Understanding and addressing socio-cultural barriers to medical male circumcision in traditionally non-circumcising rural communities in sub-Saharan Africa

Abstract

Given the success of recent clinical trials establishing the safety and efficacy of adult medical male circumcision in Africa, attention has now shifted to barriers and facilitators to programmatic implementation in traditionally non-circumcising communities. In this study, we attempted to develop a fuller understanding of the role of cultural issues in the acceptance of adult circumcision. We conducted four focus group discussions with 28 participants in Mutoko in Zimbabwe, and 33 participants in Vulindlela, in KwaZulu-Natal, South Africa, as well as 19 key informant interviews in both settings. We found the concept of male circumcision to be an alien practice, particularly as expressed in the context of local languages. Cultural barriers included local concepts of ethnicity, social groups, masculinity, and sexuality. On the other hand, we found that concerns about the impact of HIV on communities resulted in willingness to consider adult male circumcision as an option if it would result in lowering the local burden of the epidemic. Adult medical male circumcision promotional messages that create a synergy between understandings of both traditional and medical circumcision will be more successful in these communities.

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

“…This indicates that if VMMC is to be successful, information regarding the expected amount of pain (after the operation) and what recuperation entails need to be disseminated. Similar to findings from men in Mutoko, Zimbabwe by Khumalo-Sakutukwa et al (2013), men in Mhondoro-Ngezi highlighted that their reluctance towards VMMC was due to the 'forced abstinence' that comes with post-circumcision healing period. Men perceive the recovery period as a factor that might undermine their masculinity.…”

“…These factors subsequently become obstacles that undermine the uptake of VMMC. Although similar to findings reported elsewhere (see Brooks et al, 2010;Khumalo-Sakutukwa et al, 2013), this paper provides a comprehensive qualitative picture of barriers to VMMC from the perspective of uncircumcised males, while previous studies of VMMC in Zimbabwe were often heavily biased towards quantitative methods (Hatzold et al, 2014). By utilising purely qualitative methods, this study provides a rich picture of feelings and attitudes towards VMMC among men across various age categories.…”

Knowledge, attitudes and practices of male circumcision for Human Immunodeficiency Virus (HIV) prevention among voluntary counselling and testing clients in a centre in northern Namibia

“…The findings from studies in traditionally uncircumcised societies in South Africa and Zimbabwe show no significant differences with regard to circumcision status and employment, relationship status, level of education or religion. [25] Such findings concur with those of this study.…”

“…These results concur with findings from non-circumcising communities where participants believe that MC improves penile hygiene and offers protection against diseases like HIV/AIDS. [25] Furthermore, circumcised men in this study expressed more positive beliefs about circumcision and its health benefits than uncircumcised men. Compared to 58.1% of uncircumcised men, 74% of circumcised men reported that it is easier to acquire HIV infection if the male is uncircumcised.…”

Circumcision Status and Time to Sexual Debut Among Youth in Sub-Saharan Africa: Evidence from Six Demographic and Health Surveys

“…In most of these societies, there is a longstanding and elaborate pre-existing system of ritual knowledge and rites of passages that predates the introduction of medical male circumcision for HIV prevention; since the lack of circumcision is now associated with increased health risks, especially ulcerative sexually transmitted diseases. However, despite the scientific evidence about the medical benefits of the practice, many of these countries have adopted an ambivalent position about circumcision, neither officially supporting nor discouraging it [17,18].…”