Assessment of Knowledge, Attitudes and Practices of Men towards Voluntary Male Medical Circumcision: Study of Men between 15 to 49 Years at Rundu State Hospital
DOI: 319 Downloads 6785 Views
Author(s)
Abstract
Abstract: This paper presented evidence from 50 self administered-questionnaires and interviews with a sample of Rundu men who participated in a mixed descriptive research study. The purpose of this study was to describe the knowledge, attitude and practice of men who came for voluntary male medical circumcision: A case of men aged 15 to 49 years in Rundu. The study also explored the factors that hindered the men not to go for VMMC. A survey was carried out with a sample size of 50 men who are between the ages of 15 to 49 years, who visited Rundu Hospital and were uncircumcised. Despite genuine interest in circumcision, stumbling blocks in the decision-making process deterred men from undergoing the surgery. The following were revealed during the study The high cost of travelling long distance to get the service for VMMC, Men were often hesitant to give high priority to circumcision because of fear of the surgery and also the long periods of wound recovering, had limited access to accurate information on medical circumcision, which they could have used to allay their fears, Some of the barriers were identified in their decision-making process especially their beliefs of MMC being performed in winter have deep roots in their behaviour. Moreover, unavailability of health care facilities in the marginalized areas of Kavango East Region is a barrier to service provision and also inadequate service provision meant that some men who attempted to get circumcised were turned away by the clinic. The correlation matrix was used to shows the direction and strength of the correlation between knowledge, attitude and practice. The correlation between knowledge and attitude showed a strong positive correlation. Therefore the knowledge men have on medical circumcision as HIV prevention strategy influences the attitude men have on male circumcision. The correlation between attitude and practice showed a positive correlation. The correlation coefficient being 0.783 and the p-value at 0.000 which is less than the benchmarked 0.05. also, the correlation between knowledge and practice showed a positive correlation of 0.783 and the p-value lies at 0.000, that is, it has correlation significance at 5% level of significance. Thus implying that at 5% level of significance, return on attitude is linearly related to practise. Finally, the study suggested some recommendations that can address some of the challenges hindering men to get MMC services. These are: dissemination of accurate and factual information, highlighting MC health benefits in STI and HIV prevention particularly in communities with lower level of education.
Keywords
Knowledge, Attitudes, Practices
Cite this paper
Ntombizodwa Makurira Nyoni, Sikukumwa Ellion,
Assessment of Knowledge, Attitudes and Practices of Men towards Voluntary Male Medical Circumcision: Study of Men between 15 to 49 Years at Rundu State Hospital
, SCIREA Journal of Clinical Medicine.
Volume 2, Issue 3, June 2017 | PP. 15-62.
References
[ 1 ] | Albarracin, D., Johnson, B. & Zanna, M. (2005) Attitudes: Introduction and Scope, in, The Handbook of Attitudes: Routledge. |
[ 2 ] | Albert, L. M., Akol, A., L’Engle, K., Tolley, E. E., Ramirez, C. B., Opio, A., Tumwesigye N. M., Thomsen, S., & Baine S. O. (2011). Acceptability of male circumcision for prevention of HIV infection among men and women in Uganda. Retrieved From http://dx.doi.org/10.1080/09540121. |
