Skip to main content

Advertisement

SpringerLink
Log in

Acceptability of Male Circumcision for Prevention of HIV Infection in Malawi

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Numerous epidemiological and biological studies report male circumcision (MC) to have a significant protective effect against HIV-1 acquisition. This study assesses the acceptability of MC in four districts in Malawi, a country with high HIV-1 prevalence and low prevalence of MC. Thirty-two focus group discussions were conducted with 159 men and 159 women ages 16–80 years. Acceptability was lower in the north where the practice was little known, higher in younger participants and higher in central and southern districts where MC is practiced by a minority Muslim group (Yao). Barriers to circumcision included fear of infection and bleeding, cost, and pain. Facilitators included hygiene, reduced risk of STI, religion, medical conditions, and enhanced sexual pleasure. If MC services are introduced in Malawi, acceptance is likely to vary by region, but many parents and young men would use the services if they were safe, affordable and confidential.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Auvert, B., Taljaard, D., Lagarde, E., Sobngwi-Tambeko, J., Sitta, R., and Puren, A. (2005). Randomized, Controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 trial. PLOS Medicine, 2, 1–11.

    Google Scholar 

  • Bailey, R. C. (2001). Male circumcision as an effective HIV prevention strategy: Current evidence. Paper presented at 8th Conference on Retroviruses and Opportunistic Infections. Foundation for Retrovirology and Human Health. [On-Line]. Available: http://www.retroconference.org/2001/symsession. cfm?catID=90.

  • Bailey, R. C., Muga, R., Poulussen, R., and Abicht, H. (2002). The acceptability of male circumcision to reduce HIV infections in Nyanza Province, Kenya. AIDS Care, 14(1), 27–40.

    Article  PubMed  CAS  Google Scholar 

  • Bailey, R. C., Plummer, F. A., and Moses, S. (2001). Male circumcision and HIV prevention: Current knowledge and future research directions. Lancet Infectious Diseases, 1, 223–231.

    Article  PubMed  CAS  Google Scholar 

  • Bongaarts, J., Reining, P., and Conant, F. (1998). The relationship between male circumcision and HIV infection in African populations. AIDS, 3, 373–377.

    Article  Google Scholar 

  • Buve, A., Auvert, B., Lagarde, E., Kahindo, M., Hayes, R., and Carael, M. (2000). Male circumcision and HIV spread in sub-Saharan Africa. Abstract MoOrC192, XIII International Conference on AIDS, Durban, South Africa.

    Google Scholar 

  • Caldwell, J., and Caldwell, P. (1996). The African AIDS epidemic. Scientific American, 274, 62–68.

    Article  PubMed  CAS  Google Scholar 

  • Dukers, N., Goudsmit, J., DeWit, J. B. F., Prins, M., Weverling, G. J., and Coutinho, R. A. (2001). Sexual risk behavior relates to the virological and immunological improvements during highly active antiretroviral therapy in HIV-1 infection. AIDS, 15, 369–378.

    Article  PubMed  CAS  Google Scholar 

  • Halperin, D. T., and Bailey, R. C. (1999). Male circumcision and HIV infection: 10 years and counting. Lancet, 354, 1813–1815.

    Article  PubMed  CAS  Google Scholar 

  • Kebaabetswe, P., Lockman, S., Mogwe, S., Mandevu, R., Thior, I., Essex, M., et al. (2003). Male circumcision: An acceptable strategy for HIV prevention in Botswana. Journal of Sexually Transmitted Infection, 79, 214–219.

    Article  CAS  Google Scholar 

  • Kitzinger, J. (1994). Focus groups: methods or madness? In M. Boulton(Ed.), Challenges and innovation: Methodological advances in social research on HIV/AIDS. London: Taylor and Francis.

    Google Scholar 

  • Kreuger, R. A. (1998). Analyzing and reporting focus group results. Thousand Oaks: Sage.

    Google Scholar 

  • Lagarde, E., Taljaard, D., Puren, A., Reathe, R. T., and Bertran, A. (2003). Acceptability of male circumcision as a tool for preventing HIV infection in a highly infected community in South Africa, AIDS, 17, 89–95.

    Article  PubMed  Google Scholar 

  • Lukobo, M. (2005). Male circumcision and HIV prevention in Zambia. DrPh dissertation: Health Policy and Administration, School of Public Health, University of Illinois at Chicago.

  • Lule, S. G., and Lema, V. M. (2000). Critical appraisal of the integration of STI/HIV prevention and control in health service in Malawi, Unpublished manuscript.

  • MDHS. (2001). Malawi Demographic and Health Survey 2000. Zomba, Malawi and Calverton, MD: National Statistical Office [Malawi] and ORC Macro.

  • Mattson, C. L., Bailey, R. C., Muga, R., Poulussen, R., and Onyango, T. (2005). Acceptability of male circumcision and predictors of circumcision preference among men and women in Nyanza Province, Kenya. AIDS Care, 17(2), 182–194.

    Article  PubMed  CAS  Google Scholar 

  • Mattson, C. L., Bailey, R. C., Muga, R., Poulussen, R., and Onyango, T. (2004). Feasibility of medical male circumcision in Nyanza Province, Kenya. East African Medical Journal, 85(5), 230–235.

    Google Scholar 

  • Ministry of Information. (2003). [On-Line]. Available: http://www. maform.com.

  • Ministry of Health and Population. (2003). Management of sexually transmitted infections using syndromic management approach: Guidelines for service providers (2nd edn.). Malawi: Lilongwe.

