Key challenges to voluntary medical male circumcision uptake in traditionally circumcising settings of Machinga district in Malawi

Rodney Masese,Gertrude Mwalabu,Pammla Petrucka,Patrick Mapulanga

doi:10.1186/s12889-021-11979-z

Abstract

BackgroundVoluntary medical male circumcision (VMMC) is becoming more popular as an important HIV prevention strategy. Malawi, with a high HIV and AIDS prevalence rate of 8.8% and a low male circumcision prevalence rate of 28% in 2016, is one of the priority countries recommended for VMMC scale-up. This paper investigates the attitudes and key challenges to VMMC adoption in a traditionally circumcising community in Malawi where male circumcision is culturally significant.MethodsA mixed design study using quantitative and qualitative data collection methods was carried out to determine the attitudes of 262 randomly selected males towards VMMC in a culturally circumcising community in Malawi. Statistical Package for the Social Sciences (SPSS) version 20 was used to analyse the quantitative data. To identify predictors of VMMC uptake, we used logistic regression analysis. To identify the themes, qualitative data were analysed using content analysis.ResultsThe findings indicate that, while more males in this community prefer medical circumcision, traditional circumcision is still practised. Panic (63%) perceived surgical complications (31%), and cost (27%) in accessing VMMC services were some of the barriers to VMMC uptake. Age and culture were found to be statistically significant predictors of voluntary medical male circumcision in the logistic analysis. According to qualitative data analysis, the key challenges to VMMC uptake were the involvement of female health workers in the circumcision team and the incentives provided to traditional circumcisers.ConclusionAccording to the findings of this study, VMMC services should be provided in a culturally competent manner that respects and considers existing cultural beliefs and practices in the community. Coordination between local leaders and health workers should be encouraged so that VMMC services are provided in traditional settings, allowing for safe outcomes, and increasing VMMC uptake.

Highlights

Voluntary medical male circumcision (VMMC) is becoming more popular as an important Human Immunodeficiency Virus (HIV) prevention strategy
All of the participants belonged to a religious group, with Muslims accounting for the vast majority (74%, n = 194) and Christians accounting for the remainder
Despite the fact that other studies have reported on the influential role those local leaders play in creating demand for VMMC [39, 45], the current study discovered that some local leaders and traditional circumcisers encouraged traditional circumcision due to the associated personal financial gains

Summary

Introduction

Voluntary medical male circumcision (VMMC) is becoming more popular as an important HIV prevention strategy. Voluntary medical male circumcision (VMMC) has emerged as an effective and costeffective intervention for reducing the risk of heterosexual transmission of HIV and other Sexually Transmitted Infections [1]. Malawi is one of the 14 priority countries with the highest-burden recommended to expand VMMC services as an HIV prevention strategy, with an estimated 8.8%HIV prevalence rate among those aged 15–49 and nearly 70,000 new infections each year [7, 8]. Despite this recommendation, its implementation remains extremely low, among traditionally circumcised communities [9]. Like in other African communities, is done for religious or cultural reasons rather than for medical reasons [10,11,12]

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Discussion

Conclusion