[ 3 ] | American Academy of Pediatrics. (2012). Male Circumcision. Task Force on Circumcision. Pediatrics. Retrieved From http://pediatrics.aappublications.org/content/130/3/e756. |
[ 4 ] | Atashili, J. (2006). Adult Male Circumcision to Prevent HIV. International Journal of Infectious Diseases, 10(3) 202-205. |
[ 5 ] | Auvert, B., Ballard, R., Campbell, C., Caraël, M., Carton, M., Fehler, G., Gouws, E., MacPhail, C., Taljaard, D., Van Dam, J., & Williams, B. (2001). HIV Infection among Youth in a South African Mining Town is Associated with Herpes Simplex Virus-2 Seropositivity and Sexual Behaviour. Journal of AIDS, 15(7) 885–898. |
[ 6 ] | Auvert, B., Taljaard, D., Lagarde, E., Sobngwi-Tambekou, J., Sitta, R., & Puren, A. (2005). Randomized Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial. Journal of Medicine, 2(11)1112-1122. |
[ 7 ] | AVAC. (2010). Making Medical Male Circumcision work for Women. Retrieved from http://www.avac.org/ht/a/GetDocumentAction/i/31646. |
[ 8 ] | Babbie, E. (2006). Conducting qualitative field research. In The practice of social research (11th ed.). U. S. A.: Thomson Wadsworth. |
[ 9 ] | Bailey, R. C., Moses, S., Parker, C. B., Agot, K., Maclean, I., Krieger, J. N., Williams, C. F., Campbell, R. T., & Ndinya-Achola, J. O. (2007). Male Circumcision for HIV Prevention in Young Men in Kisumu, Kenya: A Randomised Controlled Trial. Lancet, 369(9)643-56. |
[ 10 ] | Bailey, R. C., Plummer, F. A., & Moses, S. (2001). Male circumcision and HIV Prevention: Current Knowledge and Future Research Directions. The Lancet Infectious Diseases, Vol.1 No.4: pp 223-232. |
[ 11 ] | Bailey, R. C., Muga, R., Poulussen, R., & Abicht, H. (2002). The Acceptability of Male Circumcision to Reduce HIV Infections in Nyanza Province, Kenya. Journal of AIDS Care, Vol.14. No.1: pp27–40. |
[ 12 ] | Bandura, A. (1992). Social Cognitive Theory and Exercise of Control over HIV infection. In M. H., DiClemente, R. J., & Peterson, J. L (Eds.). 1994. Preventing AIDS; theories and Methods of Behavioural Interventions. |
[ 13 ] | Berglund, C. (2007). Ethics for Health Care. Retrieved from https://elibrary.utas.edu.au/utas/file/1dbc2063-2a6c-4fcb-9e001079e6b231ae/1/Berglund,%20C% 202007,%20Ethics%20for20Health%20Care, 3rd%20ed.%20Oxford%20University%20Press,%20 Melbourne.%20pp.%2088-113..pdf. |
[ 14 ] | Bonner, K. (2001). Male Circumcision as an HIV control strategy: not a ‘natural condom’. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11765391. |
[ 15 ] | Bowa, K. (2006) Strategies and approaches for male circumcision programming. WHO meeting report: Strategies and Approaches for MC Programming, Geneva, and 5-6 December 2006. |
[ 16 ] | Brito, M. O., Luna, M., and Bailey, R. C. (2010). The Feasibility and Acceptability of Male Circumcision among Men, Women, and Health Providers of the Altagracia Province, Dominican Republic. AIDS Care, 22(12): 1530-1535. |
[ 17 ] | Brito, M. O., Caso, L. M., Balbuena. H, Bailey, R. C. (2009). Acceptability of Male Circumcision for the Prevention of HIV/AIDS in the Dominican Republic. PLoS ONE, 4(11): e7686-e7687. |
[ 18 ] | Burns, N., and Grove, S. K. (2011). The practice of nursing research: Appraisal, synthesis, and generation of evidence. St. Louis, MO: Saunders Elsevier. |
[ 19 ] | Burns, R. B., & Burns, R. A. (2008). Business Research Methods and Statistics Using SPSS. Journal of small business, 43(4) 368-381. |
