Use of Economic Compensation to Increase Demand for Voluntary Medical Male Circumcision in Kenya: Qualitative Interviews With Male Participants in a Randomized Controlled Trial and Their Partners

Interventions to increase demand for medical male circumcision are urgently needed in eastern and southern Africa. Following promising evidence that providing economic compensation can increase male circumcision uptake in Kenya, there is a need to understand the role of this intervention in individuals' decision-making regarding circumcision and explore perceptions of the intervention and concerns such as coercion

West Chatham County : an action-oriented community assessment : findings and next steps of action

This paper details the Action-Oriented Community Assessment (AOCA) of West Chatham County conducted from October 2005 through April 2006 by five graduate students in the Department of Health Behavior and Health Education at the University of North Carolina at Chapel Hill School of Public Health. The project was conducted in partnership with the Chatham County Community Health Assessment Team and another student team working in the eastern side of the county, and was guided by three field advisors from the Chatham County Public Health Department and Chatham Habitat for Humanity. The field advisors helped initiate contacts within the community and offered guidance and advice throughout the process. The AOCA is designed to assess a community’s strengths and needs as identified by those in the community and to encourage service providers and community members to take action to address identified needs. To gain an understanding of the community, the team began the process by attending community events and collecting secondary data. The team interviewed a total of thirty-three service providers and community members about their perspectives on important issues in West Chatham, and held a community forum on April 28, 2006, to present results on the following five topics: infrastructure planning, communication, recreation, division and diversity, and service barriers for Latinos. Detailed below are the themes presented at the forum and the action steps that emerged to address these issues. Population growth has lead to a need for better planning for resources and infrastructure, especially water and sewage. 1. Members of the group will create a grassroots education project on the issue of water. 2. Members of the group will encourage people to attend Board of Commissioners meetings through advertisements at churches. 3. Members of the group will encourage the County and municipalities to work together. The lack of common communication sources creates disparities in knowledge about programs, services, and social activities. 1. Members of the group will consult with business leaders about the cost-effectiveness of producing part of the Chatham News/Chatham Record in Spanish and then approach the editor/owner of the newspaper to discuss. 2. A member of the group will investigate adding news that is broadcast in English on WNCA to the Spanish radio broadcast at WNCA. 3. Members of the group will promote the recent upgrade of WNCA to 5000 watts on the Chatham Schools website (http://www.chatham.k12.nc.us/). 4. A member of the group will send letters to all the churches in Chatham County. The messages to be included in the letter were undecided. West Chatham County needs additional resources, such as land and funding, for recreational facilities, which could serve as a gathering place for community members as well as a place for physical activity. 1. Group members committed to creating a task force with diverse representation of all racial groups to use as a space for individuals to voice recreation needs. a. Include people from School Board, Board of Commissioners, Recreation Department, and recreation coaches. b. Investigate funding opportunities. c. Lobby for recreational needs of specific groups and county as a whole. The lack of interaction between racial/ethnic groups contributes to misunderstanding and divisions between these groups. 1. Group members will organize a diversity task force. 2. Create an in-depth “dismantling racism” program and encourage as a required training for government employees and people in the education system. Language barriers continue to restrict Latinos’ access to services. 1. Approach service providers and identify their needs for bilingual communication. 2. Involve county commissioners to increase bilingual signs in the county. 3. Invite the Adult Basic Skills Coordinator to be a part of the group that is interested in reducing language barriers. 4. Make ESL classes more accessible through additional training, advertising, transportation, and childcare. a. Contact Chatham churches about starting classes and offering a basic curriculum. This document details the West Chatham AOCA process and results and is intended to serve as a resource for the Chatham County Public Health Department, the Community Health Assessment Team, and other service providers and community members in Chatham County. It is divided into five sections: Introduction, Findings, Community Forum, Methodology, and Limitations, Recommendations, and Conclusion. It is the team’s hope that service providers and community members will use information in the document to inform current and future program planning, and continue to build upon the many positive efforts occurring in West Chatham.Master of Public Healt

Effect of Providing Conditional Economic Compensation on Uptake of Voluntary Medical Male Circumcision in Kenya: A Randomized Clinical Trial

Novel strategies are needed to increase the uptake of voluntary medical male circumcision (VMMC) in sub-Saharan Africa and enhance the effectiveness of male circumcision as an HIV prevention strategy

Increasing Support for Contraception as HIV Prevention: Stakeholder Mapping to Identify Influential Individuals and Their Perceptions

BACKGROUND: Voluntary contraceptive use by HIV-positive women currently prevents more HIV-positive births, at a lower cost, than anti-retroviral drug (ARV) regimens. Despite this evidence, most prevention of mother-to-child transmission (PMTCT) programs focus solely on providing ARV prophylaxis to pregnant women and rarely include the prevention of unintended pregnancies among HIV-positive women. METHODOLOGY/PRINCIPAL FINDINGS: To strengthen support for family planning as HIV prevention, we systematically identified key individuals in the field of international HIV/AIDS-those who could potentially influence the issue-and sought to determine their perceptions of barriers to and facilitators for implementing this PMTCT strategy. We used a criteria-based approach to determine which HIV/AIDS stakeholders have the most significant impact on HIV/AIDS research, programs, funding and policy and stratified purposive sampling to conduct interviews with a subset of these individuals. The interview findings pointed to obstacles to strengthening linkages between family planning and HIV/AIDS, including the need for: resources to integrate family planning and HIV services, infrastructure or capacity to provide integrated services at the facility level, national leadership and coordination, and targeted advocacy to key decision-makers. CONCLUSIONS/SIGNIFICANCE: The individuals we identified as having regional or international influence in the field of HIV/AIDS have the ability to leverage an increasingly conducive funding environment and a growing evidence base to address the policy, programmatic and operational challenges to integrating family planning with HIV/AIDS. Fostering greater support for implementing contraception for HIV prevention will require the dedication, collaboration and coordination of many such actors. Our findings can inform a targeted advocacy campaign

Women and ARVâ based prevention: opportunities and challenges

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138349/1/jia29419.pd

Women's roles in voluntary medical male circumcision in Nyanza Province, Kenya.

