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Promoting male circumcision as HIV prevention in sub-Saharan Africa: An evaluation of the ethical and pragmatic considerations of adopting a demand creation approach

Promoting male circumcision as HIV prevention in sub-Saharan Africa: An evaluation of the ethical... Male circumcision for HIV prevention is being promoted in 14 sub-Saharan African countries. Campaigns take a demand creation approach, a strategy based on generating awareness of and demand for an intervention. This article analyzes campaign materials, making the case that a focus on demand per se, at the expense of quality public health information, constitutes an ethical and pragmatic campaign flaw. Clinical trials have demonstrated that circumcision can reduce transmission of HIV from women to men by 53–60%. Since circumcision does not approach 100% prevention efficacy for men and does not directly protect women, behavioural and structural interventions remain necessary, leading international health bodies to position circumcision as an add-on to behavioural interventions. However, in practice, circumcision promotion often lacks information about behavioural prevention. At times, campaigns omit any HIV prevention message. Instead, campaigns variously favour representing circumcision as a route to normative masculinity, to sexual prowess, or to good citizenship, among others. Alongside their targeted outcomes, public health campaigns also contribute to public discourses around sexuality and non-HIV aspects of health, in this case potentially leading to confusion and mistrust. The current public health promotion strategy for circumcision threatens to undermine the social processes needed to support HIV prevention. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Global Public Health Taylor & Francis

Promoting male circumcision as HIV prevention in sub-Saharan Africa: An evaluation of the ethical and pragmatic considerations of adopting a demand creation approach

Global Public Health , Volume 15 (9): 15 – Sep 1, 2020

Promoting male circumcision as HIV prevention in sub-Saharan Africa: An evaluation of the ethical and pragmatic considerations of adopting a demand creation approach

Global Public Health , Volume 15 (9): 15 – Sep 1, 2020

Abstract

Male circumcision for HIV prevention is being promoted in 14 sub-Saharan African countries. Campaigns take a demand creation approach, a strategy based on generating awareness of and demand for an intervention. This article analyzes campaign materials, making the case that a focus on demand per se, at the expense of quality public health information, constitutes an ethical and pragmatic campaign flaw. Clinical trials have demonstrated that circumcision can reduce transmission of HIV from women to men by 53–60%. Since circumcision does not approach 100% prevention efficacy for men and does not directly protect women, behavioural and structural interventions remain necessary, leading international health bodies to position circumcision as an add-on to behavioural interventions. However, in practice, circumcision promotion often lacks information about behavioural prevention. At times, campaigns omit any HIV prevention message. Instead, campaigns variously favour representing circumcision as a route to normative masculinity, to sexual prowess, or to good citizenship, among others. Alongside their targeted outcomes, public health campaigns also contribute to public discourses around sexuality and non-HIV aspects of health, in this case potentially leading to confusion and mistrust. The current public health promotion strategy for circumcision threatens to undermine the social processes needed to support HIV prevention.

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References (31)

Publisher
Taylor & Francis
Copyright
© 2020 Informa UK Limited, trading as Taylor & Francis Group
ISSN
1744-1706
eISSN
1744-1692
DOI
10.1080/17441692.2020.1761423
Publisher site
See Article on Publisher Site

Abstract

Male circumcision for HIV prevention is being promoted in 14 sub-Saharan African countries. Campaigns take a demand creation approach, a strategy based on generating awareness of and demand for an intervention. This article analyzes campaign materials, making the case that a focus on demand per se, at the expense of quality public health information, constitutes an ethical and pragmatic campaign flaw. Clinical trials have demonstrated that circumcision can reduce transmission of HIV from women to men by 53–60%. Since circumcision does not approach 100% prevention efficacy for men and does not directly protect women, behavioural and structural interventions remain necessary, leading international health bodies to position circumcision as an add-on to behavioural interventions. However, in practice, circumcision promotion often lacks information about behavioural prevention. At times, campaigns omit any HIV prevention message. Instead, campaigns variously favour representing circumcision as a route to normative masculinity, to sexual prowess, or to good citizenship, among others. Alongside their targeted outcomes, public health campaigns also contribute to public discourses around sexuality and non-HIV aspects of health, in this case potentially leading to confusion and mistrust. The current public health promotion strategy for circumcision threatens to undermine the social processes needed to support HIV prevention.

Journal

Global Public HealthTaylor & Francis

Published: Sep 1, 2020

Keywords: Circumcision; HIV prevention; sub-Saharan Africa; demand creation; VMMC

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