Consent for Comprehension Assessment with Adult Men … · Email: [email protected] The UNZA Ethics Committee: Ridgeway Campus PO Box 50110 Lusaka, Zambia Tel:256067 Fax: +260

Consent for Comprehension Assessment with Adult Men Preparing for Circumcision Title of the research “Evaluation of the informed consent process for male circumcision roll-out in Zambia and Swaziland” Purpose of the study Hello, my name is……………….. I work at…………………... The Population Council, a non-profit research organization based in New York, is doing a study about informed consent for male circumcision. I have been hired by the Population Council to administer a questionnaire to men who have gone through the informed consent process but have not yet undergone male circumcision. We want to find out how well men understand the male circumcision procedure before agreeing to it and how that process could be improved in the future. Study steps We will be interviewing men from different clinics in X [fill in name of country] where male circumcision is offered. Men will be interviewed at the clinic after going through the informed consent process, but before they have been circumcised. If you agree to take part in this interview, it will last about 10-15 minutes. I will read you a series of statements and ask you to tell me whether you think each one is true or false. After our interview, you will then go to the provider who will perform the MC surgery. It is your choice to take part in this interview or not. If you choose to be interviewed, you can decide not to answer any of the questions you are asked. You can also choose to stop the interview at any time. Whether or not you agree to take part in this interview, it will not affect your medical care at the clinic now or in the future. Confidentiality The answers that you give will be entered into a computer but will not be linked with your name. The only place your name will be written down is on this informed consent form. All information you provide will be kept in a locked file and your name will never be used in the research reports. Discomforts and risks You may feel uncomfortable talking about male circumcision, HIV and other sensitive topics. You may also refuse to answer any question, or any part of a question, at any time. Compensation You will not be charged, nor will you be paid for participating in this study. Benefits Taking part in this interview has no direct benefits for you; however we will provide you with the correct answers to our questions. Your interview will help us find out more about men’s experiences with male circumcision and the counseling and informed consent process. What we learn in this study may help to improve the informed consent process for male circumcision services in the future. Offer to answer questions and freedom to withdraw from the study If you have questions about the study you may ask them now or you can call: [Fill in information for each site] If you don’t have any questions and agree to take part in this study then I will ask you to sign this form stating that I, the interviewer, have informed you of your rights as a research participant and that you have agreed to be interviewed today. This is the only place where

your name will be written down. If you do not wish to sign your name, you may simply mark the space with an ‘X’ or use a thumb print. If you have any questions after we speak with you today, please contact: Kelvin Munjile Study Coordinator and Supervisor Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Paul Hewett, Ph. D Director of Male Circumcision Program Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Email: [email protected] The UNZA Ethics Committee: Ridgeway Campus PO Box 50110 Lusaka, Zambia Tel:256067 Fax: +260 1 250753 [email protected] or [email protected]

Participant's statement THE INTERVIEW HAS BEEN EXPLAINED TO ME. I HAVE BEEN GIVEN A CHANCE TO ASK ANY QUESTIONS I MAY HAVE. I AM CONTENT WITH THE ANSWERS TO ALL OF MY QUESTIONS. I ALSO KNOW THAT:

• MY RECORDS WILL BE KEPT PRIVATE AND CONFIDENTIAL; • I CAN CHOOSE NOT TO BE INTERVIEWED, NOT TO ANSWER CERTAIN QUESTIONS, OR TO

STOP THE INTERVIEW AT ANY TIME; • IF I REFUSE TO BE INTERVIEWED, IT WILL NOT AFFECT MY REGULAR MEDICAL CARE AT THE

CLINIC TODAY OR IN THE FUTURE. We thank you for your time. If you need to ask us any further questions after the discussion, please contact: [fill in name, contact number for each clinic] Name of participant (print): __________________________________ __________ __________________________________ Date Signature or Mark of Participant _______________ __________________________________ Date Signature of Witness (if participant is illiterate) Interviewer’s statement I, THE UNDERSIGNED, HAVE DEFINED AND EXPLAINED TO THE PARTICIPANT IN A LANGUAGE THAT HE UNDERSTANDS, THE PROCEDURES TO BE FOLLOWED, THE RISKS AND BENEFITS INVOLVED, AND THE OBLIGATIONS OF THE INTERVIEWER. Interviewer Name (Print): _________________________________________ __________ __________________________________ Date Signature of Interviewer

MC Informed Consent Study; Zambia - Bemba Last Modified: 30 Oct. 2009

Consent for Comprehension Assessment with Adult Men Preparing for Circumcision Title of the research “Kufwayilikisha ukwishiba bwino ifyo ukusumina pakusembululwa kwenda kubaume”. Purpose of the study Mulishini, ishina lyandi ninebo……………….ndabomba ku……………….. BaPopulation Council, akabungwe akabomba milimo yakufwayilikisha akashili kamakwabo kaba munchende yaku New York, balechita umulimo wakufwayilikisha pafyakuyisuminina pafyakusembululwa kwabaume. Nabampelako inchito baPopulation Council ukwipusha amepusho ali pachipepala kuli bashitata abapitile mukulanshanya kwakuyisumina abshilaya mukusembululwa. Tulefwaya kwishiba ifyo baumfwikishe inshila shakusembululwa kwabaume ilyo tabala sumina elyo ifyo iyi nshila ingaba bwino kuntanshi. Study steps Twakulalanshanya nabashitata kufuma kuclinic yapusanapusana mu X [lemba ishina lyachalo] uko balechita mulimo wakusembululwa kwabaume. Bashitata tukalalanshanya nabo kuclinic lilya bapwisha kulanshanya kwakuyisumina, ilyo tabalaya mukusembululwa. Inga mulesumina ukusendako lubali mukulanshanya uku, kwala sende fye nshita kwati 10-15 minutes. Nalamibelengelako amalembo elyo nalamilomba kuti munjebe inga muletontonkanya ati chishinka nangu bufi. Inga twapwisha mwalaya kubabomba mulimo wakusumbula kuti batwalilile ukusembulula. Kuyisalila fye mwebene ukusendeko lubali mukufwayilikisha uku nangu ukukana.Inga mwasala ukusendako lubali mukulanshanya uku, kuti mwakana ukwasuka amepusho twalamipusha. Kuti mwasala ukulesha ukulanshanya uku panshita fye iliyonse. Kusumina nangu ukukana ukusendako lubali mukufwayilikisha uku, tachakalenge ukuti muleke uksangako ubwafwilisho kuclinic nomba nangu kuntanshi. Confidentiality Amasuko mwalatupela akabikwa palicomputer ishina lyenu talyakabemo. Ishina lyenu likalembwafye pachipepala chakusumininapo. Amasuko oonse mwalatupela akabikwa munchende yakomwako elyo ishina lyenu talyakabemo mulilipoti. Discomforts and risks Kuti chamumfwisha ububi kulanda pafya kusembululwa kwamwaume, HIV elyo nafimo fimo fishupa ukulandapo. Kuti mwakana ukwasuka amepusho yamo yamo nangu mbali imo mulipusho, shita fye iliyonse. Compensation Tatwamilipilishe, nangula kumilipila mukusndako lubali mukufwayilikisha uku. Benefits Kusendako lubali mukulanshanya uku takuli icho mwala sangamo imwe; kwena twala mipela amasuko ayachine kumepusho yenu. Kulanshanya kwesu kukatwafwilisha kwishiba ifyo basitata bomfwa pafwakusembululwa kwabaume elyo nokulanshanya munkama elyo nakwisuminina. Ifyo twalasambila mukulanshanya uku kukafwilishako kuwamya milimo yakusembulwa kwabaume munshiku shakuntanshi. Offer to answer questions and freedom to withdraw from the study Inga namukwata amepusho ayakumine kukulanshanya uku mukwayi kuti mwayipusha nomba nangu ukutuma foni: [lemba ishina lyanchende]


Inga tamukwete amepusho elyo mulesumina ukusendako lubali mukufwayilikisha uku lelo nalamilomba ukuti musayine pachipepala ichi kulanda ukutila Ine, ulemipusha amepusho, ninondolola bwino bwino ifilefwayikwa ukwishiba imwe inga abalesendako lubali elyo ukutila namusumina kuti tulanshanye lelo. Pepepala apa epalalemwapo ishina lyenu fye. Inga tamulefwaya ukulemba ishina lyenu, mukwayi kuti mwalemba chi ‘X’ nangu kuti mwabomfya umunwe. Inga mwakwata amepusho lilya twapwisha kulanda nenu lelo, mukwayi moneni: Kelvin Munjile Study Coordinator and Supervisor Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Paul Hewett, Ph. D Director of Male Circumcision Program Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Email: [email protected] The UNZA Ethics Committee: Ridgeway Campus PO Box 50110 Lusaka, Zambia Tel:256067 Fax: +260 1 250753 [email protected] or [email protected]


Participant's statement NABANONDOLWELA IFYAKUFWAYILIKISHA UKU. NABAMPELAKO NENSHITA YAKWIPUSHA AMEPUSHO NKWETE. NASEKELAMO MUMASUKO BAMPELA KUMEPUSHO YANDI. ELYO NINJISHIBA UKUTI:

• AMASUKO YANDI AKATEKWAFYE MUNKAMA; • KUTI NASALA UKUKANA KUNJIPUSHA AMEPUSHO, KUSHASUKA AMEPUSHO YAMO

YAMO,OLO UKULESHA AMEPUSHO INSHITA ILIYONSE; • INGA NASALA UKUKANA KUNJIPUSHA, TACHAKALENGE UKUTI NKWATE UBWAFYA

MUKUKWATA UBWAFWILISHO KUCLINIC NOMBA OLO KUNTANSHI Twatasha sana mukutupela inshita. Inga mulefwaya ikwipusha amepusho aliyonse inga twapwisha ukulanshanya, mukwayi kuti mwamona: [lembe ishina, foni namba yaclinic] Name of participant (print): __________________________________ __________ __________________________________ Date Signature or Mark of Participant _______________ __________________________________ Date Signature of Witness (if participant is illiterate) Interviewer’s statement I, THE UNDERSIGNED, HAVE DEFINED AND EXPLAINED TO THE PARTICIPANT IN A LANGUAGE THAT HE UNDERSTANDS, THE PROCEDURES TO BE FOLLOWED, THE RISKS AND BENEFITS INVOLVED, AND THE OBLIGATIONS OF THE INTERVIEWER. Interviewer Name (Print): _________________________________________ __________ __________________________________ Date Signature of Interviewer

