Psychosocial Motives for Undergoing Male Circumcision (MC) in High HIV Epidemic Areas and the Probable Impact on the Mass MC Strategy of HIV Prevention: A Case Study of Swaziland

Abstract

While millions of men have been circumcised cumulatively under the mass male circumcision campaigns for the prevention of HIV, the uptake of male circumcision (MC) is below the set targets. This suggests that prevention of HIV is not a convincing motive for circumcision to the majority of men. Notably some men are undergoing male circumcision for other psychosocial motives, rather than the primary public health motive of preventing HIV transmission. These motives have not been explicitly studied in order to ascertain their potential impact on the male circumcision strategy of HIV prevention. This study aimed at assessing the psychosocial motives for undergoing male circumcision in Swaziland and determines their potential impact on the success of the mass male circumcision strategy. A qualitative study design was used, in which in-depth individual face-to-face unstructured interviews were conducted with 17 men seeking health care services at the Family Life Association of Swaziland clinic in Mbabane, Swaziland. All men aged 18 years and above were eligible. Results indicate that some men are undergoing circumcision primarily for psychosocial reasons rather than for HIV prevention. These psychosocial motives include: giving in to pressure from public health advocates, sexual partners and peers; to perceived sexual benefits of the procedure; to demonstrate one’s manhood, as well as to utilise the free and readily available male circumcision services. However, subsequent safe post-MC sexual behaviour is not guaranteed. Nevertheless, it was recommended that these motives be emphasised in the mass male circumcision campaigns, along with appropriate health education, in order to complement HIV prevention in promoting uptake of male circumcision and ensuring safe post-circumcision sexual behaviour.