'Just a snip?' : Lemba circumcisers' perspectives on medical male circumcision for HIV prevention in Mberengwa district of rural Zimbabwe.

Abstract

Medical Male Circumcision (MMC) is an HIV ‘prevention technology’ hailed for holding the promise to containing the epidemic. MMC augments the vision of the Joint United Nations Programme on HIV/AIDS (UNAIDS) that pins hope on the possibility of zero new infections through the adoption of a comprehensive prevention approach. This study’s impetus stems from the view that the success of MMC is anchored not only on the premise that its wide-scale implementation subsequently lowers HIV incidence in heterosexual men practicing vaginal penetrative sex, but is also dependent on the readiness of the target population to undergo circumcision. From a culture-centred approach which holds that health promotion programmes should be planned, implemented and evaluated within the context of the relevant socio-cultural beliefs and value systems prevalent in a particular community, the study is a qualitative exploration of perceptions on MMC for HIV prevention among the Lemba people of Mberengwa. The Lemba are a traditionally circumcising cultural group. In light of the culture-centred approach, how they perceive MMC is worth investigation if success has to be achieved in its implementation among this cultural group. The objective of the study is to identify factors influencing collaboration of Lemba traditional circumcisers and medical institutions rolling out voluntary MMC. Purposively selected Lemba surgeons and elders participated in this study. Findings suggest that the Lemba practise male circumcision not as a mere surgical operation but as a symbolic cultural ritual that is value laden. However, they are ready to embrace MMC provided that it is done in a way that does not compromise the cultural values they attach to male circumcision. A deeper insight into Lemba perspectives generated in this study has been used to suggest ways in which the Ministry of Health and Child Care in Zimbabwe can scale-up roll out of voluntary MMC in Mberengwa through creating synergies between cultural and medical perspectives. For example, the majority of participants suggested that making use of Lemba initiates with medical training to conduct circumcisions in Murundu camps can help increase uptake of VMMC.