Men's attitudes: A hindrance to the demand for voluntary medical male circumcision – A qualitative study in rural Mhondoro-Ngezi, Zimbabwe

Abstract

Male circumcision has witnessed a paradigm shift from being regarded as a religious and cultural practice to a global intervention strategy meant to curb transmission of HIV. This is particularly evident in sub-Saharan African countries where the HIV prevalence is greater than 15%. Zimbabwe adopted the voluntary medical male circumcision (VMMC) strategy in 2009; however, since then the uptake of the intervention has only 10% of the adult male population has reported having been circumcised. To better understand this limited uptake of VMMC, we conducted a qualitative study with uncircumcised men aged 15-79 years in Mhondoro-Ngezi, Zimbabwe. Through assessing men's attitudes towards VMMC in seven focus group discussions, conducted between July and August 2012, this article seeks to provide improved strategies for delivering this intervention in Zimbabwe. These data reveal that, in general, men have a negative attitude towards VMMC. Specific barriers to the uptake of VMMC included the perceived challenge to masculinity, post-circumcision stigma, lack of reliable and adequate information and perceptions about the appropriateness of VMMC. These results suggest that structural interventions aimed at reducing stigma related to circumcision, in addition to increased efforts to disseminate accurate information about VMMC, are required in order to dispel men's attitudes that hinder demand for VMMC.

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

“…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. Other research has shown the importance of understanding such long-held beliefs which influence the use and uptake of biomedical technology (Aggleton, 2007;Andersson et al, 2011;Moyo et al, 2015) as well as the importance of taking into account other community member views, including the views of men's sexual partners in order to support VMMCa finding also illustrated in recent work in Zambia (Cook et al, 2015;Riess et al, 2014) Uganda (Gilliam et al, 2010) and northern Tanzania (Osaki et al, 2015). In settings with mixed ethnic groups, such as the fishing communities where this study was set, the messages about the purpose of VMMC, and the procedures to follow to promote healing, compete with beliefs which promote unsafe behaviour (Kamath & Limaye, 2015;Toefy et al, 2015).…”

“…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). In Zimbabwe, where the majority of ethnic groups do not practice circumcision, Hatzold and colleagues and Moyo and colleagues (Hatzold et al, 2014;Moyo, Mhloyi, Chevo, & Rusinga, 2015) describe the social and cultural barriers to introducing VMMC. In South Africa too, local concepts of ethnicity and identity have influenced the perceptions and uptake of VMMC (Khumalo-Sakutukwa et al, 2013;Vincent, 2008).…”

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

“…For example, Adams and Moyer (2015) found that some Swazi men perceived circumcision as a threat to their masculinity due to perceived negative effects it could have on their sex lives (e.g., loss of sensitivity, inability to pleasure female partners). Moyo, Mhloyi, Chevo, and Rusinga (2015) and Khumalo-Sakutukwa et al (2013) found similar masculinity-related barriers to men's circumcision in their studies in Zimbabwe and South Africa, respectively.…”

Health care service providers’ experiences, understanding and conceptions of voluntary medical male circumcision in KwaZulu-Natal, South Africa

“…In KwaZulu-Natal, South Africa it was found that VMMC is associated with perceptions of gender identity and masculinity including sexual performance, sexual image and self-identity (31). In Zimbabwe the perceived challenge to masculinity was one of the major barriers to acceptability and uptake of VMMC (32).…”