“If You Are Not Circumcised, I Cannot Say Yes”: The Role of Women in Promoting the Uptake of Voluntary Medical Male Circumcision in Tanzania

Abstract

Voluntary Medical Male Circumcision (VMMC) for HIV prevention in Tanzania was introduced by the Ministry of Health and Social Welfare in 2010 as part of the national HIV prevention strategy. A qualitative study was conducted prior to a cluster randomized trial which tested effective strategies to increase VMMC up take among men aged ≥20 years. During the formative qualitative study, we conducted in-depth interviews with circumcised males (n = 14), uncircumcised males (n = 16), and participatory group discussions (n = 20) with men and women aged 20–49 years in Njombe and Tabora regions of Tanzania. Participants reported that mothers and female partners have an important influence on men’s decisions to seek VMMC both directly by denying sex, and indirectly through discussion, advice and providing information on VMMC to uncircumcised partners and sons. Our findings suggest that in Tanzania and potentially other settings, an expanded role for women in VMMC communication strategies could increase adult male uptake of VMMC services.

Exploring drivers for safe male circumcision: Experiences with health education and understanding of partial HIV protection among newly circumcised men in Wakiso, Uganda

“…Such influence through beliefs about sexual performance has also been reported in many studies in WHO priority SMC countries [30, 28, 21, 36, 29, 37–39] and elsewhere [40]. Perception of partner preference for circumcised men has also been reported in other places [34, 24, 41, 26, 40, 42].…”

“…A study in Zambia found that women’s acceptance of circumcision and discussion with partners influenced men’s readiness to undergo SMC [25, 22] and in Kenya, a study documented that some women who were ‘more knowledgeable’ about circumcision educated their partners and encouraged them to go for the service [34]. Studies in Botswana and Tanzania showed both direct and indirect influence as well, with women using “soft” language to convince partners, mindful not to endanger their marriages or relationships, while others even denied partners sex to effect circumcision decisions [28, 29]. However, in contrast to this, in a study in Rakai, Uganda [35], conducted before the national scale up of SMC, female partners were reported as deterring rather than motivating the decision to get circumcised.…”

“…However, these studies have been largely based on community views and male informants who have not yet been circumcised [21, 22, 24–27, 23]. Only a few included self-reports of circumcised men [28–30]. This study explored the drivers of adult men’s circumcision decisions from the perspective of SMC clients, their experiences with health education at health facilities and personal understanding of partial HIV protection that SMC offers.…”

Increasing voluntary medical male circumcision uptake among adult men in Tanzania

“…In-depth interviews and participatory group discussions were used to identify barriers and facilitators to uptake of VMMC among men aged 20–34 years, whereas DCEs assessed the intervention components that could potentially increase VMMC uptake among 20–34 year olds. These findings informed specific components of the intervention [22,23]. The intervention applied information, motivation, and behaviour theory to findings from the formative study [24].…”

“…Our formative work also highlighted the need for an expanded role for women in VMMC communication strategies [23]. This study used mobile information booths to provide counselling and education services to female partners of VMMC clients.…”