Voluntary medical male circumcision and condoms for HIV prevention among school youth: marginal voices for a coherent sexual and reproductive school health policy in Zimbabwe.

Abstract

Background: Voluntary medical male circumcision (VMMC) is a component of HIV prevention. It is important to the HIV prevention agenda in priority settings; characterised by hyper endemic and generalised epidemics coupled with low percentages of circumcised males. Literature relating to school youth vis-à-vis VMMC and condoms is sorely missing. The study sought to fill this gap. Method: The study adopted a qualitative research design and an interpretivist paradigm. It used focus group discussions (FGDs) with learner participants, and key informant interviews (KIIs) with adults drawn from four schools (two per district: Mberengwa and Zvishavane). Seven sex-segregated FGDs were conducted. In terms of KIIs, a total of nine adults participated in one-on-one in-depth interviews. Adult participants were either Guidance and Counselling educators or health workers. Seven educators and two health workers participated in the KIIs. Data were thematically analysed. Findings: Both FGDs and KIIs produced rich and thick data indicating that school learners have limited knowledge and comprehension of basic facts related to HIV and AIDS. Many of the learner participants were ignorant of facts around VMMC for HIV prevention. Findings suggest that the acceptability of VMMC is high, but there is need for improving access to VMMC services. Furthermore, the need to make VMMC more comprehensive through increasing access to condoms and robust sex education, were some of the prominent findings. The study revealed that HIV prevention options, particularly for female learners were too limited, and those for boys were largely fragmented. Participants also identified several challenges that confront educators, the education system, and other stakeholders in their attempt to mitigate HIV among school adolescents, and adolescent sexual and reproductive health. These include a discriminatory, judgmental and narrow focused legal and policy framework. Conclusion: The study’s findings suggest that learners tend to prefer risk reduction methods to risk avoiding strategies such as abstinence. As such, most of the learner participants framed abstinence as being Utopian. Both data sets advance a discourse of a rights-based approach to adolescent sexual and reproductive health that is not dismissive of the agency of young people in enhancing sexual health and well-being.