[ 20 ] | Castellsague, X., Bosch, F. X., Munoz, N., Meijer, C. J. L. M., Shah, K. V., De Sanjose, S., Eluf-Neto, J., Ngelangel, C. A., Chichareon, S., Smith, J. S., Herrero, R. & Franceschi, S. (2002). Male Circumcision, Penile Human Papillomavirus Infection and Cervical Cancer in Female Partners. The New England Journal of Medicine. Vol.6 No.15: pp1105-12. |
[ 21 ] | Chikutsa, A. (2011). Contextualizing the adoption of MC as an HIV prevention strategy in Zimbabwe. Retrieved December 17, 2012, from http://uaps2011princeton.edu/papers/110446. |
[ 22 ] | Churchill, G. A. (2004). Marketing Research: Methodological Foundations. New York: Saunders College. |
[ 23 ] | Cichocki, M. R. N. (2008). Circumcision Reduces the Risk of HIV Infection: How Surgery Can Protect Against HIV. [Online], Available: http://aids.about.com/od/HIVprevention/a/circuMCision.htm. [Downloaded: 04/25/09 10: 06 AM]. |
[ 24 ] | Cooper, D. R., & Schindler, P. S.(2006). Marketing Research. New York: McGraw Hill. |
[ 25 ] | Creswell, J. W. (2013). Research Design: Qualitative, Quantitative and Mixed Methods Approaches. London: Sage Publications. |
[ 26 ] | De Vincenzi, I. &Mertens, T. (1994). Male Circumcision: A Role in HIV Prevention. AIDS, 8 (2)153-60. |
[ 27 ] | Dempsey, P. A., & Dempsey, A. D. (2004). Nursing Research and Basic Statistical Applications.3RD Edition. Jones and Bartlett: Boston. |
[ 28 ] | DHS. (2006). Demographic and Health Surveys: MEASURE DHS. Health Transition Review.7: 337-359. |
[ 29 ] | Doyle, D. (2005). Ritual Male Circumcision: A Brief History. Journal of Royal College of Physicians Edinburgh. Vol.2. No.5: pp279-85. |
[ 30 ] | Doyle, S. M., Kahn, J. G., Hosang, N., & Carroll, P. R. (2010). The Impact of Male Circumcision on HIV Transmission. The Journal of Urology, 183(1)21-26. |
[ 31 ] | Esfeld. (2003). What are Social Practices? Retrieved from www.unil.ch/webdav/site/philo/shared/DocsPerso/EsfeldMichael/.../Indaga03.pdf. |
[ 32 ] | Filho, W. L. Úbelis, A. and Bērziņa, D. (2015). Sustainable Development, Knowledge Society and Smart Future Manufacturing. |
[ 33 ] | Fink, A. J. (1989). New Born Circumcision: A Long-Term Strategy for AIDS Prevention. Journal of the Royal Society of Medicine, 8(3) 695-95. |
[ 34 ] | Fishbein, M., Middlestadt, S. E., & Hitchcock, P. J. (1991). Using information to change sexually transmitted disease-related behaviours: An analysis based on the Theory of reasoned Action. In M. H., DiClemente, R. J., & Peterson, J. L (Eds.). Preventing AIDS; theories and Methods of Behavioural Interventions. |
[ 35 ] | Gasasira, R. A., Sarker, M., Tsague, T., Nsazimana, S., Gwiza, A., Mbabazi, J., Karema, C., Asiimwe, A., Mugwanez, P. (2010). Determinants of circumcision and willingness to be circuMCised by Rwandan men. Retrieved on from http://www.biomedcentral.com/1471-2458/12/134. |
[ 36 ] | Gray, R., Kiwanuka, N., Quinn, T., Sewankambo, N., Serwadda, D., Mangen, F., Lutalo, T., Nalugoda, F., Kelly, R., Meehan, M., Chen, M., Li, C., &Wawer M (2000). Male Circumcision and HIV Acquisition and Transmission: Cohort Studies in Rakai, Uganda. Rakai Project Team. AIDS, 14 (15) 2371-2381. |
[ 37 ] | Gray, R. H., Kigozi, G., Serwadda, D., Makumbi, F., Watya, S., Nalugoda, F., Kiwanuka, N., Moulton, L. H., Chaudhary, M. A., Chen, M. Z., Sewankambo, N. K., Wabwire-Mangen, F., Bacon, M. C., Williams, C. F. M., Opendi, P., Reynolds, S. J., Laeyendecker, O., Quinn, T. C., &Wawer, M. J. (2007). Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet, 369 (9562) 657-666. |
[ 38 ] | Hair, F. J., Wolfinbarger, M., Ortinau, D. J., & Bush R. P. (2008). Essentials of Marketing Research. New York: McGraw-Hill/Irwin. |
