|
Perceived benefits of male circumcision and client preferences for clinic design and marketing of male circumcision in Johannesburg, South Africa
N. Martinson1, F. Selk2, J. McIntyre3, G. Gray3, J. Bridges2
1Perinatal HIV Research Unit (PHRU), Johns Hopkins School of Medicine, Soweto, South Africa, 2John Hopkins Bloomberg School of Public Health, Baltimore, MD, United States, 3Perinatal HIV Research Unit, Soweto, South Africa
Background: Male Circumcision (MC) has been shown to reduce HIV-acquisition in men. Using established market research methods, we evaluated the relative value of critical aspects of mass MC programmes among uncircumcised young men and parents of boys; including an assessment of sexual disinhibition.
Methods: We implemented a discrete choice experiment (DCE) among 640 participants (parents=403; uncircumcised males=237). Respondents were identified through a randomized household survey in Johannesburg; with oversampling to ensure balance between black (n=220), mixed-race/coloured (n=202), and white (n=218) respondents. They were presented with three sets of paired comparison, forced-selection tasks; comparing groups of attributes of MC demand and were asked, of the pair presented to them, to select that group which best represented their views. The sets were divided into: 1) Perceived benefits of circumcision; the role of sexual disinhibition was added by including subsequent condom avoidance as a potential benefit of MC. 2) Preferred social-marketing modes for mass circumcision services. 3) Circumcision clinic design. Responses were analyzed using logistic regression (overall and stratified by race, socioeconomic status, and language).
Results: Overall, perceived benfits of MC were prevention of HIV-acquisition in men (p< 0.001), prevention of sexually transmitted infection (STI) acquisition by men (p< 0.001), hygiene (p< 0.05), and enjoyable sex (p< 0.05), there was strong aversion to selection of avoidance of condom use (p< 0.001). Respondents strongly preferred MC clinics with scheduled follow-up after the procedure (p< 0.001), low infection rates (p< 0.001), less pain (p< 0.001), and an indoor waiting room (p< 0.001). For social-marketing of MC, television (p< 0.001), church/school leader endorsement (p< 0.001), and a nation-wide campaign (p< 0.001) were preferred over other marketing modes .
Conclusions: Our results suggest that subsequent condom avoidance, are not included in decision-making for MC. Market research, assessing client preferences, are an important adjunct to the design of mass MC programmes.
|