Acceptability of Male Circumcision for Prevention of HIV Infection in Malawi

Abstract

Numerous epidemiological and biological studies report male circumcision (MC) to have a significant protective effect against HIV-1 acquisition. This study assesses the acceptability of MC in four districts in Malawi, a country with high HIV-1 prevalence and low prevalence of MC. Thirty-two focus group discussions were conducted with 159 men and 159 women ages 16-80 years. Acceptability was lower in the north where the practice was little known, higher in younger participants and higher in central and southern districts where MC is practiced by a minority Muslim group (Yao). Barriers to circumcision included fear of infection and bleeding, cost, and pain. Facilitators included hygiene, reduced risk of STI, religion, medical conditions, and enhanced sexual pleasure. If MC services are introduced in Malawi, acceptance is likely to vary by region, but many parents and young men would use the services if they were safe, affordable and confidential.

Male Circumcision: Implications for Women as Sexual Partners and Parents

“…30,31 Concerns about hygiene have also been reported anecdotally among sex workers. For example, a sex worker in Nkhotakota, Malawi, said ''the uncircumcised can harbour husks (m'deya) and sperm are trapped within the foreskin and so get disease easily'' .…”

“…For example, a sex worker in Nkhotakota, Malawi, said ''the uncircumcised can harbour husks (m'deya) and sperm are trapped within the foreskin and so get disease easily'' . 30 Both sex workers and young, unmarried women in focus groups conducted in four diverse districts in Malawi believed that circumcised men both enjoy sex more and give more pleasure to their partners than uncircumcised men. 30 Women who had experienced sex with both circumcised and uncircumcised partners in a US study reported a strong preference for circumcised over uncircumcised sexual partners, both for aesthetic reasons and for various sexual activities, ranging from fellatio and manual stimulation to sexual intercourse 32 while in another US study circumcised men reported more varied sexual experience than uncircumcised men.…”

“…30 Both sex workers and young, unmarried women in focus groups conducted in four diverse districts in Malawi believed that circumcised men both enjoy sex more and give more pleasure to their partners than uncircumcised men. 30 Women who had experienced sex with both circumcised and uncircumcised partners in a US study reported a strong preference for circumcised over uncircumcised sexual partners, both for aesthetic reasons and for various sexual activities, ranging from fellatio and manual stimulation to sexual intercourse 32 while in another US study circumcised men reported more varied sexual experience than uncircumcised men. 33 On the other hand, a survey of women recruited through magazines and anti-circumcision websites found a great preference for uncircumcised men, 34 and in a New Zealand study women reported more vaginal dryness during intercourse with circumcised men.…”

“…35 However, as women in the Malawi study concluded, male circumcision may be irrelevant to women's pleasure, with any difference arising from how the woman responds, her preconceived ideas about male circumcision and how she has been socialised. 30 …”

“…For example, in the Malawi study, women indicated that there were expectations that boys would be counselled on sexuality, genital hygiene and good behaviour. 30 The WHO/UNAIDS Montreux recommendations called for male circumcision programmes to maximise opportunities for education and behaviour change communication, promoting shared sexual decision-making, gender equality and improved health of both women and men. 6 Such services for adolescents and young adults can use social change communication strategies to question and support transformative changes in gender norms and roles.…”