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

Tynan, Anna, Hill, Peter S., Kelly, Angela, Kupul, Martha, Aeno, Herick, Naketrumb, Richard, Siba, Peter, Kaldor, John and Vallely, Andrew (2013) 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. BMC Public Health, 13 749: 749.1-749.18. doi:10.1186/1471-2458-13-749


Author Tynan, Anna
Hill, Peter S.
Kelly, Angela
Kupul, Martha
Aeno, Herick
Naketrumb, Richard
Siba, Peter
Kaldor, John
Vallely, Andrew
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
Journal name BMC Public Health   Check publisher's open access policy
ISSN 1471-2458
Publication date 2013-08
Year available 2013
Sub-type Article (original research)
DOI 10.1186/1471-2458-13-749
Open Access Status DOI
Volume 13
Issue 749
Start page 749.1
End page 749.18
Total pages 18
Place of publication London , United Kingdom
Publisher BioMed Central
Collection year 2014
Language eng
Formatted 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.

Keyword Community participation
Male circumcision
Penile cutting
Hiv
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Australian Centre for International & Tropical Health
Official 2014 Collection
School of Public Health Publications
 
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