[ 39 ] | Halperin, D. T., Fritz, K., MC Farland, W. &Woelk, G. (2005). Acceptability of Adult Male Circumcision for Sexually Transmitted Disease and HIV Prevention in Zimbabwe. Sexually Transmitted Diseases, 32 (4)238–39. |
[ 40 ] | Herman-Roloff, A., Otieno, N., Agot, K., Ndinya-Achola, J., & Bailey, R. C. (2011). Acceptability of Medical Male Circumcision among Uncircumcised Men in Kenya One Year after the Launch of the National Male Circumcision Program. PLOS ONE, 6(5): 1-6. Retrieved December 12, 2012 from PLOS ONE. |
[ 41 ] | Hinkle, J. L & Cheever, H. K.( 2008). Brunner and Suddarth’s textbook of medical-surgical nursing. Retrieved from www.abebooks.com/.../Brunner-Suddarths-Textbook-Medical-Surgical-Nursing http://www.malecircuMCision.org/programs/documents/Kenya_VMMC_Communication_Strategy.pdf. |
[ 42 ] | Johnson, R. B., Onwuegbuzie, A. J. and Turner, L. A. (2007). Toward a Definition of Mixed Methods Research. Journal of Mixed Methods Research, 17(3) 143-148. |
[ 43 ] | Joubert, G., & Ehrlich, R. (2007). Epidemiology a research manual for South Africa.2ndedition. Cape Town: Oxford University Press. |
[ 44 ] | Kebaabetswe, P., Lockman, S., Mogwe, S., Mandevu, R., Thior, I., Assex, M. & Shapiro, R. L. (2003). Male Circumcision: An Acceptable Strategy for HIV Prevention in Botswana. Sexual Transmitted Infections, 79(3) 214-19. |
[ 45 ] | Kelly, R., Kiwanuka, N., &Wawer, M. J. (1999). Age of Male Circumcision and Risk of the Prevalent HIV infection in Rural Uganda. AIDS. |
[ 46 ] | Kim, D., & Myung-Geol, P. (2006). The effect of male circumcision on sexuality. http://www.health.am/sex/more/the-effect-of-male-circuMCision-on-sexuality/. |
[ 47 ] | Ku, J. H., Kim, M. E., Lee, N. K. & Park, Y. H. (2003). Circumcision Practice Patterns in South Korea: Community based survey. Sexual Transmitted Infections. |
[ 48 ] | Kumar, V., Aaker, D. A., & Day, G. S. (2009). Essentials of Marketing Research. New York: John Wiley & Sons. |
[ 49 ] | Lagarde, E., Dirk, T., Puren, A., Reathe, R. T. &Bertran, A. (2003). Acceptability of Male Circumcision as a Tool for Preventing HIV Infection in a Highly Infected Community in South Africa. AIDS, 17(1)89-95. |
[ 50 ] | Londish, G. L., & Murray J. M. (2008). Significant reduction in HIV prevalence according to male circumcision intervention in sub-Saharan Africa. http://ije.oxfordjournals.org/content/37/6/1246.full.pdf+html. |
[ 51 ] | Lukobo, M. D. & Bailey, R. C. (2007). Acceptability of Male Circumcision for Prevention of HIV Infection in Zambia. AIDS Care, 19(4)471-77. |
[ 52 ] | MalhotrA, N. K. and Birks, D. (2007). Marketing Research: An Applied Approach. London: Prentice Hall. |
[ 53 ] | Marck, J. (1997). Aspects of male circumcision in sub-equatorial African culture history. Southern Africa Region: two years and counting. A sub-regional consultation Windhoek. |
[ 54 ] | Mattson, C. L., Bailey, R. C., Muga, R., Poulussen, R., & Onyango, T. (2005). Acceptability of Male Circumcision and Predictors of Circumcision preference among Men and Women in Nyanza Province in Kenya, AIDS Care, 17(2) 182-94. |
[ 55 ] | Mavhu, W., Buzdugan, R., Langhaug, L. F., Benedikt, C., Sherman, J., Laver, S. M., Mundida, O., Woelk, G., & Cowan, F. M., (2011). Prevalence and factors associated in knowledge of the willingness for MC in rural Zimbabwe. Tropical Med Int Health 16(5) 589-597. |
[ 56 ] | McCoombe, S. G., &Short, R. V. (2006) Potential HIV-1 target cells in the human penis. AIDS 20, 1491–1495. |