MC Informed Consent Study; Zambia - Nyanja Last Modified: 30 Oct. 2009

Consent for Comprehension Assessment with Adult Men Preparing for Circumcision Title of the research “Kuonesesa mwamene kuyendela kuzivomelela pavamudulidwe wamwamuna kwamene kulikuchitika muno Mu Zambia nakuSwaziland” Purpose of the study Muli bwanji, zina langa ndine……………….nisebenza ku…………………… BaPopulation Council, kabungwe kofufuza fufuza kamene sikafuna pindu kamene kali mumuzinda wa New York, bagwila nchito yofufuzafufuza pankhani yozivomelela pankhani yamudulidwe wamwamuna. Bananipasa nchito baPopulation Council kuti nizifunsa mafunso ali pachipepala kuli bazibambo, bamene banapita mukucheza mwachisinsi koma bakalibe kudulidwa. Tifuna kuziba kuti azibambo amafika pati kuziba mayendesedwe yamudulidwe wamwamuna paja bakalibe kuvomela ndipo njila iyi inga pangiwe bwanji bwino musogolo mwake. Study steps Tifunsa mafunso azibambo kuchoka kumaclinic osiyanasiyana mu X [lemba zina laziko] kwamene mudulidwe uchitiwa. Azibambo tizabafunsa bakasiliza chabe kucheza mwachisinsi koma bakalibe kuyenda kudulidwa. Ngati muvomela kutenga mbali mumafunso, chizatenga nthawi monga 10-15 minutes. niza mubelengelani malembe ali 10 na kumufunsani kuti muniuze ngati muganiza ati nizo ona olo boza. Tikasiliza mafunso, muzayenda kuli bamene bagwila nchito yamudulidwe kuti bagwile nchito yawo. Nikuzifunila mweka mukutenga mbali mumafunso olo kukana. Ngati musanka kufunsiwa, mungasankeso kusayanka mafunso ena muzafunsiwa. Munga sankenso kuyimisa mafunso nthawi ili yonse. Kuvomela olo kukana kutenga mbali mumafunso, sichizalenga kuti muleke kulandila tandizo kuclinic manje olo musogolo mwake. Confidentiality Mayanko muzatipasa tizayika pacomputer koma zina lanu sitizayika. Malo chabe azankala nazina lanu nipachipepala chovomelelapo. Mayanko onse muzatipasa azayikiwa mumalo mokomewa ndipo zina lanu sitizayisebenzesa mumalembe yalipoti. Discomforts and risks Kapena sichinga kumveseni bwino kucheza nkhani yamudulidwe wamwamuna, HIV na nkhani zinanango zovuta kukamba. Munga fune kukana kuyanka mafunso ena, olo mwina mbali ina yafunso, nthawi ili yonse. Compensation Sitizakulipilisani, kapena kukulipilani mukutenga mbali munchito iyi. Benefits Kutenga mbali mukucheza uku kulibe kulandila chilichonse monga kwayimwe. Uku kucheza kuzatitandiza kusakila kuziba vambili vokuza bazibambo na mudulidwe wamwamuna. Vamene tizapunzila lelo vingatandize kupeleka pamwamba njila kuvomela nchito zamudulidwe wamwamuna musogolo mwake. Offer to answer questions and freedom to withdraw from the study Ngati muli namafunso kukuza nchito iyi munga funse manje olo mungatume foni: [Lembani zina lamalo] Ngati mulibe mafunso ali yonse ndipo muvomelela kutenga mbali munchito iyi kansi niza kupempani kuti musayine pachipepa ichi kutantauza kuti ine, amene afunsa mafunso, naku uzani vonse vamene vifunika monga muntu amene atenga mbali ndipo kuti mwavomela kuti


nimifunseni lelo. Ichi chipepa chovomela bakulu ndiye malo eka pamene pazalembewapo zina lanu. Ngati simufuna kusayina zina lanu, mungalembe chabe chi ‘X’ olo munga se benzese chikumo. Ngati muzankala namafunso tikasiliza kukamba nayimwe lelo, chonde onani: Kelvin Munjile Study Coordinator and Supervisor Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Paul Hewett, Ph. D Director of Male Circumcision Program Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Email: [email protected] The UNZA Ethics Committee: Ridgeway Campus PO Box 50110 Lusaka, Zambia Tel:256067 Fax: +260 1 250753 [email protected] or [email protected]


Participant's statement BANIFOTOKOZELA PANKHANI YAKUCHEZA UKU. BANIPASAKO MUPATA OFUNSA MAFUNSO AMENE NINGA NKHALE NAYO. MAYANKO AMENE BANIPASA KUMAFUNSO YANGA ONSE NIKONDWELA NAYO. NIZIBANSO KUTI:

• MAYANKO YANGA AZASUNGIWA MWACHISINSI NA CHIKULIPILILO; • NINGA SANKE KUSATENGA MBALI MUKUCHEZA UKU, KUSAYANKA MAFUNSO YENA,OLO

KUSIYA PAKATIKATI NTHAWI ILI YONSE. • NGATI NAKANA KUTENGA MBALI MUKUCHEZA UKU, SICHIZANILETELA VUTO MUKULANDILA

TANDIZO KUCLINIC ILI YONSE MANJE OLO MUSOGOLO MWAKE. Zikomo potipasa nthawi. Ingati muzafuna kutifunsa mafunso tikasiliza kukambilana, chonde wonani: [lemba zina, foni namba ya clinic] Name of participant (print): __________________________________ __________ __________________________________ Date Signature or Mark of Participant _______________ __________________________________ Date Signature of Witness (if participant is illiterate) Interviewer’s statement I, THE UNDERSIGNED, HAVE DEFINED AND EXPLAINED TO THE PARTICIPANT IN A LANGUAGE THAT HE UNDERSTANDS, THE PROCEDURES TO BE FOLLOWED, THE RISKS AND BENEFITS INVOLVED, AND THE OBLIGATIONS OF THE INTERVIEWER. Interviewer Name (Print): _________________________________________ __________ __________________________________ Date Signature of Interviewer

Consent to Participate in a Key-Informant Interview Title of the research “Evaluation of the informed consent process for male circumcision roll-out in Zambia and Swaziland” Purpose of the study Hello, my name is……………….. I work at…………………... The Population Council, a non-profit research organization based in New York, is doing a study about informed consent for male circumcision. We are doing some research about of the informed consent process for male circumcision here in X. I have been hired by the Population Council to talk to key informants like you because you have an important perspective about how potential clients and communities understand male circumcision. We also want to hear your ideas for how this process of informing communities and individuals about male circumcision could be improved in the future. Study steps I would like to ask you questions from a written interview guide; however this interview will be more like a conversation. I will ask you some very general questions related to the community environment for which male circumcision takes place, and I will also ask for your opinions about available information, practices, and/or local beliefs. Sometimes my questions will focus on adult circumcision clients and sometimes they will focus on adolescent circumcision clients. If you agree to be interviewed, you can decide not to answer any of the questions you are asked. You can also choose to stop the interview at any time. There are no right or wrong answers to any of the questions. We only want to know your opinions and ideas. Confidentiality To help me remember what you say on the day you are interviewed, I will take notes. Our conversation will also be tape recorded. Only our research team will listen to the tape to be able to write down what you said. Your name will not be recorded on the tape – you can use a nickname instead. After the interview has been written down, the tape will be destroyed. The only place your name will be written down is on this consent form. All information you provide will be kept in a locked file and your name will never be used in the research reports. While your name will not be used specifically in any reports, the opinions you give during this interview will be linked to your professional position or status within the community. Discomforts and risks You may feel uncomfortable talking about male circumcision, HIV and other sensitive topics. We hope that will not happen and I will do my best to make you feel comfortable during the interview. You may also refuse to answer any question, or any part of a question, at any time. Compensation You will not receive any money for taking part in this interview. Benefits Taking part in this interview has no direct benefits for you. Your interview will help us find out more about men’s experiences with male circumcision in their communities, the counseling and informed consent process. What we learn from talking to you and key informants in this study may help to improve male circumcision services in the future. Offer to answer questions and freedom to withdraw from the study

Then we will go ahead and begin. But first, I will ask you to sign this form stating that I, the interviewer, have informed you of your rights and that you have agreed to be interviewed today. This consent form is the only place where your name will be written down. If you do not wish to sign your name, you may simply mark the space with an ‘X’ or use a thumb print. If you have any questions after we speak with you today, please contact: Kelvin Munjile Study Coordinator and Supervisor Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Paul Hewett, Ph. D Director of Male Circumcision Program Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Email: [email protected] The UNZA Ethics Committee: Ridgeway Campus PO Box 50110 Lusaka, Zambia Tel:256067 Fax: +260 1 250753 [email protected] or [email protected]



STOP THE INTERVIEW AT ANY TIME; • IF I REFUSE TO BE INTERVIEWED, IT WILL NOT AFFECT ANY SERVICES I RECEIVE NOW OR IN

THE FUTURE. We thank you for your time. If you need to ask us any further questions after the discussion, please contact: [fill in name, contact number for each clinic] Name of participant (print): _________________________________ __________ __________________________________ Date Signature or Mark of Participant _______________ __________________________________ Date Signature of Witness (if participant is illiterate) Interviewer’s statement I, THE UNDERSIGNED, HAVE DEFINED AND EXPLAINED TO THE PARTICIPANT IN A LANGUAGE THAT HE UNDERSTANDS, THE PROCEDURES TO BE FOLLOWED, THE RISKS AND BENEFITS INVOLVED, AND THE OBLIGATIONS OF THE INTERVIEWER. Interviewer Name (Print): _________________________________________ __________ __________________________________ Date Signature of Interviewer

