Current Joint United Nations Programme on HIV/AIDS (UNAIDS) statistics show that 68% of total HIV infections occur in sub-Saharan Africa (SSA) . Despite of the availability of already known HIV prevention methods, most new infections continue to occur in this region . Recently, three randomized controlled trials in African countries have demonstrated that medical male circumcision reduces the risk of acquiring sexually transmitted infections (STIs), including HIV, from infected women to uninfected men by about 60% [2–4]. The World Health Organization (WHO) and UNAIDS estimate that approximately 30% of males aged 15 years or older are circumcised globally, and two thirds are Muslims . In addition, the report shows that ethnicity and social- or health-related factors are determinants of male circumcision, and that male circumcision is almost universal in North and most of West Africa. On the contrary, male circumcision is less common in South Africa (SA)  where the national HIV prevalence and male circumcision in SA is 18.1% and 35% respectively . In line with the benefits of male circumcision, recently, population-based data from Orange Farm in SA have shown lower HIV prevalence and incidence among circumcised men compared to uncircumcised men . Thus, WHO and UNAIDS have widely recommended the scaling up of male circumcision activities in countries and regions with heterosexual epidemics with high HIV and low male circumcision prevalence [1, 8]. It is emphasised that as male circumcision only provides partial protection of male acquisition of HIV, it should not replace other existing biomedical and behavioural interventions. Furthermore, male circumcision has proven to be effective in reducing the risks of penile cancer  and cervical cancer in female partners of circumcised men [10, 11], urinary tract infections in infants and children , ulcerative STIs , bacterial vaginosis and trichomonas among female partners of circumcised men . One of the potential challenges in adopting male circumcision in African communities as an HIV intervention strategy may be the lack of awareness that it could minimize risks of HIV transmission.
In Tanzania, the national HIV prevalence is 5.6% , and there is great regional heterogeneity with adult HIV prevalence ranging from 1% to 15% . Similarly, the prevalence of male circumcision in Tanzania was estimated to be 70% , with some regions having a greater than 95% circumcision rate, while others are as low as 24% . The reasons for the geographical differences could be that male circumcision is influenced by culture, traditions and religion . For regions where male circumcision is mainly done for cultural reasons, about 75% of men are circumcised . In a draft proposal on national strategy for scaling up male circumcision for HIV prevention, the government of the United Republic of Tanzania set a goal of 80% Voluntary Medical Male Circumcision (VMMC) coverage . This strategy prioritizes eight regions of relatively high HIV rates and low male circumcision prevalence, and men aged 10–24 years and 25–34 years are targeted as the primary and secondary priority groups respectively.
There have been many efforts to mitigate the increasing and devastating impact of HIV and AIDS in Tanzania. Initial efforts were directed to HIV prevention as well as reducing the personal and social impact of the epidemic . This was based on Information, Education, and Communication (IEC) campaigns that were regarded as vital in improving people’s knowledge, attitudes and practices on HIV prevention. Additionally, voluntary HIV counselling and testing (VCT) was introduced as a strategy for preventing HIV transmission . The target of the government has been to encourage people who are HIV negative to take definitive steps to avoid becoming infected and for those who are HIV infected to receive the necessary counselling to cope with their status and prolong their life without infecting sexual partners who are negative. Accessibility to antiretroviral therapy (ART) that prolongs life of infected people and reduces the risk of HIV transmission has been a priority, although to date, only 30% of people with advanced HIV infections are able to access ART . For those who are HIV negative, male circumcision has been advocated as an important strategy to complement the existing biomedical prevention methods to reduce HIV transmission from infected women to uninfected men [2–4].
The purpose of this article is therefore to understand the perceptions of male circumcision as a potential strategy against HIV transmission by recruiting members of the Police Force in Dar es Salaam. Members of the police force are heterogeneous as they come from different ethnic groups and religious backgrounds. A previous study showed that the prevalence of HIV in the police force was comparable to that in the general population . Findings from this study will provide an understanding to enable better planning for the scale-up of male circumcision and therefore provision of a holistic HIV prevention package.
The analysis of the data is informed by principles of content analysis guided by socio-ecological model (SEM). The SEM is an approach to health promotion that offers a broad perspective that includes a comprehensive approach integrating multiple levels of influence to impact health behaviour and ultimately health outcomes [22–24]. Improving the health of vulnerable populations may require interventions that target multiple levels of influence [23, 25]. In the present study, SEM is used as an analytic tool. The findings are synthesised in the model to acknowledge both personal and environmental influences that will inform the development of targeted interventions , specifically the promotion of medical male circumcision.