title: Male circumcision for HIV prevention in India: emerging viewpoints and practices of health care providers.
abstract: A compelling case for promoting male circumcision (MC) as an intervention for reducing the risk of heterosexually acquired HIV infection was made by dissemination of the results of three studies in Africa. The WHO/UNAIDS recommendation for MC for countries like India, where the epidemic in concentrated in high-risk groups, advocates MC for specific population groups such as men at higher risk for HIV acquisition. A multicentre qualitative study was conducted in four geographically distinct districts (Belgaum, Kolkata, Meerut and Mumbai) in India during June 2009 to June 2011. Two categories of health care providers: Registered Healthcare Providers (RHCPs) and traditional circumcisers were interviewed by trained research staff who had received master's level education using interview guides with probes and open-ended questions. Respondents were selected using purposive sampling. A comparative analysis of the perspectives of the RHCP vs. traditional circumcisers is presented. Representatives of both categories of providers expressed the need for Indian data on MC. Providers feared that promoting circumcision might jeopardize/undermine the progress already made in the field of condom promotion. Reservation was expressed regarding its adoption by Hindus. Behavioural disinhibition was perceived as an important limitation. A contrast in the practice of circumcision was apparent between the traditional and the trained providers. MC should be mentioned as a part of comprehensive HIV prevention services in India that includes HIV counselling and testing, condom distribution and diagnosis and treatment of sexually transmitted infections. It should become an issue of informed personal choice rather than ethnic identity.
authors.affiliation: a Indian Council of Medical Research , New Delhi , India.
authors.forename: Anju
authors.initials: A
authors.lastname: Sinha
authors.affiliation: a Indian Council of Medical Research , New Delhi , India.
authors.forename: Nomita
authors.initials: N
authors.lastname: Chandhiok
authors.affiliation: b National AIDS Research Institute , Pune , India.
authors.forename: Seema
authors.initials: S
authors.lastname: Sahay
authors.affiliation: c Pondicherry University , Puducherry , India.
authors.forename: Sibnath
authors.initials: S
authors.lastname: Deb
authors.affiliation: d Tata Institute of Social Sciences , Mumbai , India.
authors.forename: Shalini
authors.initials: S
authors.lastname: Bharat
authors.affiliation: e LLRM Medical College , Meerut , India.
authors.forename: Abhilasha
authors.initials: A
authors.lastname: Gupta
authors.affiliation: f Regional Medical Research Institute , Belgaum , India.
authors.forename: Sripad
authors.initials: S
authors.lastname: Bhatt
authors.affiliation: b National AIDS Research Institute , Pune , India.
authors.forename: Vidisha
authors.initials: V
authors.lastname: Kanthe
authors.affiliation: b National AIDS Research Institute , Pune , India.
authors.forename: Bijesh
authors.initials: B
authors.lastname: Kumar
authors.affiliation: b National AIDS Research Institute , Pune , India.
authors.forename: Neelam
authors.initials: N
authors.lastname: Joglekar
authors.affiliation: b National AIDS Research Institute , Pune , India.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Paranjape
authors.affiliation: g National Institute of Epidemiology , Chennai , India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Mehendale
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002944:Circumcision, Male / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007194:India; D008297:Male; D010818:Practice Patterns, Physicians'; D012749:Sexually Transmitted Diseases / Q000517:prevention & control
keywords: India; health care providers; male circumcision; perspectives; practices; prevention