Communication-related factors influencing the uptake of voluntary medical male circumcision among men in Lilongwe Urban, Malawi

Abstract

Voluntary Medical Male Circumcision (VMMC) has been promoted as an effective biomedical intervention in the reduction of the risk of new HIV and STI infections. The government of Malawi and its stakeholders including the World Health Organization have committed a lot of resources to VMMC programming. However, research shows that its uptake among men is still low in Malawi. This study, therefore, investigated the communication-related factors that influence decision-making in the uptake of VMMC among men in Lilongwe, Malawi. To achieve this aim, twenty-five men, aged between 18 and 35 years old were interviewed on what influenced them to undergo VMMC. The study found that the respondents were influenced to uptake VMMC mostly by peer pressure and the need for conformity; partner/girlfriend demand and considerations; and advice from health personnel. The paper concludes that although the final decision was theirs to make, the men in the study underwent circumcision under duress and/or coercion. It cannot be said to be voluntary. The medical necessity of VMMC can be said to be voluntary if it is negotiated and consented to without duress. Although the ABOUT THE AUTHOR Dr Peter Mhagama is a Senior Lecturer in the Department of Language and Communication at the Polytechnic, a constituent of the University of Malawi. He holds a PhD in Media and Communication obtained in 2015 from the University of Leicester in the UK. His research interests include Media and Development; Communication for Development; Social and Behaviour Change Communication; Citizen Participation and Empowerment; Political Economy of Communication; Media Freedom; and Audience Studies. The research reported in the paper is part of the ongoing research being conducted in the department in the area of Social and Behaviour Change Communication (SBCC). The paper is based on the work of my Master's student, Patrick Makono, whom I have co-authored with. PUBLIC INTEREST STATEMENT Voluntary Male Medical Circumcision (VMMC) is one of the effective strategies for reducing new HIV/AIDS infections. The WHO and UNAIDS recommended the inclusion of male circumcision in HIV-prevention guidelines in countries in Southern Africa, including Malawi, with low circumcision rates and generalized epidemics. VMMC in Malawi was launched in 2012 with the government aiming to achieve 80% coverage among men aged 10-34 by 2020. Considering that there are more barriers than enablers of circumcision, this target of circumcising 80% of the eligible men was quite ambitious. The barriers include social and cultural factors and physical pain, whereas the benefits include improved sex, hygiene, and protection from HIV. However, when the VMMC campaign was scaled up across the country, uptake remained relatively low. It was from this background that the researchers examined the communication-related factors that influence men to uptake VMMC. The findings reported in this paper are part of ongoing studies in Behaviour Change communication being carried out by the department.

Exploring Culturally-preferred Communication Approaches for Increased Uptake of Voluntary Medical Male Circumcision (VMMC) Services in Rural Malawi

“…Health workers were preferred to disseminate such information because they were considered trained and well experience in disseminating health information hence expected to possess the required competence to carry out the task of reaching out to various audiences with VMMC messages. Although this contradicts the ndings of other studies in Malawi that show that peers are the preferred source of health information this nding is also consistent with other studies that have been conducted on VMMC communication and have shown that health personnel are among the most trusted and preferred sources of information among males [12,32]. The focus on health experts as the rightful sources and disseminators of VMMC messages agrees with the approach used by the Ministry of Health in Kenya which prioritized capacity building of health personnel including those involved in health communication [33].…”

“…Related to VMMC communication, Mhagama et al had concluded that although VMMC was purportedly voluntary, most up-takers did not do so voluntarily [12]. According to the study that was conducted in Lilongwe, men were in uenced to uptake VMMC mostly by peer pressure and the need for conformity; partner/girlfriend demand and considerations; and advice from health personnel [12]. That men opt for VMMC under duress impedes on VMMC uptake [12].…”

“…According to the study that was conducted in Lilongwe, men were in uenced to uptake VMMC mostly by peer pressure and the need for conformity; partner/girlfriend demand and considerations; and advice from health personnel [12]. That men opt for VMMC under duress impedes on VMMC uptake [12]. It is therefore the task of communication to bring to the fore the salience of voluntariness in VMMC in order to increase uptake among men.…”

“…In the same period, Malawi performed cumulatively 887,205 medical circumcisions [5].Communication has been integral to VMMC implementation and speci cally in VMMC demand creation in Malawi [2,6]. The rst VMMC communication strategy in Malawi was implemented from 2012 to 2016 [2, 8-10].The 2010 Situation Analysis Report recommended a VMMC communication strategy to create demand for services [2,4,6,11,12]. At regional level, ndings of a study in Kenya adds weight behind communication as a tool for increasing VMMC uptake [13].…”

A review of public health, social and ethical implications of voluntary medical male circumcision programs for HIV prevention in sub-Saharan Africa

“…It is to be expected that youths may be challenged to freely choose and comprehend the significance of VMMC, particularly those from disadvantaged backgrounds who may lack familiarity with being asked to choose for medical procedures, as some studies have borne out [ 40 ]. Concerns have also been raised about aggressive persuasion strategies, including various forms of “demand creation” (including the use of economic incentives), peer pressure, and stigmatization of the non-circumcised [ 85 , 86 ]. Results of studies on information disclosure and comprehension in VMMC consent processes are mixed, with some studies indicating that participants generally understand the nature and implications of VMMC [ 87 ], while others suggest the information provided emphasizes benefits over risks [ 88 ] and that participants have a poor understanding of key elements [ 35 ].…”