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BMC Public Health
Published in: BMC Public Health 1/2013

Open Access 01-12-2013 | Research article

Listening to diverse community voices: the tensions of responding to community expectations in developing a male circumcision program for HIV prevention in Papua New Guinea

Authors: Anna Tynan, Peter S Hill, Angela Kelly, Martha Kupul, Herick Aeno, Richard Naketrumb, Peter Siba, John Kaldor, Andrew Vallely, for the Male Circumcision Acceptability and Impact Study (MCAIS) team

Published in: BMC Public Health | Issue 1/2013

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Abstract

Background

The success of health programs is influenced not only by their acceptability but also their ability to meet and respond to community expectations of service delivery. The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have recommended medical male circumcision (MC) as an essential component of comprehensive HIV prevention programs in high burden settings. This study investigated community-level perceptions of MC for HIV prevention in Papua New Guinea (PNG), a setting where diverse traditional and contemporary forms of penile foreskin cutting practices have been described.

Methods

A multi-method qualitative study was undertaken in four provinces in two stages from 2009 to 2011. A total of 82 in-depth interviews, and 45 focus group discussions were completed during Stage 1. Stage 2 incorporated eight participatory workshops that were an integral part of the research dissemination process to communities. The workshops also provided opportunity to review key themes and consolidate earlier findings as part of the research process. Qualitative data analysis used a grounded theory approach and was facilitated using qualitative data management software.

Results

A number of diverse considerations for the delivery of MC for HIV prevention in PNG were described, with conflicting views both between and within communities. Key issues included: location of the service, service provider, age eligibility, type of cut, community awareness and potential shame amongst youth. Key to developing appropriate health service delivery models was an appreciation of the differences in expectations and traditions of unique cultural groups in PNG. Establishing strong community coalitions, raising awareness and building trust were seen as integral to success.

Conclusions

Difficulties exist in the implementation of new programs in a pluralistic society such as PNG, particularly if tensions arise between biomedical knowledge and medico-legal requirements, compared to existing socio-cultural interests. Community participatory approaches offer important opportunities to explore and design culturally safe, specific and accessible programs.
Appendix
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Metadata
Title
Listening to diverse community voices: the tensions of responding to community expectations in developing a male circumcision program for HIV prevention in Papua New Guinea
Authors
Anna Tynan
Peter S Hill
Angela Kelly
Martha Kupul
Herick Aeno
Richard Naketrumb
Peter Siba
John Kaldor
Andrew Vallely
for the Male Circumcision Acceptability and Impact Study (MCAIS) team
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2013
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-13-749

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High school dropout and long-term sickness and disability in young adulthood: a prospective propensity score stratified cohort study (the Young-HUNT study)

Research article

Development and implementation of the Baltimore healthy carry-outs feasibility trial: process evaluation results

Research article

Suicide and related health risk behaviours among school learners in South Africa: results from the 2002 and 2008 national youth risk behaviour surveys

Research article

The role of community conversations in facilitating local HIV competence: case study from rural Zimbabwe

Research article

Positive psychology interventions: a meta-analysis of randomized controlled studies

Research article

Tuberculosis case finding based on symptom screening among immigrants, refugees and asylum seekers in Rome