HIV This Week

Acceptability of medical male circumcision in the traditionally circumcising communities in Northern Tanzania
Wambura M, Mwanga JR, Mosha JF, Mshana G, Mosha F, Changalucha J. BMC Public Health. 2011 May 23;11:373
Data from traditionally circumcising communities show that non-circumcised males and those circumcised in the medical settings are stigmatised. This is because traditional circumcision embodies local notions of bravery as anaesthetics are not used. This study was conducted to assess the acceptability of safe medical circumcision before the onset of sexual activity for HIV infection risk reduction in a traditionally circumcising community in Tanzania. A cross-sectional study was conducted among males and females aged 18-44 years in traditionally circumcising communities of Tarime District in Mara Region, North-eastern Tanzania. A face-to-face questionnaire was administered to females to collect information on the attitudes of women towards circumcision and the preferred age for circumcision. A similar questionnaire was administered to males to collect information on sociodemographic, preferred age for circumcision, factors influencing circumcision, client satisfaction, complications and beliefs surrounding the practice. Results were available for 170 males and 189 females. Of the males, 168 (98.8%) were circumcised and 61 (36.3%) of those circumcised had the procedure done in the medical setting. Of those interviewed, 165 (97.1%) males and 179 (94.7%) females supported medical male circumcision for their sons. Of these, 107 (64.8%) males and 130 (72.6%) females preferred prepubertal medical male circumcision (12 years or less). Preference for prepubertal circumcision was significantly associated with non-Kurya ethnic group, circumcision in the medical setting and residence in urban areas for males in the adjusted analysis. For females, preference for prepubertal circumcision was significantly associated with non-Kurya ethnic group and being born in urban areas in the adjusted analysis. There is a shift of preference from traditional male circumcision to medical male circumcision in this traditionally circumcising population. However, this preference has not changed the circumcision practices in the communities because of the community social pressure. The male circumcision national programme should take advantage of this preference for medical male circumcision by introducing safe and affordable circumcision services and mobilising communities in a culturally sensitive manner to take up circumcision services.

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Editor’s note: Given the numbers of male circumcisions that the 13 priority countries in sub-Saharan Africa are aiming to complete by 2015, many people believe that less attention should be given to communities that have high male circumcision prevalence already through traditional circumcising practices. This study suggests that these communities should not be left behind. Parents are concerned about bleeding, delays in wound healing, and adverse events. They also would prefer that the procedure
be done before sexual activity starts. Although 97% of men and 95% of women in this study supported voluntary medical male circumcision (VMMC) for their sons, 64% of men had been circumcised traditionally and uptake of VMMC is low due to social pressure and increased cost. If safe, affordable, and culturally sensitive VMMC services were made available, as they have been elsewhere in parts of Africa that practice traditional circumcision, it would not be long before parents and young people align
their actions with their preferences. There will be more on male circumcision in the next issue of HIV This Week, but in the meantime, do check out the Joint Strategic Action Framework on Voluntary Medical Male Circumcision that was launched by UNAIDS and PEPFAR on behalf of WHO and other partners last week at the International Conference on AIDS and Sexually Transmitted Infections in Africa held in Addis Ababa, Ethiopia. You can find it at: http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspubl...