title: Unpacking early infant male circumcision decision-making using qualitative findings from Zimbabwe.
abstract: Early infant male circumcision (EIMC) has been identified as a key HIV prevention intervention. Exploring the decision-making process for adoption of EIMC for HIV prevention among parents and other key stakeholders is critical for designing effective demand creation interventions to maximize uptake, roll out and impact in preventing HIV. This paper describes key players, decisions and actions involved in the EIMC decision-making process.
  
  
  
  Two complementary qualitative studies explored hypothetical and actual acceptability of EIMC in Zimbabwe. The first study (conducted 2010) explored hypothetical acceptability of EIMC among parents and wider family through focus group discussions (FGDs, n = 24). The follow-up study (conducted 2013) explored actual acceptability of EIMC among parents through twelve in-depth interviews (IDIs), four FGDs and short telephone interviews with additional parents (n = 95). Short statements from the telephone interviews were handwritten. FGDs and IDIs were audio-recorded, transcribed and translated into English. All data were thematically coded.
  
  
  
  Study findings suggested that EIMC decision-making involved a discussion between the infant's parents. Male and female participants of all age groups acknowledged that the father had the final say. However, discussions around EIMC uptake suggested that the infant's mother could sometimes covertly influence the father's decision in the direction she favoured. Discussions also suggested that fathers who had undergone voluntary medical male circumcision were more likely to adopt EIMC for their sons, compared to their uncircumcised counterparts. Mothers-in-law/grandparents were reported to have considerable influence. Based on study findings, we describe key EIMC decision makers and attempt to illustrate alternative outcomes of their key actions and decisions around EIMC within the Zimbabwean context.
  
  
  
  These complementary studies identified critical players, decisions and actions involved in the EIMC decision-making process. Findings on who influences decisions regarding EIMC in the Zimbabwean context highlighted the need for EIMC demand generation interventions to target fathers, mothers, grandmothers, other family members and the wider community.
authors.affiliation: Centre for Sexual Health & HIV/AIDS Research (CeSHHAR), 9 Monmouth Road Avondale West, Harare, Zimbabwe. wmavhu@gmail.com.|University College London, London, UK. wmavhu@gmail.com.
authors.forename: Webster
authors.identifier: 0000-0003-1881-4398
authors.initials: W
authors.lastname: Mavhu
authors.affiliation: Population Services International, Harare, Zimbabwe.
authors.forename: Karin
authors.initials: K
authors.lastname: Hatzold
authors.affiliation: Ministry of Health & Child Care, Harare, Zimbabwe.
authors.forename: Getrude
authors.initials: G
authors.lastname: Ncube
authors.affiliation: Centre for Sexual Health & HIV/AIDS Research (CeSHHAR), 9 Monmouth Road Avondale West, Harare, Zimbabwe.
authors.forename: Shamiso
authors.initials: S
authors.lastname: Fernando
authors.affiliation: Centre for Sexual Health & HIV/AIDS Research (CeSHHAR), 9 Monmouth Road Avondale West, 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: Population Services International, Harare, Zimbabwe.
authors.forename: Roy
authors.initials: R
authors.lastname: Dhlamini
authors.affiliation: Ministry of Health & 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 & HIV/AIDS Research (CeSHHAR), 9 Monmouth Road Avondale West, Harare, Zimbabwe.|University College London, London, UK.
authors.forename: Frances M
authors.initials: FM
authors.lastname: Cowan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002944:Circumcision, Male / Q000379:methods*; D003657:Decision Making; D005220:Fathers / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000517:prevention & control; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010290:Parents / Q000523:psychology; D036301:Qualitative Research; D015030:Zimbabwe
keywords: Decision-making; Early infant male circumcision; Interventions; Qualitative; Zimbabwe