Haiti has more than 120,000 people living with HIV, the most in the Caribbean region. Such statistics suggest that beyond additional HIV education and condom promotion, there is a compelling need to integrate new HIV prevention strategies that have recently gained consensus and evidence of efficacy. One approach that the Government of Haiti is considering is newborn medical male circumcision (NMMC). While NMMC could generate significant reduction in future HIV/STI transmission in Haiti, its effectiveness depends on widespread access and population-level uptake. How best to increase uptake among parents of newborn males, particularly in Haiti, has not been explored. However, the determinants of health decisions in resource-limited settings are increasingly being elucidated. One model, the integrative model of behavioral prediction, posits that the key factors include individual attitudes, community norms and self-efficacy. These factors can be strengthened and modified to increase an individual's intent and behavioral action. Our group has successfully used this model to create a video-based educational intervention that reduced the rate of new STIs in clinic patients in the U.S. We will adapt that model and the intervention development process to address uptake of NMMC among parents of newborn boys in urban Haiti by developing and pilot testing a brief video based educational intervention to promote NMMC. The proposed study is innovative and is likely to have high public health importance because this will be the first study to test acceptability of NMMC for future HIV/STI prevention in Haiti.
The World Health Organization and the American Academy of Pediatrics have endorsed the safety and long- term benefits of newborn medical male circumcision (NMMC), and international HIV prevention policy making institutions have advocated further research on its promotion and integration in countries highly affected by the HIV epidemic. This is very much the case in Haiti, which has the most people living with HIV in the Caribbean. Thus, there is a critical need for low cost strategies to slow the HIV epidemic, and increased demand for and participation in interventions like NMMC has large public health implications.