Consent for Semi-structured Interview with Adult Men who Have Undergone Circumcision Title of the research “Evaluation of the informed consent process for male circumcision roll-out in Zambia and Swaziland” Purpose of the study Hello, my name is……………….. I work at…………………... The Population Council, a non-profit research organization based in New York, is doing a study about informed consent for male circumcision. I have been hired by the Population Council to talk to men who have been circumcised recently. We want to find out what you were told about male circumcision before you had the procedure. We are interested in learning how the explanation of what was going to happen during the MC surgery matches your actual experiences. We also want to hear your ideas for how the process could be improved in the future. Study steps We will be talking to up to 30 men when they come back to the clinic for their 7 day follow-up visit or at their home after being circumcised. . If you agree to take part in this interview, we will talk for about 30-45 minutes. It is your choice to take part in this interview or not. If you choose to be interviewed, you can decide not to answer any of the questions you are asked. You can also choose to stop the interview at any time. Whether or not you agree to take part in this interview, it will not affect your medical care at the clinic now or in the future. There are no right or wrong answers to any of the questions. We only want to know your opinions and ideas. Confidentiality To help me remember what you say here today, I will take notes. Our conversation will also be tape recorded. Only our research team will listen to the tape to be able to write down what you said. Your name will not be recorded on the tape – you can use a nickname instead. After the interview has been written down, the tape will be destroyed. The only place your name will be written down is on this informed consent form. All information you provide will be kept in a locked file and your name will never be used in the research reports. Discomforts and risks You may feel uncomfortable talking about male circumcision, HIV and other sensitive topics. We hope that will not happen and I will do my best to make you comfortable during the interview. You may also refuse to answer any question, or any part of a question, at any time. Compensation We will reimburse you K25,000, as compensation for your time. Benefits Taking part in this interview has no direct benefits for you. Your interview will help us find out more about men’s experiences with male circumcision and the counseling and informed consent process. What we learn from talking to men in this study may help to improve male circumcision services in the future. Offer to answer questions and freedom to withdraw from the study If you have questions about the study you may ask them now or you can call: [Fill in information for each site]

If you don’t have any questions and agree to take part in this study then I will ask you to sign this form stating that I, the interviewer, have informed you of your rights as a participant and that you have agreed to be interviewed today. This is the only place where your name will be written down. If you do not wish to sign your name, you may simply mark the space with an ‘X’ or use a thumb print. If you have any questions after we speak with you today, please contact: Kelvin Munjile Study Coordinator and Supervisor Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Paul Hewett, Ph. D Director of Male Circumcision Program Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Email: [email protected] The UNZA Ethics Committee: Ridgeway Campus PO Box 50110 Lusaka, Zambia Tel:256067 Fax: +260 1 250753 [email protected] or [email protected]




CLINIC NOW OR IN THE FUTURE. We thank you for your time. If you need to ask us any further questions after the discussion, please contact: [fill in name, contact number for each clinic] Name of participant (print): _________________________________ __________ __________________________________ Date Signature or Mark of Participant _______________ __________________________________ Date Signature of Witness (if participant is illiterate) Interviewer’s statement I, THE UNDERSIGNED, HAVE DEFINED AND EXPLAINED TO THE PARTICIPANT IN A LANGUAGE THAT HE UNDERSTANDS, THE PROCEDURES TO BE FOLLOWED, THE RISKS AND BENEFITS INVOLVED, AND THE OBLIGATIONS OF THE INTERVIEWER. Interviewer Name (Print): _________________________________________ __________ __________________________________ Date Signature of Interviewer


Consent for Semi-structured Interview with Adult Men who Have Undergone Circumcision Title of the research “Kufwayilikisha ukwishiba bwino ifyo ukusumina pakusembululwa kwenda kubaume”. Purpose of the study Mulishini, ishina lyandi ninebo……………….ndabomba ku……………….. BaPopulation Council, akabungwe akabomba milimo yakufwayilikisha akashili kamakwabo kaba munchende yaku New York, balechita umulimo wakufwayilikisha pafyakuyisuminina pafyakusembululwa kwabaume. Nabampelako inchito baPopulation Council kulanda nabashitata abasembululwa chanombaline. Tulefwaya kwishiba ifyo bamwebele fya kuma kukusembululwa kwabaume ilyo tamulati musemblulwe. Tulefwalisha sana ukusambilila ifyo bamilondolwele ifyalefwayikwa ukuchitika ifyo fyayendele pamo nefyo mwaumfwile. Tulefwaya futi kumfwako ifyo iyi nshila ingaba bwino kuntanshi Study steps Twalalnshanya abali 30 inga babwelela kuclinic lilya kwapita inshiku 7 nangu kumayanda kufuma mukusembululwa . Inga mulesumina ukusendako lubali mukulanshanya uku, twalalanshanya munshita yakumana ku 30-45 minutes. Kuyisala fye mwebene ukusendako ulubali mukulanshanya uku nangu ukukana.Inga mwasla kuti tulanshanye, kuti mwasala kushasuka amepusho yamo yamo twalamwipusha. Futi kuti mwasala kuleka ukusendako lubali inshita fye ili yoonse. Kusumina nangu ukukana ukusendako lubali mumepusho, tachakamileshe kupokelela bwafwilisho kuclinic nomba nangu kuntanshi. Takuli amasuko ayachine nangu ayabufi kumepusho aliyonse. Tufwaya fye ukwishiba ifyo mutontonkanya nefyo mwayishiba. Confidentiality Kungafwilishako ukwibukisha ifyo mwalalanda lelo, nalalemba. Kulanshanya kwesu futi twalateping’a. Abotubomba nabo mukufwayilikisha uku ebakakutikako kumatepu kuti balembe bwino ifyo mwalanda. Ishina lyenu tatwayiteng’e iyo-kuti mwabomfya ishina yabufi. Inga twapwisha ukulemba, tepu ikonaulwa. Ishina lyenu lyalalembwafye pachipepala chakusumininapo. Amasuko oonse mwalatupela akabikwa munchende yakomwa elyo neshina lyenu tatwakalibomfye mulipoti. Discomforts and risks Kuti chamumfwisha ububi kulanda pafya kusembululwa kwamwaume, HIV elyo nafimo fimo fishupa ukulandapo. Tulesubila tachachitike elyo nalayesha kumona kutila mwaumfwa bwino mushita tulelanshanya. Kuti mwakana ukwasuka amepusho yamo yamo, nangu imbali imo yalipusho, inshita iliyonse. Compensation. Twalamimepelako K 25,000 kumitasha ukutupelako inshita. Benefits Kusendako lubali mukulanshanya uku takuli icho mwala sangamo imwe; kwena twala mipela amasuko ayachine kumepusho yenu. Kulanshanya kwesu kukatwafwilisha kwishiba ifyo basitata bomfwa pafwakusembululwa kwabaume elyo nokulanshanya munkama elyo nakwisuminina. Ifyo twalasambila mukulanshanya uku kukafwilishako kuwamya milimo yakusembulwa kwabaume munshiku shakuntanshi. Offer to answer questions and freedom to withdraw from the study


Inga namukwata amepusho akumine kukulanshanya uku kuti mwayipusha nomba nangu ukutuma foni: [Lemba ishina lyanchende] Inga tamukwete amepusho aliyonse elyo mulesumina ukusendako lubali mukufwayilikisha uku nalamilomba ukuti musayineko apa pachipepala ichi kutila ine, neulemipusha amepusho, nimyeba fyoonse filefwayikwa kuti mwishibe inga abalesendako ulubali elyo ukutila namusumina kulanshanya nayine lelo. Apa epalalembwapo ishina lyenu peka. Inga tamulefwaya ukulemba ishina lyenu, kuti mwalemba fye chi ‘X’ nangu kuti mwabomfya umunwe. Inga mwakwata amepusho lilya twapwisha kulanda nenu lelo, mukwayi moneni: Kelvin Munjile Study Coordinator and Supervisor Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Paul Hewett, Ph. D Director of Male Circumcision Program Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Email: [email protected] The UNZA Ethics Committee: Ridgeway Campus PO Box 50110 Lusaka, Zambia Tel:256067 Fax: +260 1 250753 [email protected] or [email protected]





MUKUKWATA UBWAFWILISHO KUCLINIC NOMBA OLO KUNTANSHI Twatasha sana mukutupela inshita. Inga mulefwaya ikwipusha amepusho aliyonse inga twapwisha ukulanshanya, mukwayi kuti mwamona: [lembe ishina, foni namba yaclinic] Name of participant (print): _________________________________ __________ __________________________________ Date Signature or Mark of Participant _______________ __________________________________ Date Signature of Witness (if participant is illiterate) Interviewer’s statement I, THE UNDERSIGNED, HAVE DEFINED AND EXPLAINED TO THE PARTICIPANT IN A LANGUAGE THAT HE UNDERSTANDS, THE PROCEDURES TO BE FOLLOWED, THE RISKS AND BENEFITS INVOLVED, AND THE OBLIGATIONS OF THE INTERVIEWER. Interviewer Name (Print): _________________________________________ __________ __________________________________ Date Signature of Interviewer


