title: A typology of penile cutting in Papua New Guinea: results of a modified Delphi study among sexual health specialists.
abstract: Male circumcision (MC) significantly reduces the risk of HIV acquisition in men. The geographical, linguistic and cultural diversity of Papua New Guinea (PNG) makes issues of acceptability and implementation complex, and culturally appropriate HIV and Sexually Transmissible Infection (STI) prevention strategies are crucial in this setting. A modified Delphi approach was conducted with sexual health specialists to document and classify variants of penile cutting as part of a programme of research being carried out to investigate the acceptability and potential epidemiological impact of MC for HIV prevention in PNG, and options for future roll-out. Three broad categories were identified: circumcision, longitudinal incisions (including dorsal slit procedures) and incisions that did not alter the profile of penis or foreskin. The typology provides a universal language for health practitioners and policy makers that will inform future sexual health deliberations. The popularity of dorsal slit procedures in PNG has significant implications due to its procedural simplicity and limited resource requirements, making it an attractive provider option compared to medical circumcision. Further research is urgently required to examine the effectiveness of dorsal slit procedures for HIV prevention in PNG, the prevalence of various forms of penile cutting and the extent to which health staff are currently engaged in dorsal slit procedures.
authors.affiliation: Australian Centre for International and Tropical Health, School of Population Health, The University of Queensland, Brisbane, Australia. peter.hill@sph.uq.edu.au
authors.forename: Peter S
authors.initials: PS
authors.lastname: Hill
authors.forename: Anna
authors.initials: A
authors.lastname: Tynan
authors.forename: Greg
authors.initials: G
authors.lastname: Law
authors.forename: John
authors.initials: J
authors.lastname: Millan
authors.forename: Kelwyn
authors.initials: K
authors.lastname: Browne
authors.forename: Joyce
authors.initials: J
authors.lastname: Sauk
authors.forename: Martha
authors.initials: M
authors.lastname: Kupul
authors.forename: Angela
authors.initials: A
authors.lastname: Kelly
authors.forename: Peter
authors.initials: P
authors.lastname: Siba
authors.forename: John
authors.initials: J
authors.lastname: Kaldor
authors.forename: Andrew
authors.initials: A
authors.lastname: Vallely
mesh_terms: D002944:Circumcision, Male / Q000145:classification*; D003697:Delphi Technique; D052816:Foreskin / Q000601:surgery*; D015658:HIV Infections / Q000517:prevention & control; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010219:Papua New Guinea