1. AN ANALYSIS OF THE ACCEPTANCE OF
VOLUNTARY MEDICAL MALE
CIRCUMCISION:
A Case of eight wards in Harare Urban
November 2014
Jackson Jack
Key Words: Acceptability, Male Circumcision,
Prevalence, VMMC
Introduction:
More than two decades after the discovery of HIV, the
range of public health measures to control sexual
transmission is still limited (1). An acceptable
intervention would have been a highly effective
vaccine that offers long-lasting protection, but as yet
the search for such a vaccine has proven elusive and
the probability of having one in the foreseeable future
is uncertain (2). An effective HIV vaccine as reported
by Johnson et al (2008) remains a distant dream
although it is as Eaton and Kalichman (2010) (3) puts
it, the most sought after of all the HIV prevention
technologies.
As argued by Rennie et al (2007) (4), given the results
of the clinical trials, and the steady rise in new HIV
infections in resource-poor countries, it would be
unethical not to seriously consider one of the most
promising and most controversial new approaches to
HIV-prevention – Voluntary Medical Male
Circumcision (VMMC). While tolerating debates
about Male Circumcision (MC), it is prudent that MC
be hailed as suggested by experts, advocates and as
politically declared by WHO and UNAIDS (5).
There is wide consensus among most experts in the
HIV/AIDS scientific community that MC, although
not a ‘magic bullet’, is a critical component in the ‘tool
box’ of HIV prevention approaches (5). MC as the new
weapon in the fight against the deadly HIV epidemic,
should be used wisely. Johnson KE (2009) (6) argues
that circumcision provides only partial protection and
higher risk behaviours can nullify circumcision’s
effect. The full impact of MC as suggested by
Nagelkerke et al (2007) and Johnson et al (2008) will
only be apparent after more than a decade.
The Issue:
Zimbabwe’s Voluntary Medical Male Circumcision
(VMMC) 2010-2015 strategy aims to circumcise 80%
of men aged 15-29 years. However, the progress
towards attaining this target has been slower than
expected. This study assessed the acceptance of
VMMC by men within the ages 15 to 29 years in eight
wards of Harare Urban.
Research Methodology:
A survey was conducted with 146 men aged 15-29
years to find out their knowledge, attitudes and beliefs
about VMMC. Covert observational visits were made
to the VMMC sites in Harare Urban to assess
information that was being shared during the
counselling sessions.
Major findings:
The VMMC counselling sessions are quite clear on
how VMMC prevents the transmission of HIV and
STIs as well as how it prevents cervical and penile
cancer. The results indicated that men were aware that
male circumcision (MC) reduces HIV and STI
transmission, but they were not fully convinced of its
preventative mechanism. Men are also sceptical about
the sexual effects of VMMC. Some of them are of the
notion that it reduces their libido whilst some fear that
the operation can result in their manhood being
disabled.
Conclusion:
Men are not convinced with the information or
messages on how VMMC prevents HIV and STIs
hence their reluctance to change their beliefs towards
VMMC. This uncertainty is a barrier to VMMC
acceptance.
Recommendations:
The VMMC campaigns should clearly and publicly
inform men of the mechanisms on how VMMC
prevents STIs and HIV infections. It will be helpful to
include the biological explanation which is more
convincing. Not to be taken lightly is the sexual effects
of VMMC, a fear that most men have. The myths
surrounding the VMMC operation should also be
addressed as most men fear that their manhood might
be disabled after the VMMC operation
References:
1. Modelling the Public Health Impact of Male Circumcision for
HIV prevention in high prevalence areas in Africa. NJD,
Nagelkerke. 16, s.l. : BMC Infectious Diseases, 2007, BMC
Infectious Diseases, Vol. 7.
2. Update on Male Circumcision: Prevention. KE, Johnson. 3,
2008, Vol. 10.
3. Risk Compensation in HIV Prevention: Implication for Vaccines,
Microbicides and other biomedical HIV prevention technologies.
KS, Eaton LA and Kalichman. NIH Public Access, pp. 165-172.
4. Male Circumcision and HIV prevention: ethical, medical and
public health tradeoffs in low-income countries. Rennie S, M.A.
2012, pp. 357-361.
5. Male circumcision for HIV prevention: current evidence and
implementation in sub-Saharan Africa. Wamai RG, Morris BJ,
Bailis SA, Sokal D, Klausner JD, Appleton R, Sewankambo N,
Cooper DA, Bongaarts J, de Bruyn G, Wodal AD, Banerjee J.
2011, Journal of the International AIDS Society.
6. Update on Male Circumcision: Prevention. KE, Johnson. 3,
2008, Vol. 10.