Acceptability and feasibility of early infant male circumcision for HIV prevention in Malawi

Abstract

BackgroundVoluntary medical male circumcision (VMMC) has been successfully implemented in 14 countries as an additional HIV prevention intervention. As VMMC programs mature in most countries, the focus is now on how to sustain the HIV prevention gains realised from VMMC. As part of preparations for the sustainability phase, countries are either piloting or preparing to pilot early infant male circumcision (EIMC). This qualitative study explored the acceptability and feasibility of EIMC in Malawi in order to inform pilot implementation.MethodsIn 2016, 23 focus group discussions were held across Malawi with participants from several ethnicities and religions/faiths. Additionally, 21 key informant interviews were held with traditional and religious leaders, traditional circumcisers (ngalibas), policy-makers, programme managers and health-care workers. Audio recordings were transcribed, translated into English (where necessary), and thematically coded using NVivo 10.ResultsDiscussions highlighted the socio-cultural significance of MC in Malawi. Knowledge or experience of EIMC was poor although acceptability was high among most ethnic/religious groups and key informants. Participants identified EIMC's comparative HIV benefits although a few health-care workers expressed scepticism. All participants said EIMC should be offered within a clinical setting. In addition to fathers, maternal uncles and traditional leaders were deemed key decision-makers. Potential barriers to EIMC included concerns about procedure safety as well as cultural considerations. Key informants felt it was feasible to offer EIMC in Malawi. Participants' recommendations, including phased implementation, engagement of traditional leaders, use of external mobilisers and initially reaching out to influential parents, will be taken into account when designing a pilot EIMC program.ConclusionsEIMC is potentially an acceptable and feasible HIV prevention intervention for most ethnic/religious groups in Malawi if wide-ranging, culturally appropriate demand-creation activities are developed, piloted, evaluated and appropriately implemented.

Description of adverse events among adult men following voluntary medical male circumcision: Findings from a circumcision programme in two provinces of South Africa

“…Even with compelling evidence that VMMC reduces HIV acquisition in men, uptake has been sub-optimal in East and Southern Africa. Safety concerns around the VMMC service have the potential to deter service uptake [ 13 , 30 – 32 ]. The VMMC programme among adult men in Gauteng and North West Provinces of South Africa was able to reach both mature men aged 25–45 years, and married men.…”

Changing Cultural Practices: A Case Study of Male Circumcision in South Africa

“…But traditions and cultures are not forever fixed, as can be seen in the growing interest and focus on changing gender relations in society. Black South African mothers, for instance, are beginning to play a key role in the circumcision decision-making process and becoming involved in the preparation and postoperative processes ( Chilimampunga et al, 2017 ; Mavhu et al, 2017 ; Peltzer et al, 2010). Simon’s mother became an agent of change in the circumcision practice in her family by influencing the decision-making process in relation to her youngest son’s circumcision (Simon’s brother) and thereby challenging patriarchy, even though this is not traditionally accepted or allowed.…”

“…Simon’s mother became an agent of change in the circumcision practice in her family by influencing the decision-making process in relation to her youngest son’s circumcision (Simon’s brother) and thereby challenging patriarchy, even though this is not traditionally accepted or allowed. The role of Black South African women in circumcision decision-making has been amplified and publicized in several research studies ( Chilimampunga et al, 2017 ; Mavhu et al, 2017 ; Peltzer et al, 2010). But there is still limited literature on how women influence men’s decisions in this regard, or that explains how women perceive their roles and negotiate and transform their personal identity in a traditionally male space ( Osaki et al, 2015 ).…”

Phimosis and Circumcision: Concepts, History, and Evolution

“…At the same time, prospective studies were developed and data analyzed with the aim of confirming current impact studies. [51][52][53][54][55][56] The Benefits of Circumcision Although limited by selection bias, several observational studies and meta-analyses point to the inversely proportional relationship between circumcision and STD acquisition, evidencing circumcision as a protective factor. [57][58][59] Three clinical trials conducted in Africa randomized eleven thousand HIV-negative adult men for circumcision.…”