Women’s knowledge and perception of male circumcision before and after its roll-out in the South African township of Orange Farm from community-based cross-sectional surveys

Abstract

The roll-out of medical male circumcision (MC) is progressing in Southern and Eastern Africa. Little is known about the effect of this roll-out on women. The objective of this study was to assess the knowledge and perceptions of women regarding MC in a setting before and after the roll-out. This study was conducted in the South African township of Orange Farm where MC prevalence among men increased from 17% to 53% in the period 2008–2010. Data from three community-based cross sectional surveys conducted in 2007, 2010 and 2012 among 1258, 1197 and 2583 adult women, respectively were studied. In 2012, among 2583 women, 73.7% reported a preference for circumcised partners, and 87.9% knew that circumcised men could become infected with HIV. A total of 95.8% preferred to have their male children circumcised. These three proportions increased significantly during the roll-out. In 2007, the corresponding values were 64.4%, 82.9% and 80.4%, respectively. Among 2581 women having had sexual intercourse with circumcised and uncircumcised men, a majority (55.8%, 1440/2581) agreed that it was easier for a circumcised man to use a condom, 20.5% (530/2581) disagreed; and 23.07 (611/2581) did not know. However, some women incorrectly stated that they were fully (32/2579; 1.2%; 95%CI: 0.9% to 1.7%) or partially (233/2579; 9.0%; 95%CI: 8.0% to 10.2%) protected when having unprotected sex with a circumcised HIV-positive partner. This study shows that the favorable perception of women and relatively correct knowledge regarding VMMC had increased during the roll-out of VMMC. When possible, women should participate in the promotion of VMMC although further effort should be made to improve their knowledge.

Association of Male Circumcision with Women’s Knowledge of its Biomedical Effects and With Their Sexual Satisfaction and Function: A Systematic Review

“…There was high-consistency evidence for a positive association between MC and women’s sexual satisfaction, based on seven included publications. Measures were heterogeneous across publications, including level of sexual satisfaction [ 43 , 44 ], incomplete sexual needs fulfillment [ 45 ], and overall rating of the sexual experience [ 47 ]. No RCTs compared satisfaction between circumcision intervention arms, but three surveys were included of female partners of men who had received MC for HIV prevention, comparing their sexual satisfaction before and after the men’s procedures.…”

“…These included partners of participants in the Ugandan circumcision RCT, of whom 97.1% reported improvement or no change and 2.9% with decreased satisfaction [ 41 ]; partners of participants in the Zambian Spear and Shield project [ 47 ] (62.2% improvement, 15.7% no change, 13.2% decreased, 8.8% no opinion); and partners of Kenyan men followed longitudinally (91% reported improvement, other responses not presented) [ 48 ], all supporting a beneficial impact of MC. In addition, one cross-sectional study of women in South Africa reported nonsignificant increases in women’s perceived pleasure during sex with a circumcised partner, though it was not clear if these women had actual sexual experiences with circumcised men, or if these were assumed perceptions [ 44 ].…”

“…2 ). Even one publication that compared women’s knowledge from 2007-2012 in a specific setting that experienced rapid MC scale-up found no significant increase [ 44 ]. This observation could have resulted from MC educational efforts being primarily directed at men.…”

The Role of Female Partners in the uptake of Voluntary Medical Male Circumcision in Sub-Saharan Africa: A Review

“…The results of the study by Maraux et al (2017) found that women had favoured circumcised men before and after the roll-out of VMMC in South Africa. Furthermore, women had substantially good knowledge about MC.…”

“…According to Semeere et al (2016), women are considered to be health advocates in the communities they reside in, and are therefore a possible source of demand generation for circumcision, due to their given ability to influence men by providing the correct information and insight about the procedure. Research studies on the acceptability and perceptions regarding VMMC have documented extensively the fact that women occupy a central role in the scale up of VMMC (Westercamp & Bailey, 2007;Lanham et al, 2012;Maraux et al, 2017). A recent demand creation intervention by Semeere et al (2016) highlighted the feasibility of pregnant women engaging their partners regarding VMMC.…”