Key considerations in scaling up male circumcision in Tanzania: views of the urban residents in Tanzania

Abstract

Background

Male circumcision (MC) reduces the risk of sexually transmitted infections (STI) including HIV. The WHO and UNAIDS recommend male circumcision as an additional intervention to prevent HIV infection.  Tanzania is embarking on activities to scale up safe male circumcision for HIV prevention and other related health benefits. In line with this, it is crucial to assess views of the population using specific groups. This paper describes perceptions on male circumcision and strategies of enhancing uptake of male circumcision in urban Tanzania using members of the police force.

Methods

We conducted a cross sectional survey among the police officers (PO) in Dar es Salaam, Tanzania. The PO serves as a source of the clinical trial participants in on-going phase I/II HIV vaccine trials. Three hundred and thirteen (313) PO responded to a self-administered questionnaire that comprised of socio-demographic characteristics, reasons for not circumcising, perceptions regarding circumcision, methods of enhancing male circumcision, communication means and barriers to promote circumcision. This was followed by a physical examination to determine MC status.

Results

The prevalence of circumcision was 96%. Most (69%) reported to have been circumcised in the hospital.  The reported barriers to MC among adults and children were: anticipation of pain, cost, fear to lose body parts, and lack of advice for adult’s circumcision.  Sensitization of parents who take children to the reproductive and child health services was recommended by most respondents as the appropriate strategy to promote MC.  The least recommended strategy was for the women to sensitize men. Use of radio programs and including MC issues in school curricula as means of enhancing community sensitization regarding MC were also highly recommended. Other recommendations include use of public media, seminars at work and issuance of circumcision regulations by health authorities.

Conclusions

The present study reveals male circumcision was common in a selected  urban population. There are various barriers and channels of communication regarding male circumcision.   In view of scaling MC in Tanzania, use of radio messages, inclusion of male circumcision in the school curricula and sensitization at the RCH clinics are likely to promote early medical MC.