Key challenges to voluntary medical male circumcision uptake in traditionally circumcising settings of Machinga district in Malawi

Abstract

Background Voluntary medical male circumcision (VMMC) is becoming more popular as an important HIV prevention strategy. Malawi, with a high HIV and AIDS prevalence rate of 8.8% and a low male circumcision prevalence rate of 28% in 2016, is one of the priority countries recommended for VMMC scale-up. This paper investigates the attitudes and key challenges to VMMC adoption in a traditionally circumcising community in Malawi where male circumcision is culturally significant. Methods A mixed design study using quantitative and qualitative data collection methods was carried out to determine the attitudes of 262 randomly selected males towards VMMC in a culturally circumcising community in Malawi. Statistical Package for the Social Sciences (SPSS) version 20 was used to analyse the quantitative data. To identify predictors of VMMC uptake, we used logistic regression analysis. To identify the themes, qualitative data were analysed using content analysis. Results The findings indicate that, while more males in this community prefer medical circumcision, traditional circumcision is still practised. Panic (63%) perceived surgical complications (31%), and cost (27%) in accessing VMMC services were some of the barriers to VMMC uptake. Age and culture were found to be statistically significant predictors of voluntary medical male circumcision in the logistic analysis. According to qualitative data analysis, the key challenges to VMMC uptake were the involvement of female health workers in the circumcision team and the incentives provided to traditional circumcisers. Conclusion According to the findings of this study, VMMC services should be provided in a culturally competent manner that respects and considers existing cultural beliefs and practices in the community. Coordination between local leaders and health workers should be encouraged so that VMMC services are provided in traditional settings, allowing for safe outcomes, and increasing VMMC uptake.

Barriers to Voluntary Medical Male Circumcision Uptake to Prevent HIV Transmission: A Qualitative Study among Married Men

“…Some of the males on the circumcision team felt uncomfortable because there were female health professionals there, especially since they weren't ill. Participants reported that some males erect when a female provider gets them ready for circumcision which correlates the results in Malawi (Masese et al, 2021). Sexual dissatisfaction after being circumcised was a barrier to VMMC uptake as mentioned by many participants.…”

“…To half the AIDS epidemic by 2030, HIV prevention will continue to be crucial. One of the five UNAIDS (Joint United Nations Program on HIV and AIDS) pillars of HIV prevention is male circumcision (Masese et al, 2021). In countries in Eastern and Southern Africa where there are generalized epidemics of HIV, voluntary male medical circumcision (VMMC) programs are a critical part of the HIV prevention strategy because male circumcision has been shown to reduce the risk of men contracting HIV from heterosexual sex by about 60% (Cork et al, 2020).…”

Acceptability, feasibility and appropriateness of intensified health education, SMS/phone tracing and transport reimbursement for uptake of voluntary medical male circumcision in a sexually transmitted infections clinic in Malawi: a mixed methods study

“…On the contrary, our study may have limited generalizability in rural settings. We hypothesize that barriers such as culture and religion are likely to be more dominant in rural settings than in urban settings [9]. However, considering that most of men in the study had up to secondary school education, findings could be somewhat similar if this study was repeated in a rural setting.…”

Factors Associated with Low Uptake of Medical Male Circumcision Among Adolescent Boys in Tanzania: A Multinomial Logistic Regression Modeling

“…In many traditionally circumcising communities, TMC rivals MMC. 40 In these communities, men who are medically circumcised are often stigmatized and ridiculed. 41 However, in Tanzania 42 The findings in this study (better uptake of MMC in traditionally circumcising communities) are in accordance with a study conducted in a traditionally circumcising community in Tanzania, which indicated a shift in preference from TMC to MMC.…”