How informed are clients who consent? a mixed-method evaluation of comprehension among clients of male circumcision services in Zambia and Swaziland
Friedland, B.A.; Apicella, L.; Schenk, K.D.; Sheehy, M.; Hewett, P.C.
Aids and Behavior 17(6): 2269-2282
2013
ISSN/ISBN: 1573-3254 PMID: 23392912 DOI: 10.1007/s10461-013-0424-1Document Number: 574800
Comprehension is fundamental for informed consent--an individual's right to choose a medical procedure, such as male circumcision (MC). Because optimal benefits depend on post-surgical behaviors, comprehension is particularly critical for MC programs. We evaluated clients' comprehension of MC's risks and benefits, wound care instructions, and risk reduction post-MC using a true/false test (n = 1181) and 92 semi-structured interviews (SSIs) in Zambia and Swaziland. Most participants (89% Zambia, 93% Swaziland) passed the true/false test, although adolescents scored lower (significantly so in Swaziland) than adults and one-third (including nearly half of adolescents in Zambia) said MC has no risks. SSIs indicated confusion between "risk" of adverse surgical outcomes and reduced "risk" of HIV; most respondents acknowledged the 6 week abstinence period post-MC, yet few said resuming sex early increases HIV risk. Providers should distinguish between surgical "risks" and reduced HIV "risk," and emphasize that HIV risk increases with sex before complete healing.
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