Consent for Semi-structured Interview with Adult Men who Have Undergone Circumcision Title of the research “Kuonesesa mwamene kuyendela kuzivomelela pavamudulidwe wamwamuna kwamene kulikuchitika muno Mu Zambia nakuSwaziland” Purpose of the study Muli bwanji, zina langa ndine……………………nisebenza ku…………….. BaPopulation Council, kabungwe kofufuzafufuza kamene sikasakila pindu kapezeka mumuzinda wa [New York], bali nanchito yofufuza pankhani yozivomelela pankhani yamudulidwe wamwamuna. Bananipasako nchito baPopulation Council, kukamba nabazibambo bamene banadulidwa chamanje manje. Tifuna kumvela vamene banamu uza pankhani yamudulidwe wabamuna pamene benze bakalibe kuyamba njila yamudulidwe. Tifunisisa kupunzila mwamene banamu uzilani pavamene vinali kufuna kuchitika mwamene vinayendelana namwamene munazimvelela. Tifunanso kumvela maganizo anu monga mwamene zingayendele pasogolo nakunkhala bwino njila zamudulidwe musogolo mwake. Study steps Tizakamba nabazibambo bamene bafika ku 30 bakabwela kuclinic monga fundo yamasiku 7 akafika nikubwela kuclinic olo mumanyumba mwawo bakasiliza kudulidwa. Ngati muvomela kutenga mbali mumafunso, tizakamba munthawi itali monga 30-45 minutes. Nikufuna kwanu kutenga mbali olo kukana. Ngati mwasanka kufunsiwa, ngati mwafuna simunga yanke mafunso amene muzafunsiwa. Mungasankenso kuyimisa mafunso nthawi ili yonse. Kuvomela olo kukana kutenga mbali mumafunso, sichizalenga kuti muleke kulandila tandizo kuclinic manje olo musogolo mwake. Kulibe mayanko yazo ona olo yaboza kumafunso. Tifuna chabe kuziba maganizo anu navamene muziba. Confidentiality Kunitandiza kukumbukila vamene uzakamba, nizalemba. Mukukambilana kwatu tizateping’anso. Bamene nizebenza nabo chabe ndiwo eka azamvelela kutepu kuti balembe bwino vamene wakamba. Zina lanu sitiza yiteping’a patepu- anga sebenzese zina lozipasa mumalo mwake. Tikasiliza kulemba, tepu izaonongewa. Zina lanu lizalembewa chabe pachipepala chovomelelapo chaba kulu. Mapepa alinamayanko yanu azakomelewa mumalo ena na zina lanu sitiza yisebenzesa mumalembe yalipoti Discomforts and risks Kapena sichinga kumveseni bwino kucheza nkhani yamudulidwe wamwamuna, HIV na nkhani zinanango zovuta kukamba. Tikulupilila kuti ichi sichizachitika ndipo nizayesa bwino bwino kuti mumvele bwino munthawi yamene tili kukambilana. Munga fune kukana kuyanka mafunso ena, olo mwina mbali ina yafunso, nthawi ili yonse. Compensation Tizakupasani ndalama K25,000 mukutipasa nthawi. Benefits Kutenga mbali mukucheza uku kulibe kulandila chilichonse monga kwayimwe. Uku kucheza kuzatitandiza kusakila kuziba vambili vamene bazibambo bapitamo vokuza mudulidwe wamwamuna nakukambilana mwachisinsi na njila yovomela mweka. Vamene tizapunzila


pokamba nabazibambo vingatandize kupeleka pamwamba zinchito zamudulidwe wamwamuna musogolo mwake. Offer to answer questions and freedom to withdraw from the study Ngati imwe olo mwana wanu munamafunso okuza nchito iyi munga funse manje olo mungatume foni: [Fill in information for each site] Ngati mulibe mafunso ali yonse ndipo mwamuvomela kutenga mbali munchito iyi kansi niza kupempani kuti musayine pachipepa ichi kutantauza kuti ine, amene afunsa mafunso, naku uzani vonse vamene vifunika ndipo kuti mwavomela kuti nimufunseni lelo. Ichi chipepa chovomela bakulu ndiye malo eka pamene pazalembewapo zina lanu. Ngati simufuna kusayina zina lanu, mungalembe chabe chi ‘X’ olo munga se benzese chikumo. Ngati muzankala namafunso tikasiliza kukamba nayimwe lelo, chonde onani: Kelvin Munjile Study Coordinator and Supervisor Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Paul Hewett, Ph. D Director of Male Circumcision Program Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Email: [email protected] The UNZA Ethics Committee: Ridgeway Campus PO Box 50110 Lusaka, Zambia Tel:256067 Fax: +260 1 250753 [email protected] or [email protected]



• MAYANKO YANGA AZASUNGIWA MWACHISINSI NA CHIKULUPILILO; • NINGA SANKE KUSATENGA MBALI MUKUCHEZA UKU, KUSAYANKA MAFUNSO YENA,OLO


TANDIZO KUCLINIC ILI YONSE MANJE OLO MUSOGOLO MWAKE.

Zikomo potipasa nthawi. Ngati muzafuna kufunsa mafunso tikasiliza, chonde wonani: [fill in name, contact number for each clinic] Name of participant (print): _________________________________ __________ __________________________________ Date Signature, Thumbprint or Mark of Participant _______________ __________________________________ Date Signature of Witness (if participant is illiterate) Interviewer’s statement I, THE UNDERSIGNED, HAVE DEFINED AND EXPLAINED TO THE PARTICIPANT IN A LANGUAGE THAT HE UNDERSTANDS, THE PROCEDURES TO BE FOLLOWED, THE RISKS AND BENEFITS INVOLVED, AND THE OBLIGATIONS OF THE INTERVIEWER. Interviewer Name (Print): _________________________________________ __________ __________________________________ Date Signature of Interviewer

Consent to Participate in a Focus Group Discussion: Parents/Guardians of Males (under age 18) who Have/ Have Not Undergone Circumcision

Title of the research “Evaluation of the informed consent process for male circumcision roll-out in Zambia and Swaziland” Purpose of the study Hello, my name is……………….. I work at…………………... I have been hired by the Population Council to talk to parents/guardians who decided or declined to have their male children under age 18 circumcised. We would like to learn more from parents/guardians about:

• How and why people elect circumcision for their children/dependents, or not; • How people understanding the of risks and benefits of circumcision; • What the attitudes of extended family and community members are toward

circumcision; • How parents/guardians of minors who were circumcised experienced the informed

consent process at the clinic. Study steps If you accept, you will be asked to take part in a group discussion with 6-9 other parents/guardians who have recently chosen [not] to have their male children circumcised. This group discussion will be led by two people from our research team. One person will be the organizer of the group who explains the purpose and procedure of the group discussion, keeps time and leads the discussion. The second researcher will write down the main points of the discussion and record the discussion on an audio tape. If you do not wish to answer any of the questions or take part in any part of the discussion, you may say so. The discussion will take place in a private space. We expect the discussion to last about 60 – 90 minutes. In this focus group discussion we will ask you to speak freely about your opinions about male circumcision and to listen to what the other members of the group have to say. It is your choice to take part in this group discussion or not. If you choose to take part, you can decide not to answer any of the questions you are asked. You can also choose to stop participating at any time. Whether or not you agree to take part in this focus group, it will not affect the medical care provided at any clinic now or in the future. There are no right or wrong answers to any of the questions that we are going to discuss in the group. We only want to know your opinions and ideas. Confidentiality To help me remember what everyone says here today, I will take notes. Our conversation will also be tape recorded. Only our research team will listen to the tape to be able to write down what everyone said. No one’s name will be recorded on the tape – everyone is free to use a nickname instead. After the FGD has been written down, the tape will be destroyed. The only place everyone’s name will be written down is on the informed consent form. All information provided by everyone in the FGD will be kept in a locked file and no one’s names will ever be used in the research reports. We also ask that all the participants keep our group discussion private and not discuss what others have said here today.

Discomforts and risks You may feel uncomfortable talking about male circumcision, HIV and other sensitive topics. We hope that will not happen and I will do my best to make you feel comfortable during the discussion. You may also refuse to answer any question, or any part of a question, at any time. It is also possible that other people in the FGD may not respect your confidentiality; we will do our best to ensure that this does not happen, however, by agreeing to participate in the FGD, it is possible that some of what you say may be shared outside of this group. Compensation We will reimburse you K50,000 to cover the costs of traveling to the FGD and for the time you spend here. You will not be charged for participating in this study. Benefits Taking part in this FGD has no direct benefits for you. This FGD will help us find out more about young males under age 18 and male circumcision. What we learn today may help to improve male circumcision services for young males under age 18 in the future. Offer to answer questions and freedom to withdraw from the study If you have questions about the study you may ask them now or you can call: [Fill in information for each site] If you don’t have any questions and agree to take part in this FGD then I will ask you to sign this form stating that I, the facilitator of the FGD, have informed you of your rights and that you have agreed to take part in this FGD today. This consent form is the only place where your name will be written down. If you do not wish to sign your name, you may simply mark the space with an ‘X’ or use a thumb print. If you have any questions after we speak with you today, please contact: Kelvin Munjile Study Coordinator and Supervisor Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Paul Hewett, Ph. D Director of Male Circumcision Program Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Email: [email protected] The UNZA Ethics Committee: Ridgeway Campus PO Box 50110 Lusaka, Zambia Tel:256067 Fax: +260 1 250753 [email protected] or [email protected]

Participant's statement THE FGD HAS BEEN EXPLAINED TO ME. I HAVE BEEN GIVEN A CHANCE TO ASK ANY QUESTIONS I MAY HAVE. I AM CONTENT WITH THE ANSWERS TO ALL OF MY QUESTIONS. I ALSO KNOW THAT:

• MY RECORDS WILL BE KEPT PRIVATE AND CONFIDENTIAL; • I CAN CHOOSE NOT TO TAKE PART IN THE FGD, NOT TO ANSWER CERTAIN QUESTIONS, OR

TO WITHDRAW FROM THE FGD AT ANY TIME; • IF I REFUSE TO TAKE PART IN THE FGD, IT WILL NOT AFFECT MY REGULAR MEDICAL CARE

AT ANY CLINIC NOW OR IN THE FUTURE. We thank you for your time. If you need to ask us any further questions after the discussion, please contact: [fill in name, contact number for each clinic] Name of participant (print): _________________________________ __________ __________________________________ Date Signature or Mark of Participant _______________ __________________________________ Date Signature of Witness (participant is illiterate) Facilitator’s statement I, THE UNDERSIGNED, HAVE DEFINED AND EXPLAINED TO THE PARTICIPANT IN A LANGUAGE THAT S/HE UNDERSTANDS, THE PROCEDURES TO BE FOLLOWED, THE RISKS AND BENEFITS INVOLVED, AND THE OBLIGATIONS OF THE FACILITATOR. Interviewer Name (Print): _________________________________________ __________ __________________________________ Date Signature of Interviewer



Title of the research “Kufwayilikisha ukwishiba bwino ifyo ukusumina pakusembululwa kwenda kubaume”. Purpose of the study Mulishani, ine ishina lyandi ninebo……………….ndabomba ku…………………. BaPopulation Council, akabungwe kashili kamakwebo akabomba mulimo wakufyayikisha kaba kumusumba waku New York. Balebomba mulimo wakufyayilikisha pafyakusembululwa kwabaume. Tulebomba mulimo wakufyayilikisha pafyakwisunina pafyakusembululwa muno mu X. Nabampelako inchito baPopulation Council yakulanshyanya nabafyashi/abasunga abana abalefwaya olo abashilefwaya abana babo baume bali nemyaka ishilefika ku 18 yakufyalwa ukusembululwa. Tulefwaya kusambilila sanasana kufuma kubafyashi/abasunga abana pa:

