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Citation Information

Type Journal Article - AIDS and Behavior
Title How informed are clients who consent? A mixed-method evaluation of comprehension among clients of male circumcision services in Zambia and Swaziland
Volume 17
Issue 6
Publication (Day/Month/Year) 2013
Page numbers 2269-2282
URL http://link.springer.com/article/10.1007/s10461-013-0424-1
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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