[ 57 ] | McDaniel, C., & Gates, D. (2010). Marketing research essentials. Cincinnati Ohio: South Western College. |
[ 58 ] | Mellish, J. M., Brink, H. & Paton, F. (2007). Teaching and Learning the Practice of Nursing. 4th edition. Durban: Butterworth’s. |
[ 59 ] | Ministry of Health and Social Services. (2008). Namibia Demographic and Health Survey 2006-07. Windhoek: Ministry of Health and Social Services. |
[ 60 ] | Ministry of Health and Social Services. (2008c). Namibia Demographic and Health Survey 2006-07. Windhoek: Ministry of Health and Social Services. |
[ 61 ] | Ministry of Health and Social Services. (2009). HIV/AIDS in Namibia: Behavioural and Contextual Factors Driving the Epidemic. Windhoek: Ministry of Health and Social Services. |
[ 62 ] | Ministry of Health and Social Services.(2008d). Desk Review on Male Circumcision in Namibia. Windhoek: Ministry of Health and Social Services. |
[ 63 ] | Mlewa. (2013). Acceptability of medical male circumcision among uncircumcised young men at Mansa College of Education, Zambia: influence of perceptions about effects on male sexuality. Retrieved from file:///C:/Users/rutendo/Downloads/mlewa_acceptability_2013%20(3).pdf. |
[ 64 ] | Morris, B. J. (2007). Why Circumcision is a Biomedical Imperative for the 21st Century. Bio Essays, 11 (29)1147-58. |
[ 65 ] | NAC. (2016). Malawi voluntary medical male circumcision communication strategy. RetrievedFromhttps://www.malecircuMCision.org/sites/default/files/document_library/VMMC_Communication_Strategy_for_Malawi_December_2012_FINAL.pdf. |
[ 66 ] | Namibia June 9-10 2009. Retrieved From: http://www.who.int/HIV/pub/malecircuMCision/cntry_experiences_se_africa_06.09.09.pdf (accessed 04 April 2016). |
[ 67 ] | Ngalande, R. C., Kapondo, L. J., & Bailey, R. C. (2006). Acceptability of Male Circumcision for Prevention of HIV Infection in Malawi. AIDSBehav, 10(4)377–385. |
[ 68 ] | Ngalande, R. C., Levy, J., Kapondo, C. P. & Bailey, R. C. (2006). Acceptability of Male Circumcision for Prevention of HIV Infection in Malawi. AIDS Behaviours, 10(4)377- 85. |
[ 69 ] | Nnko, S., Washija, R., Urassa, M. &Boerma, T. (2001). Dynamics of Male Circumcision Practices in Northwest Tanzania. Sexually Transmitted Diseases, 28(4) 214–218. |
[ 70 ] | Nonaka, I. and Toyama, B. (2006). Creating Sustainable Competitive Advantage through Knowledge-Based Management. |
[ 71 ] | Pappas-DeLuca, K. A., Simeon, F. and Kustaa, F. (2008). Preliminary Results of the Report on Findings from Qualitative Research on Male Circumcision in Namibia: Unpolished report. Windhoek: Ministry of Health and Social Services. |
[ 72 ] | Papu, J. &Verster, P. (2006). A Biblical, Cultural and Missiological Critique of Traditional Circumcision among Xhosa-Speaking Christians. ActaTheologica, 2, 178- 198. |
[ 73 ] | Patsika., & Chitura, M.(2004). Nursing Research in Practice. Module NSD209. Harare: Zimbabwe Open University. |
[ 74 ] | Patterson, B. K., Landay, A., Seigel, J. N., Flener, Z., Pessis, D., Chaviano, A. & Bailey, R. C. (2002). Susceptibility to Human Immunodeficiency Virus-1 Infection of Human Fore Skin and Cervical Tissue Grown in Explant Culture. The American Journal of Pathology, 161 (3) 867-73. |
[ 75 ] | Pierotti, R. S., & Thornton, R. (2012). Contemplating Circumcision for HIV Prevention in a Low-Uptake Environment in Malawi. University of Michigan. Unpublished. |
[ 76 ] | Plank, R. M., Makhema, J., Kebaabetswe, P., Hussein, F., Lesetedi, C., Halperin, D., Bassil, B., Shapiro, R., &Lockman, S. (2010) Acceptability of Infant Male Circumcision as Part of HIV Prevention and Male Reproductive Health Efforts in Gaborone, Botswana, and Surrounding Areas. AIDS Behave, 14 (5)1198–1202. |
