Willing and Able: Talking about sexual heath during male circumcision research in Papua New Guinea

Papua New Guinea is the largest land mass and population in Melanesia. The population experiences myriad health and social challenges including: poverty, violence, maternal mortality, intimate partner violence, malaria, TB, and Sexually Transmitted Infections including HIV. Against a background of government directed closure of social marketing for condoms, constitutional religious sensibilities, a health department official calling for 'adultery to be made a criminal act', and a purported position that it is culturally difficult to discuss the intimate, we highlight evidence that when people are provided a safe and confidential context they do openly talk about sexual health concerns. We outline how, during data collection for the 'Acceptability of Male Circumcision for HIV Prevention in PNG' study (data presented elsewhere), male participants were asked for a clinical examination and photo of their penis in order to verify circumcision status reported in the study questionnaire. Men were also given the opportunity to speak with a sexual health clinician with or without the clinical examination. We describe the high acceptance rate of clinical examination and photography of men volunteering for the study, and outline the various sexual health concerns that men presented with. Implications for health service delivery and sexual health research are discussed including: the unmet need for sexual health services, the enthusiastic acceptance to engage in clinical examination and the willingness to talk openly about sexual health concerns