Foreskin cutting beliefs and practices and the acceptability of male circumcision for HIV prevention in Papua New Guinea

Background: Male circumcision (MC) reduces HIV acquisition and is a key public health intervention in settings with high HIV prevalence, heterosexual transmission and low MC rates. In Papua New Guinea (PNG), where HIV prevalence is 0.8%, there is no medical MC program for HIV prevention. There are however many different foreskin cutting practices across the country's 800 language groups. The major form exposes the glans but does not remove the foreskin. This study aimed to describe and quantify foreskin cutting styles, practices and beliefs. It also aimed to assess the acceptability of MC for HIV prevention in PNG. Methods: Cross-sectional multicentre study, at two university campuses (Madang Province and National Capital District) and at two 'rural development' sites (mining site Enga Province; palm-oil plantation in Oro Province). Structured questionnaires were completed by participants originating from all regions of PNG who were resident at each site for study or work. Results: Questionnaires were completed by 861 men and 519 women. Of men, 47% reported a longitudinal foreskin cut (cut through the dorsal surface to expose the glans but foreskin not removed); 43% reported no foreskin cut; and 10% a circumferential foreskin cut (complete removal). Frequency and type of cut varied significantly by region of origin (p<.001). Most men (72-82%) were cut between the ages of 10 - 20 years. Longitudinal cuts were most often done in a village by a friend, with circumferential cuts most often done in a clinic by a health professional. Most uncut men (71%) and longitudinal cut men (84%) stated they would remove their foreskin if it reduced the risk of HIV infection. More than 95% of uncut men and 97% of longitudinal cut men would prefer the procedure in a clinic or hospital. Most men (90%) and women (74%) stated they would remove the foreskin of their son if it reduced the risk of HIV infection. Conclusion: Although 57% of men reported some form of foreskin cut only 10% reported the complete removal of the foreskin, the procedure on which international HIV prevention strategies are based. The acceptability of MC (complete foreskin removal) is high among men (for themselves and their sons) and women (for their sons). Potential MC services need to be responsive to the diversity of beliefs and practices and consider health system constraints. A concerted research effort to investigate the potential protective effects of longitudinal cuts for HIV acquisition is essential given the scale of longitudinal cuts in PNG

Towards a Pacific-indigenous research paradigm for Pacific social work

[Excerpt] Key points • Pacific social work research and evaluation approaches ought to align with a Pacific-Indigenous research paradigm. • A Pacific-Indigenous research paradigm includes assumptions about reality, knowledge, values and methodologies from within Pacific worldviews. • Pacific research approaches are increasingly being applied in research with Pacific communities, including: kakala, vanua, talanoa and fa’afaletui. • The Strengths Enhancing Evaluation Research (SEER) approach is an example of the application of Pacific-Indigenous evaluation in Hawai’i. • Decolonisation and positionality are important processes and considerations in Pacific research

What can be Learned about Male Circumcision and HIV Prevention from a Cohort of Students and Staff at a Papua New Guinea University: research report

[Extract] Papua New Guinea (PNG) is experiencing a generalised HIV epidemic with significant burden on individuals, families and communities. Preventing HIV requires a comprehensive range of measures to be implemented to address the multi-faceted drivers of HIV transmission. Male circumcision (MC) is now recommended by World Health Organisation (WHO) as an additional HIV prevention strategy for countries, such as PNG, where HIV is primarily transmitted via heterosexual intercourse, there is a generalised epidemic and most men are not circumcised. WHO urge that there be a locally relevant evidence base to inform any locally relevant male circumcision for HIV prevention response

A Papua New Guinea - Australia HIV research partnership: generating new knowledge, building capacity and forging new friendships

[Extract] Partnerships of mutual benefit are often forged to confront a common challenge. One such challenge is how to address HIV in Australia's nearest neighbour, Papua New Guinea (PNG). With a wide range of cultures, a largely rural population and a host of other development issues, PNG is a tough environment in which to conduct public health research. In order to overcome some of these obstacles, researchers formed a collaboration between three universities: James Cook University in Australia, and the faith-based Papua New Guinean Universities of Pacific Adventist University and Divine Word University. This article describes that partnership, outlines our research capacity building activities and describes how colleagues become friends while contributing to the national and regional HIV response

Co-interviewing across gender and culture: expanding qualitative research methods in Melanesia

Background: The social and cultural positions of both researchers and research participants influence qualitative methods and study findings. In Papua New Guinea (PNG), as in other contexts, gender is a key organising characteristic and needs to be central to the design and conduct of research. The colonial history between researcher and participant is also critical to understanding potential power differences. This is particularly relevant to public health research, much of which has emerged from a positivist paradigm. This paper describes our critical reflection of flexible researcher responses enacted during qualitative research in PNG.\ud \ud Methods: Led by a senior male HIV researcher from PNG, a male from a PNG university and a female from an Australian university conducted qualitative interviews about faith-based responses to HIV in PNG. The two researchers planned to conduct one-on-one interviews matching gender of participants and interviewer. However, while conducting the study, four participants explicitly requested to be interviewed by both researchers. This experience led us to critically consider socially and culturally situated ways of understanding semi-structured interviewing for public health research in Melanesia.\ud \ud Results: New understandings about public health research include: (i) a challenge to the convention that the researcher holds more power than the research participant, (ii) the importance of audience in Melanesia, (iii) cultural safety can be provided when two people co-interview and (iv) the effect an esteemed leader heading the research may have on people's willingness to participate. Researchers who occupy insider-outsider roles in PNG may provide participants new possibilities to communicate key ideas.\ud \ud Conclusions: Our recent experience has taught us public health research methods that are gender sensitive and culturally situated are pivotal to successful research in Melanesia. Qualitative research requires adaptability and reflexivity. Public health research methods must continue to expand to reflect the diverse worldviews of research participants. Researchers need to remain open to new possibilities for learning