title: Perspectives of Parents and Health Care Workers on Early Infant Male Circumcision Conducted Using Devices: Qualitative Findings From Harare, Zimbabwe.
abstract: The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) recommend early infant male circumcision (EIMC) for prevention of HIV. Here, we present findings from a qualitative study in Zimbabwe that assessed parental and health care workers' perspectives of EIMC conducted using devices.
  
  
  
  This qualitative study was nested within a trial of EIMC devices. Between January and May 2013, we held 4 focus group discussions (FGDs) and 12 in-depth interviews with parents and 12 in-depth interviews with clinicians (7 trial clinicians and 5 non-trial clinicians). We also conducted 95 short telephone interviews with parents who had arranged to bring their sons for EIMC but then defaulted.
  
  
  
  Parents who had adopted EIMC spoke of their initial anxieties about the procedure. Additionally, they commented on both the procedure and outcome. Parents who decided against EIMC cited fear of harm, specifically the infant's death, penile injury, and excessive pain. Misperceptions about male circumcision in general and EIMC specifically were a significant barrier to EIMC adoption and were prevalent among health care workers as well as parents. In particular, the findings suggest strong parental concerns about the fate of the discarded foreskin. Parents who chose EIMC for their newborn sons felt that the procedure was safe and expressed satisfaction with the outcome. For their part, health care workers largely thought that EIMC was safe and that the outcome was aesthetically pleasing. They also felt that it would be feasible to offer wide-scale EIMC for HIV prevention in the public sector; they recommended strategies to increase EIMC uptake, in addition to highlighting a few concerns.
  
  
  
  The qualitative study enables us to better understand parental and health care workers' perspectives of EIMC conducted using devices, especially their perspectives on EIMC safety, feasibility, acceptability, and barriers. These findings will be used to design demand-generation activities that support wider adoption of EIMC.
authors.affiliation: Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe University College London, London, United Kingdom.
authors.forename: Webster
authors.initials: W
authors.lastname: Mavhu
authors.affiliation: Population Services International, Harare, Zimbabwe khatzold@psi-zim.co.zw.
authors.forename: Karin
authors.initials: K
authors.lastname: Hatzold
authors.affiliation: Ministry of Health and Child Care, Harare, Zimbabwe.
authors.forename: Getrude
authors.initials: G
authors.lastname: Ncube
authors.affiliation: Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe.
authors.forename: Shamiso
authors.initials: S
authors.lastname: Fernando
authors.affiliation: Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe.
authors.forename: Collin
authors.initials: C
authors.lastname: Mangenah
authors.affiliation: Population Services International, Harare, Zimbabwe.
authors.forename: Kumbirai
authors.initials: K
authors.lastname: Chatora
authors.affiliation: Ministry of Health and Child Care, Harare, Zimbabwe.
authors.forename: Owen
authors.initials: O
authors.lastname: Mugurungi
authors.affiliation: University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
authors.forename: Ismail
authors.initials: I
authors.lastname: Ticklay
authors.affiliation: Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe University College London, London, United Kingdom.
authors.forename: Frances M
authors.initials: FM
authors.lastname: Cowan
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002944:Circumcision, Male / Q000295:instrumentation* / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010290:Parents; D036301:Qualitative Research; D015030:Zimbabwe