Thursday, April 7, 2016

Women’s Perceptions and Misperceptions of Male Circumcision: A Mixed Methods Study in Zambia

Women’s perceptions of male circumcision (MC) have implications for behavioral risk compensation, demand, and the impact of MC programs on women’s health. This mixed methods study combines data from the first two rounds of a longitudinal study (n = 934) and in-depth interviews with a subsample of respondents (n = 45) between rounds. Most women correctly reported that MC reduces men’s risk of HIV (64% R1, 82% R2). However, 30% of women at R1, and significantly more (41%) at R2, incorrectly believed MC is fully protective for men against HIV. Women also greatly overestimated the protection MC offers against STIs. The proportion of women who believed MC reduces a woman’s HIV risk if she has sex with a man who is circumcised increased significantly (50% to 70%). Qualitative data elaborate women’s misperception regarding MC. Programs should address women’s informational needs and continue to emphasize that condoms remain critical, regardless of male partner’s circumcision status…

Women potentially contribute substantially to MC uptake by playing an active role in their partner’s decision to obtain MC, assenting when their partner indicates an interest in circumcision, or participating in the decision about circumcising a son. They may also act as supportive partners in seeking MC services or in the post-operative period. Finally, women’s accurate knowledge of the protection MC does and does not afford is important to avoid risk compensation.

With respect to basic MC awareness and knowledge, some of our findings are encouraging. At baseline, during the very early periods of the VMMC program in Zambia, three-quarters of women had heard about MC and 64.0% of women correctly indicated that MC reduces males’ risk of HIV, increasing to 81.5% in Round 2. Similar proportions accurately responded that MC provides protection against some STIs.

However, women demonstrated a lack of more nuanced knowledge of MC’s protective effects, which is cause for concern. A strikingly large proportion of women in the quantitative survey incorrectly believed that MC fully protects men from HIV. The fact that this proportion significantly increased over time is particularly troubling. Moreover, this misperception is mirrored in the qualitative subsample, with close to half of the women not understanding that MC provides only partial protection for men. Even among those women in the subsample who had responded correctly in the quantitative survey, almost half expressed uncertainty or significant misperceptions about MC’s protective effect for men against HIV in their in-depth interviews.

We observe a similar pattern regarding women’s perception of the impact of MC on STI risk for men. Although the majority of survey respondents correctly replied that MC reduces men’s risk of some STIs, the qualitative data suggest that considerable misconceptions remain. Indeed, two-thirds of women in the qualitative subsample had misperceptions about the reduction in STI risk among men that is attributable to MC. The vast majority of these women mistakenly believed that MC completely, or almost completely, protects men against STIs. Thus, our findings indicate that even in cases where superficial knowledge is demonstrated, substantial confusion exists over the relationship between MC and men’s HIV/STI acquisition, and the degree of protection afforded. This is true even among our relatively more educated and wealthier qualitative subsample.

Full article at:

Philip Anglewicz, Editor
1Population Council, New York, United States of America
2London School of Hygiene and Tropical Medicine, London, United Kingdom
3Population Council, Lusaka, Zambia
4Population Council, Washington DC, United States of America
Tulane University School of Public Health, UNITED STATES

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