Safe male circumcision in Botswana: Tension between traditional practices and biomedical marketing

Abstract

Botswana has been running Safe Male Circumcision (SMC) since 2009 and has not yet met its target. Donors like the US Centers for Disease Control and Prevention and Africa Comprehensive HIV/AIDS Partnership (funded by the Gates Foundation) in collaboration with Botswana's Ministry of Health have invested much to encourage HIV-negative men to circumcise. Demand creation strategies make use of media and celebrities. The objective of this paper is to explore responses to SMC in relation to circumcision as part of traditional initiation practices. More specifically, we present the views of two communities in Botswana on SMC consultation processes, implementation procedures and campaign strategies. The methods used include participant observation, in-depth interviews with key stakeholders (donors, implementers and Ministry officials), community leaders and men in the community. We observe that consultation with traditional leaders was done in a seemingly superficial, non-participatory manner. While SMC implementers reported pressure to deliver numbers to the World Health Organization, traditional leaders promoted circumcision through their routine traditional initiation ceremonies at breaks of two-year intervals. There were conflicting views on public SMC demand creation campaigns in relation to the traditional secrecy of circumcision. In conclusion, initial cooperation of local chiefs and elders turned into resistance.

Voluntary medical male circumcision for HIV prevention in fishing communities in Uganda: the influence of local beliefs and practice

“…Voluntary medical male circumcision is being rolled out in many parts of sub-Saharan Africa as part of HIV prevention initiatives. While uptake has been encouraging in many places, with men from non-traditionally circumcising communities coming forward, there are many places where there is resistance to the practice (Bulled & Green, 2015;Herman-Roloff et al, 2012;Katisi & Daniel, 2015;Parkhurst et al, 2015) or misconceptions about the purpose of circumcision. Our findings indicate that while messages about the biomedical value of VMMC were reported by study participants, these messages were sometimes mixed with beliefs drawn from traditional circumcision practices.…”

“…Key local people such as traditional and religious leaders from different ethnic groups might be helpful in providing support for an approach that takes into account local beliefs about circumcision (Bulled & Green, 2015). In a study in Botswana, Katisi and Daniel (2015) showed the obstacles that the roll-out of VMMC can encounter when traditional leaders are not engaged in the process. The purpose of VMMC is open to misinterpretation within a setting that has a mixture of people from different ethnic and cultural backgrounds.…”

“…A number of studies have compared uptake of VMMC in societies with and without a tradition of male circumcision (Katisi & Daniel, 2015;Ngalande, Levy, Kapondo, & Bailey, 2006; Rennie, Perry, Corneli, Chilungo, & Umar, 2015; Weiss, Quigley, & Hayes, 2000;Westercamp & Bailey, 2007;Wilcken, Keil, & Dick, 2010). These studies show that the introduction of VMMC in societies where male circumcision is not part of religious or cultural practice has not been without challenges because of the association of the act with ethnic and religious identities (Ahlberg & Njoroge, 2013;Parkhurst, Chilongozi, & Hutchinson, 2015).…”

Exploring the roots of antagony in the safe male circumcision partnership in Botswana

“…MOVE was introduced two years after integration (2011) to help push the target. The MOVE approach uses biomedical marketing strategies like demand-creating mobilisation campaigns, television and radio advertisements, and celebrities as program ambassadors to persuade men to circumcise [ 42 ]. Dedicated clinics do not do any marketing but are simply open to the public for access of SMC services.…”

“I Feel Like More of a Man”: A Mixed Methods Study of Masculinity, Sexual Performance, and Circumcision for HIV Prevention

“…Though there are still many opponents to circumcision for HIV prevention and many challenges to implementing these strategies at scale (Dowsett & Couch, 2007; Katisi & Daniel, 2015; Sgaier, Reed, Thomas, & Njeuhmeli, 2014), by the end of 2011 1.4 million VMMC had been performed in 14 priority African countries with high HIV prevalence and low circumcision prevalence (WHO, 2011). Given this new emphasis on recruiting men to be circumcised – and expanding circumcision to new regions with low circumcision prevalence (Brito et al, 2015; Brito, Luna, & Bailey, 2010; Ning et al, 2013; Tynan et al, 2013) – there is a need to better understand men's experiences with this intervention.…”