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Male circumcision (MC) under local anesthesia: educating clients on the spot. The development of a comprehensive visual package in support of scaling up MC service delivery in priority countries
I. Schenker1, E. Gross2, P. Mkhatshwashe3, Operation Abraham Collaborative
1Jerusalem AIDS Project, Operation Abraham, Jerusalem, Israel, 2Hebrew University - Hadassah Medical Center, Pediatric Surgery, Jerusalem, Israel, 3Family Life Association of Swaziland, FLAS Mbabane Clinic, Mbabane, Swaziland
Background: MC for HIV prevention is prioritised in countries where HIV prevalence is high and MC is performed nationally below or close to 20%. Recommendations of experts convened by UNAIDS and WHO (2007) suggested MC education should:
a. Prevent men developing a false sense of security; circumcision is not a ´magic bullet´ b. Reinforce messages that MC is complementary to other prevention methods c. Guide newly circumcised men that resuming sexual activity before wound healing may lead to higher risk of HIV infection d. Highlight that circumcision is not helpful if HIV-positive. e. Clearly distinguish male circumcision from female genital mutilation.
Methods: Clients´ education was required during the first pilot we implemented in Swaziland, supporting training for scaling up MC. Three sites were used for implementing a comprehensive educational package for individual seeking MC: clinic´s waiting room, operating theater bed, discharge room. Messages were carefully tailored, culturally sensitive, drawn on local language, symbols and appropriate to understanding of the population.
Results: Pre-tested materials included: a photographs´ exhibit of inside the operating thater to relief fear of the unknown and increase confidence in safety -was displayed in pre-operation room. Colorful leaflet, text and images was handed to each client during MC abstructing minds, enhamcing prevention and healing. Written instructions and take-home leaflet was handed post recovery. 88 men interviewed pre and post operation guided developers in perfectionating messages and presentation of materials. 100% indicated that most effective education was their reading materials while under local anesthesia on the operating table. 80% indicated that healing instructions directly from their surgeon were most significant.
Conclusions: Training delegations supporting MC services scale up could incorporate effective materials and methods for communication with men before, during and after MC; addressing key challenges including risk compensation. Men are receptive and appreciate MC education tailored for them. Presentation informs replication options.
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