Women are an important audience for voluntary medical male circumcision (VMMC) communication messages so that they know that VMMC provides only partial protection against HIV. They may also be able to influence their male partners to get circumcised and practice other HIV protective measures after VMMC. This study was conducted in two phases of qualitative data collection. Phase 1 used in-depth interviews to explore women's understanding of partial protection and their role in VMMC. Phase 2 built on the findings from the Phase 1, using focus groups to test VMMC communication messages currently used in Nyanza Province and to further explore women's roles in VMMC. Sixty-four sexually active women between the ages of 18 and 35 participated. In Phase 1, all women said they had heard of partial protection, though some were not able to elaborate on what the concept means. When women in Phase 2 were exposed to messages about partial protection, however, participants understood the messages well and were able to identify the main points. In Phases 1 and 2, many participants said that they had discussed VMMC with their partner, and for several, it was a joint decision for the man to go for VMMC. These findings suggest that current VMMC messaging is reaching women, though communications could more effectively target women to increase their ability to communicate about partial HIV protection from VMMC. Also, women seem to be playing an important role in encouraging men to get circumcised, so reaching out to women could be a valuable intervention strategy for increasing VMMC uptake and promoting use of other HIV protective measures after VMMC

Identifying and addressing barriers to uptake of voluntary medical male circumcision in Nyanza, Kenya among men 18-35: a qualitative study.

BACKGROUND: Uptake of VMMC among adult men has been lower than desired in Nyanza, Kenya. Previous research has identified several barriers to uptake but qualitative exploration of barriers is limited and evidence-informed interventions have not been fully developed. This study was conducted in 2012 to 1) increase understanding of barriers to VMMC and 2) to inform VMMC rollout through the identification of evidence-informed interventions among adult men at high risk of HIV in Nyanza Province, Kenya. METHODS: Focus groups (n = 8) and interviews were conducted with circumcised (n = 8) and uncircumcised men (n = 14) from the two districts in Nyanza, Kenya. Additional interviews were conducted with female partners (n = 20), health providers (n = 12), community leaders (n = 12) and employers (n = 12). Interview and focus group guides included questions about individual, interpersonal and societal barriers to VMMC uptake and ways to overcome them. Inductive thematic coding and analysis were conducted through a standard iterative process. RESULTS: Two primary concerns with VMMC emerged 1) financial issues including missing work, losing income during the procedure and healing and family survival during the recovery period and 2) fear of pain during and after the procedure. Key interventions to address financial concerns included: a food or cash transfer, education on saving and employer-based benefits. Interventions to address concerns about pain included refining the content of demand creation and counseling messages about pain and improving the ways these messages are delivered. CONCLUSIONS: Men need accurate and detailed information on what to expect during and after VMMC regarding both pain and time away from work. This information should be incorporated into demand creation activities for men considering circumcision. Media content should frankly and correctly address these concerns. Study findings support scale up and/or further improvement of these ongoing educational programs and specifically targeting the demand creation period

Reaching at-risk women for PrEP delivery: What can we learn from clinical trials in sub-Saharan Africa?

IntroductionARV-based pre-exposure prophylaxis (PrEP) has the potential to avert many new HIV infections, yet little is known about how to reach women at high risk for HIV infection and motivate them to initiate PrEP. Clinical trials have succeeded in recruiting at-risk participants, evidenced by control arm HIV incidence ≥3% (defined by the World Health Organization as "substantial risk"). We examined experiences from HIV prevention trials to document recruitment strategies and identify practical, potentially effective strategies for reaching women in real-world PrEP delivery.MethodsWe conducted semi-structured qualitative phone interviews with 31 staff from five countries who had worked on one or more of seven ARV-based HIV prevention clinical trials. Questions explored recruitment strategies used to reach women at risk of HIV and to successfully communicate about PrEP (inclusive of oral and vaginal formulations). We structurally coded data in NVivo and analyzed codes to derive themes. We conducted results interpretation webinars with research and programmatic stakeholders to validate findings and develop recommendations.ResultsClinical trial researchers employed a range of recruitment strategies to recruit at-risk women. They recommended engaging the local community and potential PrEP users via community events, meetings with gatekeepers, and use of community advisory boards; and they encouraged interpersonal communication like presentations in waiting rooms and door-to-door recruitment to address personal concerns and prevent misinformation. Participants also stressed the importance of addressing the challenges that already exist within the health system to create a more enabling environment and delivering positive messages through a variety of communication channels to normalize PrEP.ConclusionsFindings from this study provide important insights into potentially effective ways for countries currently rolling out oral PrEP to reach at-risk women with information about PrEP and promote uptake

Number of stakeholders found by data search.

<p>(Note: The sum equals a higher number than the final stakeholder total due to several individuals who appeared in more than one of the four searches. The total number of stakeholders was reached after removing duplicate individuals.)</p

WHO/UNAIDS strategy for the prevention of mother-to-child transmission of HIV (see [1]).

<p>Triangle added for emphasis by Family Health International.</p