‘At risk by fact of birth’: perceptions and concerns about medical male circumcision for HIV prevention in northern Malawi

Abstract

In this article, we draw on critical approaches to risk to examine varied and interlaced perceptions of personal risk for HIV which young men in an area of traditionally low male circumcision have to Malawi government's new policy of medical male circumcision for HIV prevention, locally known as mdulidwe. In this article, we draw on data from in-depth interviews (n = 29) and focus groups (n = 24) with young men aged 18-24 years undertaken in 2013 in an area with traditionally low rates of circumcision, Livingstonia in the northern region district of Malawi. Our findings show that the push for medical male circumcision in this region has given rise to a perception that the penile foreskin is an inborn anomaly that leads to excessive risk for HIV provoking anxiety, confusion, uncertainty, fatalistic views, and waning faith in national response to the epidemic. Our analysis of the data indicates that medical male circumcision has ushered in a layered and sometimes conflicting understanding of risk for HIV/AIDS where established ideas grounded in sexual propriety and risk-taking are being reevaluated and reinterpreted within an emerging worldview coloured with sensibilities pertaining to notions of bodily normalcy. This indicates that the men in our study had a nuanced understanding of risk for HIV that incorporated notions of sexual risk-taking with corporeal impropriety, necessitating appropriate public risk communication about HIV/AIDS and policy responses for its prevention.

Risk perception and the influence on uptake and use of biomedical prevention interventions for HIV in sub-Saharan Africa: A systematic literature review

“…Seven studies were conducted in South Africa,[ 50 – 56 ] four each in Kenya[ 50 , 57 – 59 ] and Malawi. [ 60 – 63 ] Three studies each were conducted in Mozambique[ 64 – 66 ] and Nigeria. [ 67 – 69 ] Two studies each were conducted in Uganda,[ 70 , 71 ] Zambia,[ 72 , 73 ] and Zimbabwe.…”

“…[ 77 ] Moreover, its value as an HIV prevention tool was secondary to its increasing social value including perceived hygiene, cleanliness, and sex appeal. [ 63 ] One participant in a study in northern Malawi said, “I did not want to be a subject of discussion, so I decided to yank it out [get circumcised]. Now I am happy that I don’t really have to worry about embarrassment [of being uncircumcised].”[ 63 ]…”

“…[ 63 ] One participant in a study in northern Malawi said, “I did not want to be a subject of discussion, so I decided to yank it out [get circumcised]. Now I am happy that I don’t really have to worry about embarrassment [of being uncircumcised].”[ 63 ]…”

Perceptions of voluntary medical male circumcision among circumcising and non-circumcising communities in Malawi

“…In the Malawian context, VMMC may threaten to draw religious obligation and concerns about sexuality (particularly promiscuity and extramarital sex) closely together – making very strange bedfellows. Studies conducted elsewhere in Malawi have revealed similar, unintended cultural impacts of promoting VMMC, such as an increasing ‘pathologizing’ perception of the foreskin as a dangerous bodily feature, associated by itself (independent of behaviour) as a source of risk (Mkandawire, Dixon, Luginaah, Armah, & Arku, 2014). …”

Persistent misconceptions about HIV transmission among males and females in Malawi

“…Thus, understanding the etiology of HIV and other sexually transmitted infections (STIs) among some cultural groups could be different from clinical and biological explanations. While misconceptions about HIV transmission may be widespread among a population, there may be ethnic variations in endorsing such misconceptions, given that some ethnic groups are more likely to preserve cultural and ethnic interpretations of the disease [ 23 , 24 ].…”