• Shani elyo chinshi abantu basalila ukusembululwa abana babo/abobasunga olo ukukana;

• Ifyo abantu beshiba ubwafya nobusuma bwakusembululwa; • Balupwa nabantu bamumushi bamona shani ili lyashi lyakusembululwa; • Ifyo abafyashi/abasunga abana abasembululwa bamona iyi nshila yakuyisuminina

kuclinic. Study steps Inga mulesumina, twalamilomba ukuti mesendeko lubali mukulanshanya kwapebumba na6-9 nabambi abafyashi/abasunga abana abasala nangu ukukana kuti abana babo basembululwe chanombaline. Uku kulanshanya kwalatungululwa nabantu babili bafuma kukabungwe akafwayilikisha. Muntu umo alaba wakuleta pamo abantu nokulondolola bwino bwino icho tulechita nefyo kwalayenda uku kulanshanya pebumba, kumo panshita elyo nokutungulula ukulanshanya. Wachibili akulalemba fikankala filefuma mukulanshanya elyo nokuteping’a ukulanshanya palitepu. Inga tamulefwaya ukwasuka yamo amepusho olo kusendako lubali mulubali lumo lwakulanshanya oku, mukwayi kuti mwalanda efyo. Kulanshanya kwalabela munchende yafisamako kushaba abantu sana. Tulesubila kulanshanya uku kwali senda nshita kwati 60-90 minutes. Mukulanshanya mwibumba uku twalamilomba ukutila mube bakakuka pakulanda ifyo mulemona pali ili lyashi lyakusembululwa kwabaume elyo nokukutika sana kuli ifyo abanenu balelandapo. Kuyisalila fye mwebene ukusenda ulubali mukulanshanya oku olo ukukana. Inga mwasala ukusendako lubali, kuti mwasala kushasuka amepusho yamo yamo. Kuti futi mwasala ukuleka ukusendako lubali inshita fye ili yonse. Kusumina olo ukukana musendako lubali mukulanshanya pebumba, takwakamileshe kusengako bwafwilisho kuclinic nomba olo kuntanshi. Takuli ukwasuka kwababwino nokushaba bwino kumepusho twalakwata pebumba. Tulefwaya fye ukwishiba ifyo mwayishiba no kumona. Confidentiality Kungafwilishako ukwibukisha ifyo twala lanshanya kuno lelo, nakula lemba. Kulanshanya kwesu twalateping’a mukwayi. Beka abotubomba nabo ebakakutikako kumatepu – muli abakakuka ukubomfya ishina yakuyipelafye. Inga twapwisha ukulemba ilyashi lyoonse, tepu ekayaonaulwa. Inchende fye ikakwata amashina yenu nipapepala yakushina fye. Amesuko yoonse akabikwa munchende imo nokukomako elyo takuli shina tukabika mumalipoti. Futi tulelomba bonse balaba mwibumba ukuteka fyoonse twalalanshanya munkama elyo takuli kuya mukulanda kunse ifyo fyala landikwa lelo.


Discomforts and risks Kuti chamumfwisha ububi kulanda pafya kusembululwa kwamwaume, HIV elyo nafimo fimo fishupa ukulandapo. Tulesubila tachachitike elyo nalayesha kumona kutila mwaumfwa bwino mushita tulanshanya. Kuti mwakana ukwasuka amepusho yamo yamo, olo mbali yalipusho, mushita fye ili yoonse. Futi bamo bamo mwibumba tabakachindike inkama; twalayesha sana kumo ukutila ichi tachichitike, Nangu chibe shani, mukusumina ukusendako lubali mukulanshanya pebumba, fimo fimo twala lanshanya fikalandikwa kunse lyebumba. Compensation. Twalamilipiko K50, 000 yakwandelako nenshita mwalaba kuno. Tatwamilipilishe mukusendako lubali mumulimo uyu. Benefits Kusendako lubali mukulanshanya uku takuli icho mwala sangamo imwe. Uku kulanshanya pebumba kwalatwafwilishako kwishaba abalumando bamyaka ishilefika ku 18 elyo nekusembululwa kwabaume. Ifyo twala sambilila lelo kuti fyayaafwilishako kuwamya milimo yakusembulwa kwabaume kubalumendo bamyaka ishilefika ku 18 munshiku shakuntanshi. Offer to answer questions and freedom to withdraw from the study Inga namukwata amepusho ayakumine kumulimo uyu kuti mwayipusha nomba olo kuti mwatuma foni: [lemba shina lyanchende] Inga tamukwete amepusho elyo mulesumina kusendako lubali mukulanshanya pebumba kanshi nalamilomba munsayinineko pachipepala ichi kutila Ine, neuletungulula kulanshanya pebumba, namyeba fyoonse filefwayikwa elyo namusumina ukusendako lubali mukulanshanya pebumba lelo. Ichi chipepala chakusumininapo epalabapo fye amashina yenu chapwa. Inga tamulefwaya kulemba ishina lyenu, mukwayi kuti mwalemba chi ‘X’ nangu kuti mwabomfya umunwe. Inga mwakwata amepusho lilya twapwisha kulanda nenu lelo, mukwayi moneni: Kelvin Munjile Study Coordinator and Supervisor Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Paul Hewett, Ph. D Director of Male Circumcision Program Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Email: [email protected] The UNZA Ethics Committee: Ridgeway Campus PO Box 50110 Lusaka, Zambia Tel:256067 Fax: +260 1 250753 [email protected] or [email protected]


Participant's statement KULANSHANYA PEBUMBA UKU NABANONDOLWELA. NABAMPELA NENSHITA YAKWIPUSHA AMEPUSHO NINGAKWATA. NAUMFWA BWINO KUMASUKO OONSE KUMEPUSHO YANDI. FUTI NINJISHIBA KUTI:

• AMASUKO YANDI YALATEKWA MUNKAMA • KUTI NASALA KUSHISENDAKO LUBALI MUKULANSHANYA PEBUMBA, KUSHASUKA AMEPUSHO

YAMO YAMO, OLO KULEKA FYE PAKATI SHITA FYE ILI YOONSE. • INGA NAKANA UKUSENDAKO LUBALI MUKULANSHANYA PEBUMBA, TACHAKALESHE INE

UKUKWATAKO BWAFWILISHO KUCLINIC ILI YOONSE NOMBA OLO KUNTANSHI. Twatotela sana mukutupela inshita. Inga mulefwaya ukwipusha amepusho nayambi lilya twapwisha ukulanshanya, mukwayi moneni: [lemba shina, foni namba yaclinic] Name of participant (print): _________________________________ __________ __________________________________ Date Signature or Mark of Participant _______________ __________________________________ Date Signature of Witness (participant is illiterate)



Title of the research “Kuonesesa mwamene kuyendela kuzivomelela pavamudulidwe wamwamuna kwamene kulikuchitika muno Mu Zambia nakuSwaziland” Purpose of the study Mulibwanji, zina langa ndine ……………… Nisebenza ku …………………… Bananipasako nchito baPopulation Council, kukamba namakolo/bamene basungu bana baja bamene bafuna olo bamene bakana kuti bana bawo bamuna bali nazaka zilipansi pa 18 kuti badulidwe. Tifuna kupunzila vambili kuchoka kumakolo/bamene basunga bana pali ivi:

• Bwanji anso chifukwa nchiyani bantu basanka bana bawo/bamene basunga kuti badulidwe, olo kukana;

• Nanga bantu bamawona bwanji mavuto na ubwino wamudulidwe; • Nanga bantu bamubanja naba mumunzi bayitenga bwanji nkani yamudulidwe; • Nanga makolo/bamene basunga bana bamene banadulidwa nanga banaona bwanji

nkhani yozivomelela kuClinic. Study steps Ngati muvomela, tizakupempani kuti mutenge mbali mukucheza muka bungwe kali namakolo/bamene basunga bana benango bali 6-9 bamene posachedwa apa banasanka olo kukana kuti bana bawo bamuna badulidwe. Uku kukambilana pagulu kuzatandizidwa nabantu babili bamene bachoka kugulu lofufuzafufuza nkhani. Muntu umozi azankhala obwelesa pamozi bantu nakubafotokozela bwino chifukwa namwamene kuzayendela kucheza uku, azayangana panthawi nakusogolela kucheza uku. Muntu wofufuzafufuza wacibili azankhala wolemba nkhani zikuluzikulu mukucheza uku nakuteping’a pamatepu .Ngati simufuna kuyanka mafunso aliyense olo kutenga mbali muchigawo china mukucheza uku, mungakambe choncho. Kucheza uku kuzatenga mbali mumalo obisika. Tichetekela kuti kucheza uku kuzatenga nthawi monga 60-90 minutes. Mukucheza kwatu uku tizakupempani kuti munkhale omasuka kukamba maganizo yanu pankhani yamudulidwe wamwamuna nakumvelela vamene bazakamba banzanu mugulu. Mwazifunila mweka kutenga mbali mukucheza pagulu iyi kapena iyayi. Ngati mwasanka kutenga mbali, mungasanke kusayanka mafunso yamene mufunsiwa. Mungasanke nso kuleka kutenga mbali nthawi ili yoonse. Ngati muvomela olo mukana kutenga mbali mugulu ili, sichizalenga kuti mupeze vuto kunkhani yolandili tandizo kuclinic ili yonse manje olo musogolo mwake. Kulibe mayanko azowona olo asali azowona kumafunso aliyonse amene tizacheza pamozi mugulu. Tifuna chabe kuziba vamene muziba namaganizo yanu. Confidentiality Kuti nizikumbukila chilichonse chamene aliyense azakamba lelo, nizayamba kulemba. Kucheza kwatu kuzateping’iwa patepu. Beka bamene tisebenza nawo ndiwo azamvelela kumatepu kuti bakalembe bwino chamene aliyense akamba. Kulibe zina la aliyense tizateping’a – Boonse ndimwe omasuka kusebenzesa zina lozipasa chabe mumalo mwake. Kucheza kukasila kulembewa, tepu izaonongewa. Mazina yanu azalembewa chabe papapala yozivomelela chabe. Nkhani yonse aliyense azatipasa mukucheza uku izankhala mokomewa ndipo kulibe zina la aliyense yamene izasebenzesewa mumalembe amulipoti yakufufuzafufuza. Tikupempaninso kuti kucheza kwatu uku kunkhale mwachisinsi ndipo kulibe kuyenda mukucheza nabenango vamene vakambiwa lelo.


