title: Community and healthcare providers' perspectives on male circumcision: a multi-centric qualitative study in India.
abstract: BACKGROUND
  Although male circumcision (MC) is recommended as an HIV prevention option, the religious, cultural and biomedical dimensions of its feasibility, acceptability and practice in India have not been explored till date. This study explores beliefs, experiences and understanding of the community and healthcare providers (HCPs) about adult MC as an HIV prevention option in India.
  
  
  METHODS
  This qualitative study covered 134 in-depth interviews from Belgaum, Kolkata, Meerut and Mumbai cities of India. Of these, 62 respondents were the members of circumcising (CC)/non-circumcising communities (NCC); including medically and traditionally circumcised men, parents of circumcised children, spouses of circumcised men, and religious clerics. Additionally, 58 registered healthcare providers (RHCPs) such as general and pediatric surgeons, pediatricians, skin and venereal disease specialists, general practitioners, and operation theatre nurses were interviewed. Fourteen traditional circumcisers were also interviewed. The data were coded and analyzed in QSR NUD*IST ver. 6.0. The study has not explored the participants' views about neonatal versus adult circumcision.
  
  
  RESULTS
  Members of CC/NCC, traditional circumcisers and RCHPs expressed sharp religious sensitivities around the issue of MC. Six themes emerged: Male circumcision as the religious rite; Multiple meanings of MC: MC for 'religious identity/privilege/sacrifice' or 'hygiene'; MC inflicts pain and cost; Medical indications outweigh faith; Hesitation exists in accepting 'foreign' evidence supporting MC; and communication is the key for acceptance of MCs. Medical indications could make members of NCC accept MC following appropriate counseling. Majority of the RHCPs demanded local in-country evidence.
  
  
  CONCLUSIONS
  HCPs must educate high-risk groups regarding the preventive and therapeutic role of MC. Communities need to discuss and create new social norms about male circumcision for better societal acceptance especially among the NCC. Feasibility studies on MC as an individual specific option for the high risk groups in health care setting needs to be explored.
authors.affiliation: National AIDS Research Institute, Pune, India.
authors.forename: Seema
authors.initials: S
authors.lastname: Sahay
authors.affiliation: National AIDS Research Institute, Pune, India.
authors.forename: Karikalan
authors.initials: K
authors.lastname: Nagarajan
authors.affiliation: National Institute of Epidemiology, Chennai, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Mehendale
authors.affiliation: Pondicherry University, Puducherry, India.
authors.forename: Sibnath
authors.initials: S
authors.lastname: Deb
authors.affiliation: HRRC, LLRM College, Meerut, India.
authors.forename: Abhilasha
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Tata Institute of Social Sciences, Pune, India.
authors.forename: Shalini
authors.initials: S
authors.lastname: Bharat
authors.affiliation: RMRC, Belgaum, India.
authors.forename: Shripad
authors.initials: S
authors.lastname: Bhatt
authors.affiliation: National AIDS Research Institute, Pune, India.
authors.forename: Athokpam Bijesh
authors.initials: AB
authors.lastname: Kumar
authors.affiliation: National AIDS Research Institute, Pune, India.
authors.forename: Vidisha
authors.initials: V
authors.lastname: Kanthe
authors.affiliation: Indian Council of Medical Research, Delhi, India.
authors.forename: Anju
authors.initials: A
authors.lastname: Sinha
authors.affiliation: Indian Council of Medical Research, Delhi, India.
authors.forename: Nomita
authors.initials: N
authors.lastname: Chandhiok
mesh_terms: D000328:Adult; D002944:Circumcision, Male / Q000009:adverse effects / Q000191:economics; D003142:Communication; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D006920:Hygiene; D007194:India; D008297:Male; D010146:Pain / Q000209:etiology; D036301:Qualitative Research; D012067:Religion; D012111:Residence Characteristics