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Feasibility, acceptability and willingness to participate in a male circumcision trial for the prevention of HIV acquisition in men who have sex with men in the Andes
P. Goicochea1, J. Sanchez1, M. Morales1, C. Celum2
1Investigaciones Medicas en Salud, Lima, Peru, 2University of Washington, Seattle, United States
Background: An important proportion of countries in Latin America have a concentrated HIV/AIDS epidemic in men who have sex with men (MSM) and new approaches to prevention are of need for this population. Three male circumcision (MC) trials in Africa have shown efficacy in the reduction of female to male transmission of HIV, however no MC trial has been done for MSM. We designed a formative research protocol to assess the feasibility of implementing, and the willingness of MSM to participate in a circumcision trial in three cities in two Andean countries (Lima and Iquitos in Peru; and Guayaquil in Ecuador) .
Methods: Focus group discussions (FGD) and in-depth interviews (IDI) were used with different strata of MSM, and key informants. FGD and IDI were transcribed and coded for analysis following the grounded theory approach.
Results: We did 15 FGD and 18 IDI with potential MSM participants categorized in the following MSM sub cultures: closeted, gay, transexuals, male escorts and male sex workers. We also interviewed five key informants (health authorities, community leaders and gay rights activists, in these three different cities. There are strong cultural and psychological issues surrounding the foreskin in the male culture of Peru and Ecuador. To have the foreskin pulled back to reveal the glans is a rite-du-passage from puberty to adulthood among these men. Barriers to circumcision may include aesthetic reason (the scars as a result of surgery) but also cultural (the need to have external aid to help a "natural process"). Participants agree that new prevention strategies are needed and must be assessed as far as these are evidence-based. Sexual role may mislead the intervention, those who are receptive do not see themselves as target of this intervention.
Conclusions: Sexual education and especially of male sexuality is crucial in HIV prevention interventions targeted at this population.
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