Discomforts and risks. Kapena sichinga kumveseni bwino kucheza nkhani yamudulidwe wamwamuna, HIV na nkhani zinanango zovuta kukamba. Tikulupilila kuti ichi sichizachitika ndipo nizayesa bwino bwino kuti mumvele bwino munthawi yamene tili kukambilana. Munga fune kukana kuyanka mafunso ena, olo mwina mbali ina yafunso, nthawi ili yonse. Chikonzeka kuti bena sibazakwanisa kukulupilika muchisinsi chanu, tizayesa mwampamvu kuti chisachitike ichi, chinkale bwanji, mukuvomelakutenga mbali mukucheza kwatu uku, vinango vamene muzakamba vinga yende panja nakuchezewa panja lagulu ili. Compensation Tizakubwezelani K50, 000 kulipila mayendedwe kubwela kucheza mugulu ndipo nanthawi yamene muzankhala kuno. Sitizakulipilisani mukutenga mbali munchito iyi. Benefits Kutenga mbali mukucheza uku kulibe kulandila chilichonse monga kwayimwe. Uku kucheza kuzatitandiza kusakila kuziba vambili vokuza bachinyamata bazaka zosafika ku 18 na mudulidwe wamwamuna. Vamene tizapunzila lelo vingatandize kupeleka pamwamba nchito zamudulidwe wamwamuna ku banyamata bazaka zosafika ku 18 musogolo mwake. Offer to answer questions and freedom to withdraw from the study Ngati muli namafunso panchito iyi mungafunse manje olo munga tume foni: [Fill in information for each site] Ngati mulibe mafunso ndipo muvomela kutenga mbali mukucheza uku nizakupempani kuti musayine apa kuwonesa kuti ine amene ayendesa nchito iyi, naku uzani vofunikila kwayimwe ndipo mwavomela kutenga mbali mukucheza uku lelo. Ichi chipepala chovomela ndiye peka pamene pazalembewa zina lanu. Ngati simufuna kulemba zina lanu, mungalembe chi ‘X’ olo munga se benzese chikumo. Ngati muzankala namafunso tikasiliza kukamba nayimwe lelo, chonde onani: Kelvin Munjile Study Coordinator and Supervisor Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Paul Hewett, Ph. D Director of Male Circumcision Program Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Email: [email protected] The UNZA Ethics Committee: Ridgeway Campus PO Box 50110 Lusaka, Zambia Tel:256067 Fax: +260 1 250753 [email protected] or [email protected]



• MAYANKO YANGA AZASUNGIWA MWACHISINSI NA CHIKULIPILILO • NINGA SANKE KUSATENGA MBALI MUKUCHEZA UKU, KUSAYANKA MAFUNSO YENA,OLO


TANDIZO KUCLINIC ILI YONSE MANJE OLO MUSOGOLO MWAKE. Tiwonga zikomo potipasa nthawi. Ngati mufuna kufunsa mafunso ena tikasiliza kucheza chonde onani: [fill in name, contact number for each clinic] Name of participant (print): _________________________________ __________ __________________________________ Date Signature or Mark of Participant _______________ __________________________________ Date Signature of Witness (participant is illiterate) Interviewer’s statement I, THE UNDERSIGNED, HAVE DEFINED AND EXPLAINED TO THE PARTICIPANT IN A LANGUAGE THAT HE UNDERSTANDS, THE PROCEDURES TO BE FOLLOWED, THE RISKS AND BENEFITS INVOLVED, AND THE OBLIGATIONS OF THE INTERVIEWER. Interviewer Name (Print): _________________________________________ __________ __________________________________ Date Signature of Interviewer

Informed Consent to Contact Title of the research “Evaluation of the informed consent process for male circumcision roll-out in Zambia and Swaziland” [PC STAFF: Please indicate the study or studies of interest by ticking the box below] Hello, my name is……………….. I work at…………………... The Population Council, a non-profit research organization based in New York, is doing a study about informed consent for male circumcision. We would like to contact you in the future about participation in research to improve the male circumcision informed consent and counseling process. I have explained to you today that:

We are conducting Focus Group Discussions for Parents/Guardians of children who have agreed to have their child circumcised.

We would like to know if you are willing to be contacted about taking part in a group discussion that takes approximately 60-90 minutes within the next 2 weeks. If you agree to be contacted in the future, you will be asked to specify how you want to be contacted (i.e. via phone, letter or personal visit).

We are conducting interviews with adult (age 18+) and adolescent (age 13-17) males, 7-10 days after their circumcision surgery today.

Adult Adolescent

We would like to know if you or the adolescent in your care undergoing circumcision today would be willing to be contacted about taking part in a 30-40 minute interview 7 to 10 days from today. If you agree to be contacted in the future, you will be asked to specify how you want to be contacted (i.e. via phone, letter or personal visit). When contacted in the future, you will be asked if you would like to learn more about this study. If you (the person receiving circumcision services today), or the adolescent in your care (receiving circumcision services today) would like to be part of the study, participation is completely voluntary. If you choose not to take part, it will not affect the services you receive at the clinic in any way. At any time, you may decide to stop your participation, and you are not required to return to the clinic for any future study, if you don’t want to. Whether or not you agree to be contacted, it will not affect your medical care at the clinic now or in the future. If you give us permission to contact you now, but you later change your mind, you can call the clinic and tell us so that we will not contact you for future studies. If we contact you about future research and you tell us then that you are no longer interested in participating in future research, we will not contact you again.

If you change your mind about letting us speak with you, please contact: Kelvin Munjile Study Coordinator and Supervisor Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Paul Hewett, Ph. D Director of Male Circumcision Program Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Email: [email protected] The UNZA Ethics Committee: Ridgeway Campus PO Box 50110 Lusaka, Zambia Tel:256067 Fax: +260 1 250753 [email protected] or [email protected]

Do you agree to let a study staff member contact you to ask you or the adolescent in your care whether you want to participate in this study? Please check Yes or No.

Yes: I agree to be contacted No: I do not agree to be contacted

If yes, please indicate how and where you want to be contacted:

Telephone Numbers: ___________________________ (h)

___________________________ (w) ___________________________ (mobile)

___________________________ (other contact details)

Letter Address: ______________________________________________

______________________________________________

Home visit Address if different from above:

______________________________________________

______________________________________________

Name of adult participant and/or adolescent (print): ________________________ ________________________ Date Signature, Thumb print, or Mark of Participant _______________ __________________________________ Date Signature of Witness (if participant is illiterate) __________ __________________________________ Name of study staff member (print): __________________________________ __________ __________________________________ Date Signature of Staff Member


Informed Consent to Contact Title of the research “Kufwayilikisha ukwishiba bwino ifyo ukusumina pakusembululwa kwenda kubaume”. [PC STAFF: Please indicate the study or studies of interest by ticking the box below] Mulishani, ishina lyandi ninebo…………………mbomba ku…………………. BaPopulation Council, akabungwe akabomba milimo yakufwayilikisha akashili kamakwabo kaba munchende yaku New York, balechita umulimo wakufwayilikisha pafyakuyisuminina pafyakusembululwa kwabaume. Tulefwaya tukamite kuntanshi uku kuti tukalanshanya pafyakusendako lubali mukufwayilikisha kwakumona ifyo benga wamya inshila shakusumina pamulimo wakusembululwa kwabaume elyo nokulanshanya munkama. Namilondolwela lelo ukuti:

Tulekwata kulanshanya kwapebumba kwabafyashi/abunga abana abo abasunisha abana babo kuti bakasembululwe.

Tulefwaya kuti twishibe inga mulefwaya ukuti tukamite kwisa mukusendako lubali mukulanshanya kwapebumba ikukasenda nshita nga 60-90 minutes mumilungu ibili ileyisa. Inga mulesumina tukamite kuntanshi, twalamilomba ukuti mutwebe ifyo mulefwaya ukuti tukamite (kwati ukubomfwa foni, inkalata nangu kwisamitandalila).

Tulelanshanya nabakalamba (bamyaka 18 kuya pamulu) elyo abayiche (bamyaka 13-17) baume, abkwanisha nshiku 7-10 lelo kunse kwakusembululwa.

Bakalamba Bayiche

Tulefwaya ukwishiba inga imwe nangu mulumendo mwikala nankwe ulepita mukusembululwa lelo kuti mwatemwa kuti tukamite kwisa mukusendako lubali mukulanshanya kwinga senda inshita kwati 30-40 minutes munshiku 7 kufika ku 10 kufuma lelo. Inga mulesumina kuti tukamite munshiku shileyisa, twalamilomba kuti mulanda ifyo mulefwaya kuti tukamite (kwati pali foni, inkalata nangu kumitandalila). Inga twamita kuntanshi uku, tukamipusha inga mulefwaya kusambilila fimo fimo fyakuma kulanshanya uku. Inga imwe (mwebalepokelela bwafwilisho mukusembululwa lelo), nangu mulumendo mwikala nankwe (ulepokelela bwafwilisho mukusembululwa) mulefwaya ukusendako lubali mukufwayilikisha, ukusendako lubali kuyifwayila fye mwebene. Inga mwasala kukanasendako lubali, tachakalenge ukushupikwa mukusangako bwafwilisho kuclinic munshila iliyonse. Kuti mwaleka kusendako lubali mushitafye iliyonse, elyo techakweba ati kuti bwela kuclinic nafuti kwisa mukulanshanya kuli konse munshiku shakuntanshi, inga chakweba ati tamulefwaya. Kusenda lubali nangu ukukana kumita, tachakalenge ukulesha kukwatako bwafwilisho kuclinic nomba nangu kuntanshi. Inga mwatiusuminisha kumita nomba, kuntanshi mwaya chinja amanu, kuti mwatuma imbila kuclinic nokutweba kuti nayifwe tukaleke ukumita mukufwayilikisha munshiku shakuntanshi. Inga twamita mukufwayilikisha mushiku shakuntanshi elyo mwatweba ukuti tamulefwaya ukusendako lubali mukufwayilikisha munshiku shakuntanshi, tatwakamita nafuti. Inga mwakwata amepusho lilya twapwisha kulanda nenu lelo, mukwayi moneni:


