Male Circumcision for HIV Prevention: Clinical Practices and Attitudes Among Healthcare Providers in South Africa and Zimbabwe

Abstract

Background—This study aimed to document the clinical practices and attitudes of healthcare providers in South Africa and Zimbabwe on male circumcision for HIV prevention. Methods—We conducted national surveys of physicians and nurses in both countries in 2008-2009 (N=1,444). Data on male circumcision for HIV prevention was analyzed; outcomes were patient counseling, provision of services, and desire for training. We used multivariable logistic regression to examine associations between these outcomes and clinician, practice and attitudinal variables. Results—Overall, 57% of clinicians reported counseling male patients on male circumcision, 17% were offering services (49% referrals), and 61% desired training. In the multivariable analyses, provision of services was more common in South Africa (P≤.001), but desire for training higher in Zimbabwe (P≤.01). Provision of services was highest among physicians (p≤.01) and in hospital settings (P≤.001). However, nurses had greater desire for training (P≤.05) as did younger clinicians (P≤.001). Clinicians in rural and clinic settings were just as likely to express training interest. Clinician attitudes that patients would be upset due to cultural beliefs and would increase risky behaviors were associated with less counseling and service provision (P≤.05). Conclusions—Many clinicians in South Africa and Zimbabwe showed willingness to integrate new HIV prevention evidence into practice and to become trained to offer the procedure to patients. Results suggest that both countries should consider involving nurses in male circumcision for HIV prevention, including those in rural areas, and should help clinicians to address cultural concerns.