title: Acceptability of early infant male circumcision as an HIV prevention intervention in Zimbabwe: a qualitative perspective.
abstract: BACKGROUND
  Early infant male circumcision (EIMC) is simpler, safer and more cost-effective than adult circumcision. In sub-Saharan Africa, there are concerns about acceptability of EIMC which could affect uptake. In 2009 a quantitative survey of 2,746 rural Zimbabweans (aged 18-44) indicated that 60% of women and 58% of men would be willing to have their newborn son circumcised. Willingness was associated with knowledge of HIV and male circumcision. This qualitative study was conducted to better understand this issue.
  
  
  METHODS
  In 2010, 24 group discussions were held across Zimbabwe with participants from seven ethnic groups. Additionally, key informant interviews were held with private paediatricians who offer EIMC (n = 2) plus one traditional leader. Discussions were audio-recorded, transcribed, translated into English (where necessary), coded using NVivo 8 and analysed using grounded theory principles.
  
  
  RESULTS
  Knowledge of the procedure was poor. Despite this, acceptability of EIMC was high among parents from most ethnic groups. Discussions suggested that fathers would make the ultimate decision regarding EIMC although mothers and extended family can have (often covert) influence. Participants' concerns centred on: safety, motive behind free service provision plus handling and disposal of the discarded foreskin. Older men from the dominant traditionally circumcising population strongly opposed EIMC, arguing that it separates circumcision from adolescent initiation, as well as allowing women (mothers) to nurse the wound, considered taboo.
  
  
  CONCLUSIONS
  EIMC is likely to be an acceptable HIV prevention intervention for most populations in Zimbabwe, if barriers to uptake are appropriately addressed and fathers are specifically targeted by the programme.
authors.affiliation: Zimbabwe AIDS Prevention Project, Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe. wmavhu@gmail.com
authors.forename: Webster
authors.initials: W
authors.lastname: Mavhu
authors.forename: Karin
authors.initials: K
authors.lastname: Hatzold
authors.forename: Susan M
authors.initials: SM
authors.lastname: Laver
authors.forename: Judith
authors.initials: J
authors.lastname: Sherman
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Tengende
authors.forename: Collin
authors.initials: C
authors.lastname: Mangenah
authors.forename: Lisa F
authors.initials: LF
authors.lastname: Langhaug
authors.forename: Graham
authors.initials: G
authors.lastname: Hart
authors.forename: Frances M
authors.initials: FM
authors.lastname: Cowan
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D002944:Circumcision, Male / Q000379:methods*; D003466:Cultural Characteristics; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006679:HIV Seropositivity / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010290:Parents; D010342:Patient Acceptance of Health Care; D015030:Zimbabwe