[ 77 ] | Polit, D.,& Hungler, B. (2006). Essentials of nursing research: methods, appraisal, and utilization (4th ed). J. B. Lippincott Company: Philadelphia, Pennsylvania, USA. |
[ 78 ] | Rain-Taljaard, R. C., Lagarde, E., Taljaard, D. J., Campbell, C., MacPhail, C., Williams, B. &Auvert, B. (2003). Potential for an Intervention Based on Male Circumcision in a South African Town with High Levels of HIV Infection, AIDS CARE, 15(3)315-/327. |
[ 79 ] | Rasool, R., Sameer, A. S., &Saddiqi, M. U. (2011). Male Circumcision: It’s Role in HIV Prevention. Journal of Institute of IntergrativeOmics and Applied Biotechnology, 2(5)19-24. |
[ 80 ] | Rennie, S., Muula, S. A. &Westreinch, D. (2007). Male Circumcision and HIV Prevention: Ethical, Medical and Public Health Tradeoffs in Low-Income Countries. Journal of Medical Ethics, 33(10) 357-61. |
[ 81 ] | Rizvi, S. A. H., Naqvi, S. A. A., Hussain M. &Hasan, A. S. (1999). Religious Circumcision: A Muslim View. British Journal of Urology International, 83(1) 13–16. |
[ 82 ] | Rosenstock, I. M., Strecher, V. J, & Becker (1974). Health Belief Model and HIV risk Behaviour Change. In M. H., DiClemente, R. J., & Peterson, J. L (Eds.). 1994. Preventing AIDS; theories and Methods of Behavioural Interventions.(pp. 5-22). |
[ 83 ] | Salokoski, M. (2006). How Kings are Made - How Kingship Changes: A study of Rituals and Ritual Change in Pre-Colonial and Colonial Owamboland, Namibia. Helsinki: Helsinki University Press. |
[ 84 ] | Sarantakos, S. (1998). Social Research- 2nd Edition. New York: Palgrave Macmillan. |
[ 85 ] | Sawires, S. R., Dworkin & Coates, T. J. (2007). Male circumcision and HIV/AIDS: challenges and opportunities, Retrieved on 2ndMay2012, from http://www.unaidsrstesa.org/sites/default/files/malecircuMCision/circuMCision_and_HIV-challenges _and_ opportunities_articles.pdf. |
[ 86 ] | Schoen, J. E. (1997). Benefits of New Born Circumcision: Is Europe Ignoring Medical Evidence? ArcHIVes of Disease in Childhood, 77 (1)258-260. |
[ 87 ] | Scott, B. E., Weiss, H. A. &Viljoen, J. I. (2005). The Acceptability of Male Circumcision as an HIV Intervention among a Rural Zulu population in KwaZulu-Natal South Africa. AIDS Care, 17(3)304-313. |
[ 88 ] | Shammout, A. B. 2007. Evaluating an Extended Relationship Marketing Model for Arab Guests of Five-Star Hotels. Unpublished Doctoral Thesis. Melbourne, Australia: Victoria University. |
[ 89 ] | Sigfried N, Muller M, Volmink J, Deeks J, Egger M, Low N, Weiss H, Walker S, Williamson P,.(2003). Male circumcision for prevention of heterosexual acquisition of HIV in men (Review) retrieved from http://apps.who.int/rhl/reviews/CD003362.pdf. |
[ 90 ] | Szabo, R. & Short, R. V. (2000). How Does Male Circumcision Protect Against HIV Infections? British Medical Journal, 320(7249) 159-294. |
[ 91 ] | Tarimo, E. A. M., Francis, J. M., Kakoko, D., Munseri, P., Bakari, M., &Sandstrom, E. (2012). The Perceptions on Male Circumcision as a Preventive Measure against HIV. |
[ 92 ] | Treece, E. W., & Treece, J. W. (2006). Elements of research in nursing (3rd Edition). St. Louis, MO: Mosby. |
[ 93 ] | Tustin, D., Lighthelm, A. A., Martins, J. H. & Van Wyk, J. H. (2010). Marketing Research in Practice. Pretoria: UNISA Press. |
[ 94 ] | UNAIDS. (2006). 2006 Report on the global AIDS epidemic A UNAIDS 10th anniversary special edition. Retrieved from http://data.unaids.org/pub/Report/2006/2006_gr_en.pdf. |