Kelvin Munjile Study Coordinator and Supervisor Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Paul Hewett, Ph. D Director of Male Circumcision Program Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Email: [email protected] The UNZA Ethics Committee: Ridgeway Campus PO Box 50110 Lusaka, Zambia Tel:256067 Fax: +260 1 250753 [email protected] or [email protected]


Mulesumina ukuti ababomba umulimo wakufwayilikisha bakamite kumipusha imwe nangu mulumendo mwikala nankwe kumfwa inga mulefwaya kusendako lubali mukufwayilikisha uku? Mukwayi chongeni Eya nangu awes

Eya: Ndesumina mukamfwaye fwaye. Awe: Nslefwaya kuti mukamfwaye fwaye

Inga eye, mukwayi kuti mwalanda ifyo neko tungamisanga:


___________________________ (w) ___________________________ (mobile)


Letter Address: ______________________________________________

______________________________________________


______________________________________________

______________________________________________

Name of adult participant and/or adolescent (print): ________________________ ________________________ Date Signature, Thumbprint, or or Mark of Participant _______________ __________________________________ Date Signature of Witness (if participant is illiterate) __________ __________________________________ Name of study staff member (print): __________________________________ __________ __________________________________ Date Signature of Staff Member


Informed Consent to Contact Title of the research “Kuonesesa mwamene kuyendela kuzivomelela pavamudulidwe wamwamuna kwamene kulikuchitika muno Mu Zambia nakuSwaziland” [PC STAFF: Please indicate the study or studies of interest by ticking the box below] Muli bwanji, zina langa ndine……………………….nisebenza ku…………………. BaPopulation Council, kabungwe kofufuzafufuza kamene sikasakila pindu kali mumuzinda wa New York, kakugwila nchito yokuza kuzivomela pankhani yamudulidwe wamwamuna. Tifuna kuti tikakufikileni musogolo mwake mukutenga mbali munchito yowona kuti njila youza bantu kuti bavomele kunkhani yamudulidwe wamwamuna nakukambilana mwachisinsi kwankhala bwino. Nafotokoza kwayimwe lelo kuti:

Tikamba na gulu yamakolo/bamene basunga bana baja bali nabana bamene bavomela kuti bana bawo badulidwe

Tifuna kuziba ngati mufuna tikakwitaneni pankhani yotenga mbali mukucheza pagulu kwamene kuzatenga nthawi monga chabe 60-90 minutes mubasabata yabili yamene yakonkapo. Ngati muvomela kukwitanani, tizaku pempani kuti muti uze mwamene mufunila kuti tikakwitaneni (kupitila pafoni, kalata olo kukuyendelani)

Tifunsa mafunso azimbambo (zaka 18 +) na anyamata (zaka 13-17) mumasiku 7-10 bakasiliza kudulidwa lelo.

Bakulu Banyamata

Tifuna kizba ngati imwe olo munyamata amene ali mumanja mwanu amene alikudulidwa lelo kuti takutandalilani munkhani yotenga mbali mumafunso munthawi yofika ku 30-40 minutes mumasiku 7 kufika ku 10 kuchokela lelo. Ngati muvomela kukuyendelani musogolo mwake, tizakupempani kuti mutiuze njila yamene tinga kuyitaneni (kupitila mu foni, kalata olo kukutandalilani) Tikayenda kukamba nayimwe musogolo mwake, tizakufunsani ngati muzafuna kuziba vanchito yofufuza iyi. Ngati imwe (muntu amene alikulandila tandizo lamudulidwe lelo), olo munyamata amene ali mumanja mwanu (amene alikulandila tandizo lamudulidwe lelo) mungafune kutenga mbali mumapunzilo aya, kutenga mbali nikuzifunila chabe. Ngati muzasanka kusatenga mbali, sichizalenga kuti muleke kulandila tandizo kuclinic munjila ili yonse. Pa nthawi ili yonse, mungafune kuleka kutenga mbali, ndipo ngati simufuna simunga bwele futi kuclinic mukufufuza kuzochitika musogolo mwake. Ngati mwavomela olo mwakana kukuzibisani, sichizalenga kuti muleke kulandila tandizo kuclinic manje olo musogolo mwake. Ngati mwativomelesa kuti tikakuzibiseni, koma musogolo mwachinja nzelu, munga bwele kuclinic nakutiuza kuti tisakakwitaneni kutenga mbali mukufufuza kwamene kubwela musogolo. Ngati tizakwitanani mukufufuza kwamene kuzacitika mosogolo ndipo mwatiuza kuti simufunanso kutenga mbali musogolo, sitiza kufunsaniso. Ngati muzankala namafunso tikasiliza kukamba nayimwe lelo, chonde onani:


Kelvin Munjile Study Coordinator and Supervisor Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Paul Hewett, Ph. D Director of Male Circumcision Program Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Email: [email protected] The UNZA Ethics Committee: Ridgeway Campus PO Box 50110 Lusaka, Zambia Tel:256067 Fax: +260 1 250753 [email protected] or [email protected] Nanga muvomela kuti umozi ofufuza akakufunseni imwe olo munyamata amene ali mumanja mwanu ngati mufuna kutenga mbali mukufufuza? Chonde Chongani Eye olo iyayi

Eye: nivomela kuti mukandiyitane Iyayi: sinivomela kuti mukandiyitane

Ngati eye, chonde wanesani bwanji ndipo kuti kwamene tizakuyitanilani:


___________________________ (w) ___________________________ (mobile)


Letter Address: ______________________________________________

______________________________________________


______________________________________________

______________________________________________

Name of adult participant and/or adolescent (print): ________________________ ________________________ Date Signature or Mark of Participant


_______________ __________________________________ Date Signature of Witness (if participant is illiterate) __________ __________________________________ Name of study staff member (print): __________________________________ __________ __________________________________ Date Signature of Staff Member

Assent: Comprehension Assessment of Adolescents age 13-17 Preparing for Circumcision Title of the research “Evaluation of the informed consent process for male circumcision roll-out in Zambia and Swaziland” Purpose of the study Hello, my name is……………….. I work at…………………... The Population Council, a non-profit research organization based in New York, is doing a study about informed consent for male circumcision. I have been hired by the Population Council to administer a short questionnaire to adolescents age 13-17, such as yourself, who have gone through the counseling process but have not yet undergone the male circumcision surgery. We want to find out how well adolescents understand the male circumcision procedure before agreeing to it and how that process could be improved in the future. Study steps We will be interviewing adolescents, such as yourself, from different clinics in X [fill in name of country] where male circumcision is offered. If you agree to take part in this interview, it will last about 10-15 minutes. After you have finished talking with the counselor, I will read you 10 statements and ask you to tell me whether you think each one is true or false. After our interview, you will then go to the provider who will perform the MC surgery. Your parent/guardian with you today has indicated to me that they will allow you to participate in this interview and we must get their permission. But we can’t do it without your agreement too. So, I’d like to ask you whether you agree to take part. It is your choice to take part in this interview or not. If you choose to be interviewed, you can decide not to answer any of the questions you are asked. You can also choose to stop the interview at any time. Whether or not you agree to take part in this interview, it will not affect your medical care at the clinic now or in the future. Confidentiality The answers that you give will be entered into a computer but will not be linked with your name. The only place your name will be written down is on this informed consent form. All information you provide will be kept in a locked file and your name will never be used in the research reports. Discomforts and risks You may feel uncomfortable talking about male circumcision, HIV and other sensitive topics. You may also refuse to answer any question, or any part of a question, at any time. Compensation You will not be charged, nor will you be paid for participating in this study. Benefits Taking part in this interview has no direct benefits for you, however we will provide you with the correct answers to our questions. Your interview will help us find out more about adolescent men’s experiences with male circumcision and the counseling and informed consent process. What we learn in this study may help to improve the informed consent process for male circumcision services in the future.

Offer to answer questions and freedom to withdraw from the study If you have questions about the study you may ask them now or you can call: [Fill in information for each site] If you don’t have any questions and agree to take part in this study then I will ask you to sign this form stating that I, the interviewer, have informed you of your rights as a research participant and that you have agreed to be interviewed today. This is the only place where your name will be written down. If you do not wish to sign your name, you may simply mark the space with an ‘X’ or use a thumb print. If you have any questions after we speak with you today, please contact: Kelvin Munjile Study Coordinator and Supervisor Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Paul Hewett, Ph. D Director of Male Circumcision Program Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Email: [email protected] The UNZA Ethics Committee: Ridgeway Campus PO Box 50110 Lusaka, Zambia Tel:256067 Fax: +260 1 250753 [email protected] or [email protected]




CLINIC TODAY OR IN THE FUTURE. We thank you for your time. If you need to ask us any further questions after the discussion, please contact: [fill in name, contact number for each clinic] Name of participant (print): _________________________________ __________ __________________________________ Date Signature or Mark of Participant _______________ __________________________________ Date Signature of Witness (if participant is illiterate) Interviewer’s statement I, THE UNDERSIGNED, HAVE DEFINED AND EXPLAINED TO THE PARTICIPANT IN A LANGUAGE THAT HE UNDERSTANDS, THE PROCEDURES TO BE FOLLOWED, THE RISKS AND BENEFITS INVOLVED, AND THE OBLIGATIONS OF THE INTERVIEWER. Interviewer Name (Print): _________________________________________ __________ __________________________________ Date Signature of Interviewer


