Medical male circumcision and HIV risk: perceptions of women in a higher learning institution in KwaZulu-Natal, South Africa

Abstract

Background Medical male circumcision (MMC) reduces the risk of HIV acquisition for men in heterosexual encounters by 50–60%. However, there is no evidence that a circumcised man with HIV poses any less risk of infecting his female partner than an uncircumcised man. There may be an additional risk of HIV transmission to female partners during the 6-week healing period and if condoms are used less often after circumcision. The aim was to explore young women’s perspectives on MMC, with a view to developing clear messages about the limitations of MMC in reducing women’s HIV risk. Methods We explored women’s perspectives on MMC in KwaZulu-Natal, South Africa, with a sample of 30 female tertiary students via four focus groups (two for women only; two mixed gender). Results In all groups, women communicated a thorough understanding of the partial efficacy of MMC, but believed that others would not understand this concept. Participants noted that MMC affords no direct benefit to women. Most thought that MMC would increase females’ risk of contracting HIV, that circumcised men may engage in risky behaviours and that men would increase their number of sexual partners after circumcision. Participants believed that condom use would decrease after MMC and speculated that men would have sex during the healing period, which could further compromise women’s sexual health. Conclusion The concerns expressed by women regarding MMC highlight the need for including women in the dialogue about MMC and for clarifying the impact of MMC on HIV risk for women.

Women’s knowledge and perception of male circumcision before and after its roll-out in the South African township of Orange Farm from community-based cross-sectional surveys

“…These results confirm that women should be involved in the efforts to recruit men for VMMC, as female perception of circumcision may be significantly influential in a man’s decision to undergo MC [7,17,25]. This involvement, however, is not necessarily feasible throughout Eastern and Southern Africa due to cultural resistance, in particular among health providers, such as described in Malawi [26].…”

“…In Kenya, as shown by a community-based survey, factors affecting opinion included a belief that circumcision was not part of the local culture, the perception of a long healing period following the procedure, the lack of a specific motivation to seek out services, and the general fear of pain associated with the circumcision procedure and healing process [23]. Finally, misinformation regarding the association of MC and HIV risk has been revealed in qualitative studies conducted in Tanzania [24] and South Africa [25]. …”

Periconception HIV Risk Behavior Among Men and Women Reporting HIV-Serodiscordant Partners in KwaZulu-Natal, South Africa

“…Other concerning knowledge gaps identified included that almost half of women reported that a woman is protected from HIV if her partner is circumcised. This dangerous myth has been reported in qualitative studies in the Western Cape and Tanazania (87–89). Interestingly, a study with university students in KwaZulu-Natal did not observe the same mis-information suggesting that education may overcome this misperception (89).…”

“…This dangerous myth has been reported in qualitative studies in the Western Cape and Tanazania (87–89). Interestingly, a study with university students in KwaZulu-Natal did not observe the same mis-information suggesting that education may overcome this misperception (89). Participants also demonstrated low knowledge of safer conception strategies such as sperm washing, timing sex to peak fertility, manual insemination, and treatment as prevention, thus explaining infrequent safer conception practices.…”

Healthcare providers’ knowledge, attitudes and practices towards medical male circumcision and their understandings of its partial efficacy in HIV prevention: Qualitative research in KwaZulu-Natal, South Africa

“…There is concern that women do not directly benefit from medical male circumcision (Baeten et al, 2009; Mantell et al, 2013). In this study, some healthcare providers erroneously believed that medical male circumcision would be protective for women, and some had concerns that women clients may engage in more risky behavior.…”