title: Healthcare providers' knowledge, attitudes and practices towards medical male circumcision and their understandings of its partial efficacy in HIV prevention: Qualitative research in KwaZulu-Natal, South Africa.
abstract: BACKGROUND
  Medical male circumcision has been shown to reduce HIV transmission to an uninfected male partner. In South Africa, medical male circumcision programs were rolled-out in 2010.
  
  
  OBJECTIVE
  Prior to roll-out, we explored healthcare providers' knowledge, attitudes and practices about medical male circumcision and their understandings of partial efficacy for HIV prevention.
  
  
  METHODS
  We conducted qualitative research, using in-depth interviews.
  
  
  METHODS
  Participants were from three rural and three urban primary healthcare clinics, randomly selected in eThekwini District, KwaZulu-Natal.
  
  
  METHODS
  25 healthcare providers (including nurse managers, nurses and counselors) were purposively selected from the clinics.
  
  
  METHODS
  In-depth interviews were recorded, transcribed and translated. Independent researchers reviewed the transcripts and developed a codebook based on emergent themes, using thematic analysis. NVivo 8 was used to facilitate data management, coding and analysis.
  
  
  RESULTS
  Although most providers had heard that medical male circumcision can reduce risk of HIV acquisition in men, most did not have accurate scientific understandings of this. Some providers had misperceptions about the limited/partial protection medical male circumcision offers. Many had concerns that their communities would misunderstand it, causing increased risky sexual behavior.
  
  
  CONCLUSIONS
  These data provide a baseline of providers' understandings of medical male circumcision prior to roll-out, and can be used to compare current data and ensure accurate messaging to clients. Healthcare provider messaging should build client understandings of the meaning of partially efficacious technologies.
authors: MatCH Research (Maternal, Adolescent and Child Health Research), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa. Electronic address: cmilford@matchresearch.co.za.
authors: Cecilia
authors: C
authors: Milford
authors: MatCH Research (Maternal, Adolescent and Child Health Research), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa.
authors: Letitia
authors: L
authors: Rambally
authors: HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, USA.
authors: Joanne E
authors: JE
authors: Mantell
authors: HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, NY State Psychiatric Institute and Columbia University, USA; CUNY School of Public Health, Hunter College, City University of New York, USA.
authors: Elizabeth A
authors: EA
authors: Kelvin
authors: MatCH Research (Maternal, Adolescent and Child Health Research), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa.
authors: Nzwakie F
authors: NF
authors: Mosery
authors: MatCH Research (Maternal, Adolescent and Child Health Research), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa.
authors: Jennifer A
authors: JA
authors: Smit
mesh_terms: D000328:Adult; D000368:Aged; D002944:Circumcision, Male; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D009718:Nurse Administrators; D009726:Nurses; D013019:South Africa
keywords: Acceptability; HIV prevention; Healthcare providers; Medical male circumcision; Partial efficacy; South Africa