Assent: Comprehension Assessment of Adolescents age 13-17 Preparing for Circumcision Title of the research “Kufwayilikisha ukwishiba bwino ifyo ukusumina pakusembululwa kwenda kubaume”. Purpose of the study Mulishini, ishina lyandi ninebo……………….ndabomba ku……………….. BaPopulation Council, akabungwe akabomba milimo yakufwayilikisha akashili kamakwabo kaba munchende yaku New York, balechita umulimo wakufwayilikisha pafyakuyisuminina pafyakusembululwa kwabaume. Nabampelako inchito baPopulation Council kulanda nabalumendo nga imwe, bamyaka 13-17 abalepita mukulanshanya kwamunkama bashila sembululwa. Tulefwaya kwishiba ifyo bomfwikisha ifyo babeba fya kuma kukusembululwa kwabaume ilyo tabalasumina ukusemblulwa elyo nefyo iyi nshila ingaba bwino kuntanshi. Study steps Twakula lanshanya nabalumendo, kwati iwe, kufuma kumaclinic yapusanapusana mu X [lemba ishina lyachalo] uko umulimo wakumbululwa kwabaume ulechitika. Inga mulesumina kusendako lubali mukufwayilikisha uku, twalasenda nshita kwati 10-15 minutes. Inga mwapwisha kulanda nabakansela, nalamibelengela amalembo ayali 10 elyo nalamipusha kuti munjebe inga muletontonkanya ati chachine nangu bufi. Inga twapwisha ukulanshanya, mwalaya kuli balya ababomba umulimo wkusembulula abaume. Abafyashi/abakusunga abomuli nabo lelo balanga ukutila balesumina kuti usendeko lubali mukulanshanya uku elyo bafwile batusuminisha. Kwena teti tuchite fyo ilyo taulasumina iwe. Nomba ndefwaya ukwipusha inga ulesumina kusendako lubali. Inga mulesumina kusendako lubali mumepusho, kuti mwasala kushasuka amepusho amo amo twalamipusha. Futi kuti mwasala kuleka ukusendako lubali inshita fye ili yoonse. Kusumina olo ukukana ukusendako lubali mumepusho, tachakamileshe kupokelela bwafwilisho kuclinic nomba olo kuntanshi Confidentiality Amasuko mwala tupelo tukabika pacomputer lyena ishina lyenu tatwakayibikemo. Apo tukabikapo ishina lyenu nipachipepala ichi chakusumininapo. Amasuko oonse mwalatupela tukabika munchende yakomwako elyo ishina lyenu tatwakayibikemo mulilipoto. Discomforts and risks Kuti chamumfwisha ububi kulanda pafya kusembululwa kwamwaume, HIV elyo nafimo fimo fishupa ukulandapo. Uliwakakuka kuna ukwasuka amepusho yamo yamo, mbali yimb yamepusho inshita fye iliyonse. Compensation Tatwamilipilishe, nangu kumilipila mukusendako lubali mukufwayilikisha uku. Benefits Kusendako lubali mukulanshanya uku takuli icho mwala sangamo imwe; kwena twala mipela amasuko ayachine kumepusho yenu. Kulanshanya kwesu kukatwafwilisha kwishiba ifyo basitata bomfwa pafwakusembululwa kwabaume elyo nokulanshanya munkama elyo nakwisuminina. Ifyo twalasambila mukulanshanya uku kukafwilishako kuwamya milimo yakusembulwa kwabaume munshiku shakuntanshi. Offer to answer questions and freedom to withdraw from the study Inga namukwata amepusho ayakumine kukulanshanya uku mukwayi kuti mwayipusha nomba nangu ukutuma foni: [lemba ishina lyanchende]


Inga tamukwete amepusho elyo mulesumina ukusendako lubali mukufwayilikisha uku lelo nalamilomba ukuti musayine pachipepala ichi kulanda ukutila Ine, ulemipusha amepusho, ninondolola bwino bwino ifilefwayikwa ukwishiba imwe inga abalesendako lubali elyo ukutila namusumina kuti tulanshanye lelo. Pepepala apa epalalemwapo ishina lyenu fye. Inga tamulefwaya ukulemba ishina lyenu, mukwayi kuti mwalemba chi ‘X’ nangu kuti mwabomfya umunwe. Inga mwakwata amepusho lilya twapwisha kulanda nenu lelo, mukwayi moneni: Kelvin Munjile Study Coordinator and Supervisor Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Paul Hewett, Ph. D Director of Male Circumcision Program Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Email: [email protected] The UNZA Ethics Committee: Ridgeway Campus PO Box 50110 Lusaka, Zambia Tel:256067 Fax: +260 1 250753 [email protected] or [email protected]





MUKUKWATA UBWAFWILISHO KUCLINIC NOMBA OLO KUNTANSHI Twatasha sana mukutupela inshita. Inga mulefwaya ikwipusha amepusho aliyonse inga twapwisha ukulanshanya, mukwayi kuti mwamona: [lembe ishina, foni namba yaclinic] Name of participant (print): _________________________________ __________ __________________________________ Date Signature or Mark of Participant _______________ __________________________________ Date Signature of Witness (if participant is illiterate) Interviewer’s statement I, THE UNDERSIGNED, HAVE DEFINED AND EXPLAINED TO THE PARTICIPANT IN A LANGUAGE THAT HE UNDERSTANDS, THE PROCEDURES TO BE FOLLOWED, THE RISKS AND BENEFITS INVOLVED, AND THE OBLIGATIONS OF THE INTERVIEWER. Interviewer Name (Print): _________________________________________ __________ __________________________________ Date Signature of Interviewer


Assent: Comprehension Assessment of Adolescents age 13-17 Preparing for Circumcision Title of the research “Kuonesesa mwamene kuyendela kuzivomelela pavamudulidwe wamwamuna kwamene kulikuchitika muno Mu Zambia nakuSwaziland” Purpose of the study Muli bwanji, zina langa ndine……………….nisebenza ku…………………… BaPopulation Council, kabungwe kofufuza fufuza kamene sikafuna pindu kamene kali mumuzinda wa New York, bagwila nchito yofufuzafufuza pankhani yozivomelela pankhani yamudulidwe wamwamuna. Bananipasa nchito baPopulation Council kuti nizifunsa mafunso yang’ono ali pachipepala ku banyamata bazaka 13-17, monga iwe, bamene banapita mukucheza mwachisinsi koma bakalibe kudulidwa. Tifuna kuziba kuti anyamata amafika pati kuziba mayendesedwe yamudulidwe wamwamuna paja bakalibe kuvomela ndipo njila iyi inga pangiwe bwanji bwino musogolo mwake. Study steps Tifunsa mafunso anyamata, monga iwe, kuchoka kumaclinic osiyanasiyana mu X [lemba zina laziko] kwamene mudulidwe uchitiwa. Ngati uvomela kutenga mbali mumafunso, chizatenga nthawi monga 10-15 minutes. Ukasiliza kucheza nabakansela, niza kubelengela malembe ali 10 na kukufunsa kuti uniuze ngati uganiza ati nizo ona olo boza. Tikasiliza mafunso, uzayenda kuli bamene bagwila nchito yamudulidwe kuti bagwile nchito yawo. Kolo lako/bamene bakusunga bamene ulinabo lelo bawonesa kwayine kuti bavomela kuti utenge mbali mumafunso ndipo tizafuna kuti bavomekeze. Koma sitinga kambisane popanda iwe kuvomelanso. Manje nifuna nikufunse ngati uvomela kutenga mbali. Nikuzifunila weka kutenga mbali mumafunso aya olo kukana. Ngati wasanka kutenga mbali, ungasanke kusayanka mafunso yamene tizakufunsa. Unga sanke kuyimisa mafunso nthawi ili yonse. Kuvomela olo kukana kutenga mbali mumafunso, sichizalenga kuleka kulandila tandizo kuclinic manje olo musogolo mwake. Confidentiality Mayanko uzanipasa azayikiwa pacomputer koma sazayikiwa pamozi nazina lako. Malo chabe azankala nazina lako nichipepala chovomelelapo. Mayanko onse azankala mumalo yokomewa nazina lako sitizakayisbenzesa mulipoti. Discomforts and risks Kapena sichinga kumveseni bwino kucheza nkhani yamudulidwe wamwamuna, HIV na nkhani zinango zovuta kukamba. Munga fune kukana kuyanka mafunso ena, olo mwina mbali ina yafunso, nthawi ili yonse. Compensation Sitiza kulipilisa,kapena kukulipila mukutenga mbali munchito iyi. Benefits Kutenga mbali mukucheza uku kulibe kulandila chilichonse monga kwayimwe. Uku kucheza kuzatitandiza kusakila kuziba vambili vokuza bachinyamata bazaka zosafika ku 18 na mudulidwe wamwamuna. Vamene tizapunzila lelo vingatandize kupeleka pamwamba nchito zamudulidwe wamwamuna ku banyamata bazaka zosafika ku 18 musogolo mwake.


Offer to answer questions and freedom to withdraw from the study Ingati mulinamafunso okuza nchito iyi mungafunse manje olo kutuma foni: [Lemba zina lamalo] Ngati mulibe mafunso ali yonse ndipo mwamuvomeleza mwana wanu kutenga mbali munchito iyi kansi niza muwuza kuti asayine pachipepa ichi kutantauza kuti ine, amene afunsa mafunso, naku uzani vonse vamene vifunika monga kolo/amene asunga mwana ndipo namwana wanu ndipo kuti mwavomela kuti nimufunse mwana wanu lelo. Ichi chipepa chovomela bakulu na bafana ndiye malo eka pamene pazalembewapo zina lamwana wanu. Ngati simufuna kusayina zina lanu, mungalembe chabe chi ‘X’ olo munga se benzese chikumo. Ngati muzankala namafunso tikasiliza kukamba nayimwe lelo, chonde onani: Kelvin Munjile Study Coordinator and Supervisor Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Paul Hewett, Ph. D Director of Male Circumcision Program Population Council P/Bag RW 319x; Lusaka: 10101 Plot 417, Chindo Rd, La Belva Court, Kabulonga Office tel: 0211262665 Direct tel: 0211262666 Email: [email protected] The UNZA Ethics Committee: Ridgeway Campus PO Box 50110 Lusaka, Zambia Tel:256067 Fax: +260 1 250753 [email protected] or [email protected]



• MAYANKO YANGA AZASUNGIWA MWACHISINSI NA CHIKULIPILILO; • NINGA SANKE KUSATENGA MBALI MUKUCHEZA UKU

Documents

Consent for Comprehension Assessment with Adult Men … · Email: [email protected] The UNZA Ethics Committee: Ridgeway Campus PO Box 50110 Lusaka, Zambia Tel:256067 Fax: +260