Male circumcision as an HIV reduction strategy : implications for men and women in Zimbabwe.

Abstract

Male circumcision is not a common practice in Zimbabwe except among a few ethnic groups who circumcise as a rite of passage or for religious reasons. Recent scientific research has shown evidence that male circumcision is efficacious in preventing the transmission of HIV from women to men. In response to this, Zimbabwe introduced voluntary medical male circumcision as an additional HIV prevention strategy in 2009. Prior to this, HIV prevention strategies in Zimbabwe focused on the promotion of abstinence, faithfulness and correct and consistent condom use, popularly known as the ABC approach. The purpose of this study was to evaluate the acceptability of medical male circumcision as an additional approach to preventing the acquisition of HIV. The study also intended to understand the factors which may influence the uptake of medical male circumcision for HIV reduction. In addition, the study also sought to find out the role of women in the promotion of circumcision and the implications on men’s sexual behaviour. The study adopted a mixed methods approach using the convergent parallel design in which both qualitative and quantitative data were collected simultaneously and were then merged during analysis and interpretation. A sample of 681 respondents was determined using a statistical formula and selected using random sampling. One hundred and eighty two female respondents were included in the sample because it was felt that women have a significant role to play in the promotion of medical male circumcision. Thus, it was felt important to assess their knowledge, attitudes and beliefs about circumcision in the study. In addition to the 681 individual interviews, five key informants drawn from the Ministry of Health and Child Care and other stakeholders were interviewed. Furthermore, five focus group discussions were also done to complement the data collected using individual and key informant interviews. Participants in focus group discussions were aged between 18 and 49 years. The prevalence of male circumcision among men in the study sample was found to be 15.8 percent. Of these, 40 percent were circumcised as part of the on-going HIV prevention campaign while 33 percent were circumcised for religious or cultural reasons. A further 12 percent were circumcised for medical reasons. The study also established that about 97 percent of both men and women had heard about male circumcision for HIV prevention. The findings show that men were generally more knowledgeable about voluntary medical male circumcision than women. Also, circumcised men had significantly better understanding of vi circumcision than uncircumcised men. Fifty-seven percent of men compared to 54 percent of women reported that they believe that circumcision works for HIV prevention. The study also established that there is general acceptability of the promotion of medical male circumcision for HIV prevention (76 percent for men and 84 percent for women). However, 43 percent of uncircumcised men reported that they are willing to get circumcised for HIV reduction. On risky behaviour after circumcision, 84 percent of respondents reported that they are willing to abstain for 6 weeks to allow complete healing of the wound while 75 percent reported willingness to use condoms after getting circumcised. The study concluded that knowledge and acceptability about medical male circumcision are generally high. The study also concluded that the level of willingness to get circumcised is not corresponding to the levels of knowledge and acceptability. The study attributed this gap to the embedded fear and uncertainties that people have about circumcision. The study thus recommends that there is a need to continue with promotional campaigns that target increasing knowledge in the population. There is also a need to design specific campaigns that target women in order to address the knowledge gap between men and women.