[ 95 ] | UNAIDS. (2006). Male Circumcision: Africa’s Unprecedented Opportunity. Retrieved September 30, 2012, from http://www.unaidsrstesa.or/site/default/files/malecircumsicion/MC_africa-opp-en.pdf. |
[ 96 ] | UNAIDS. (2012). Global report, AIDSinfo. Retrieved from http://www.unaids.org/en/resources/campaigns/20121120_globalreport2012/globalreport |
[ 97 ] | UNAIDS.(1999). Sexual behavioural change for HIV: Where have theories taken us? |
[ 98 ] | Urassa, M., Todd, J, Boerma, T., Hayes, R. &Ising, R. (1997). Male Circumcision and Susceptibility to HIV Infection among Men in Tanzania. AIDS, 11(1) 73-80. |
[ 99 ] | Van Dam, J., &Anastasi, M. C. (2000). Male Circumcision and HIV Prevention: Direction for Future Research. Retrieved from http://www.popcouncil.org/pdfs/circuMCision.pdf. |
[ 100 ] | Van Der Merwe, M. C. (2003). Marketing communication methods used by Tour operators in Gauteng. Unpublished Masters dissertation. University of South Africa. |
[ 101 ] | VMMC. (n.d.). Communication Strategy for Voluntary Medical Male Circumcision in Kenya. Retrieved November 14, 2012, from 78. |
[ 102 ] | Wambura, M., Mwanga, J., Mosha, J., Mshana, G., Mosha, F., & Changalucha, J. (2009). Situation Analysis for Male Circumcision in Tanzania. Retrieved March 21, 2012, from http://www.malecircuMCision.org/programs/documents/TanzaniaMaleCircuMCisionSituationAnalysis_September_09.pdf. |
[ 103 ] | Wambura, M., Mwanga, J., Mosha, J., Mshana, G., Mosha, F., & Changalucha, J (2011). Acceptability of medical male circumcision in the traditionally circuMCising communities in Northern Tanzania. Retrieved from http://www.biomedcentral.com/1471-2458/11/373. |
[ 104 ] | Weiss, H. A., Quigley, M. A. & Hayes, R. (2000). Male Circumcision and Risk of HIV Infection in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. AIDS, 14(15) 2361-70. |
[ 105 ] | Wester-camp, M., Agot, K. E., Ndinya-Achola, J., & Bailey, R. C. (2011). Circumcision Preference among women and uncircumcised men prior to scale-up of male circumcision for HIV prevention in Kisumu, Kenya. |
[ 106 ] | Wester-camp, N. & Bailey, R. C. (2007). Acceptability of Male Circumcision for Prevention of HIV/AIDS in Sub-Saharan Africa: A Review. AIDS Behavior, 11(3) 341- 55. |
[ 107 ] | Westercamp, N., & Bailey R. C. (2006). Acceptability of male circumcision for prevention of HIV/AIDS in sub-Saharan Africa: a review. In AIDS Behaviour. 2007; 11 (3)341-55, from http://fhinow/cbd/tsru/quickerLibrary/Westercamp-acceptability of MC.pdf. |
[ 108 ] | WHO & UNAIDS. (2007). Male circumcision Global Trends and Determinants of Prevalence, Safety and Acceptability. Geneva: World Health Organization and Joint United Nations Programme on HIV/AIDS. |
[ 109 ] | WHO. (2007). WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention. Retrieved From: |
[ 110 ] | WHO. (2009). Country experiences in the scale-up of male circumcision in the Eastern and Wilson, D., & De Beyer, J. (2006). Male Circumcision: Evidence and Implications. Retrieved September 23, 2012, from http://siteresources.worldbank.org/INTHIVAIDS/Resources/3757981132695455908/M&EGR_MaleCircuMCision_Mar31.pdf. |
[ 111 ] | Wiswell, T.E. (2000). The prepuce, urinary tract infections, and the consequences. Journal of Pediatrics, 105(5)860–862. |
[ 112 ] | World Health Organization &UNAIDS. (2007b). Male circumcision Global Trends and Determinants of Prevalence, Safety and Acceptability. Geneva: World Health Organization and Joint United Nations Programme on HIV/AIDS. |
[ 113 ] | Zikmund, W.G. & Babin, B.J. (2010).Essentials of Marketing Research, 3rd Ed. Ohio: Thomson South-Western. |