nie op toewyding gegrond is nie, maar eerder moontlike eksperimentasie. Hoewel die studie geen kontrolegroep met onbesnyde mans vir vergelykende doeleindes gehad het nie, dui die bevindinge op inkonsekwente kondoomgebruik onder mans, wat op sy beurt die risiko van MIV-oordrag verhoog. Die resultate dui voorts daarop dat MB-beraders ’n goed gestruktureerde beradingsprogram volg. Gevolgtrekking: Die studie het in sy doel en oogmerke geslaag. Die navorsingsproses was ontwerp om die nodige data in te samel en te ontleed ten einde die navorsingsvraag te beantwoord. Die navorsing steikenpopulasie en gevolglike steekproef was verteenwoordigend van die geografiese studiebestek. Die navorsingsinstrumente was ontwerp vir maklike gebruik deur respondente. Die verspreidings- en insamelingsmetode is gekies om so min moontlik moeite vir respondente te veroorsaak. Dít het ’n positiewe impak op die reaksiesyfer gehad, wat weer die geldigheid van die ingesamelde data verhoog het. Sowel die literatuuroorsig as die primêre navorsingsbevindinge bevestig dat MB sonder gedragsverandering allermins ’n ‘wondermiddel’ vir MIV-voorkoming is.

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