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: http://goo.gl/JgiHoa
By:
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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