    Google Scholar 

  • Moses, S., Bradley, J., Nagelkerke, N., Ronald, A., Ndinya-Achola, J., and Plummer, F. (1990). Geographical patterns of male circumcision practices in Africa: association with HIV seroprevalence. International Journal of Epidemiology, 19, 693–7.

    Article  PubMed  CAS  Google Scholar 

  • Moses, S., Plummer, F, A., Bradley, J. E., Ndinya-Achola, J. O., Nagelkerke, N. J. D., and Ronald, A. R. (1995). The East African AIDS epidemic and the absence of male circumcision: What is the link? Health Transition Review, 5, 100–104.

    Google Scholar 

  • Muhr, T. (1997). User’s manual and reference ATLAS.ti (Version 4.1). Berlin, Germany: Scientific Software Development.

    Google Scholar 

  • Mwangalawa, A. S. (1995). Community participation in AIDS activities in two pilot areas, Machinga district in Malawi. Network for AIDS Research in East and South Africa, 17, 2–4.

    Google Scholar 

  • Nnko, S., Washija, R., Urassa, M., and Boerma, J. T. (2001). Dynamics of male circumcision practices in northwest Tanzania. Sex Transmission Diseases, 28, 214–218.

    Article  CAS  Google Scholar 

  • Patterson, B. K., Landay, A., Siegel, J. N., Flener, Z., Pessis, D., Chaviano, A., et al. (2002). Susceptibility to Human Immunodeficiency Virus-1 infection of human foreskin and cervical tissue grown in explant culture, American Journal of Pathology, 161, 867–873.

    PubMed  Google Scholar 

  • Rain-Taljaard, R. C., Lagarde, E., Taljaard, D. J., Campbell, C., MacPhail, C., Williams, B., et al. (2003). Potential for an intervention based on male circumcision in a South African town with high levels of HIV infection. AIDS Care, 15(3), 315– 327.

    Article  PubMed  CAS  Google Scholar 

  • Scott, B. E., Weiss, H. A., and Viljoen, J. I. (2005). The acceptability of male circumcision as an HIV intervention among a rural Zulu population, Kwa-Zulu Natal, South Africa. AIDS Care, 17(3), 304–313.

    Article  PubMed  CAS  Google Scholar 

  • Seed, J., Mertens, A., Tudes, E., Serufilira, A., Carael, M., Karita, P., et al. (1995). Male circumcision, sexually transmitted disease, and risk of HIV. Journal of Acquired Immunodeficiency Syndrome, 8, 83–90.

    CAS  Google Scholar 

  • Sheer, S., Chu, P. L., Klausner, J. D., Katz, M. H., and Schwarcz, S. K. (2001). Effect of highly active antiretroviral therapy on diagnoses of sexually transmitted diseases in people with AIDS. Lancet, 357, 432–435.

    Article  Google Scholar 

  • Siegfried, N., Muller, M., Volmink, J., Deeks, J., Egger, M., Low, N., et al. (2003). Male circumcision for prevention of heterosexual acquisition of HIV in men. The Cochrane Database of Systematic Reviews. (Issue 3, July).

  • Szabo, R., and Short, R. V. (2000). How does male circumcision protect against HIV infection? British Medical Journal, 320,1592– 1594.

    Article  PubMed  CAS  Google Scholar 

  • Taljaard, R., Taljaard, D., Auvert, B., and Neilssen, G. (2001). Cutting it fine: male circumcision practices and the transmission of STDs in Carltonville. Abstract (MoOrC195), XIII International conference on AIDS, Durban South Africa.

  • Tyndall, M., Agoki, E., Malisa, W., Ronald, A., Ndinya-Achola, J., and Plummer, F. (1992). HIV-1 prevalence and risk of seroconversion among uncircumcised men in Kenya. Paper presented in Poster Abstracts, 8th International Conference on AIDS, Amsterdam.

    Google Scholar 

  • UNAIDS (2003). AIDS Epidemic Update, December. Geneva: UNAIDS.

    Google Scholar 

  • USAID/AIDSMark. (2002, September). Male circumcision: Current epidemiological and field evidence; program and policy implications for HIV prevention and reproductive health. Washington, DC: Author.

  • Weiss, H. A, Quigley, M. A., and Hayes, R. J. (2000). Male circumcision and risk of HIV Infection in sub-Saharan Africa: A systematic review and meta-analysis. AIDS, 14, 2261–2370.

    Article  Google Scholar 

Download references

Acknowledgments

We are grateful to Lexa Kawala, Lucky Mhango, Caroline Chitsulo and Ellius Chizimba for their assistance in the field, to Christina Chihana, Biswick Mwale, Lily Maliro, A. Maida, Chipiliro Itaye, Frank Billie for their logistical support, and to Mainza Lukobo for assistance with coding. Support for this study was provided by the National Center for Complementary and Alternative Medicine (5R24 AT 1573), the National Institute of Allergy and Infectious Diseases (AI150440), and to Ms. Ngalande through a traineeship from Fogarty AIDS International Training and Research Program at UIC (D43 TW001419).

Author information

Authors and Affiliations

  1. Kamuzu College of Nursing, Blantyre, Malawi

    Rebecca C. Ngalande

  2. Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA

    Judith Levy

  3. Kamuzu College of Nursing, Lilongwe, Malawi

    Chrissie P. N. Kapondo

  4. Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA

    Robert C. Bailey

  5. PhD Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, 1603 W Taylor Street, Chicago, Illinois, 60612, USA

    Robert C. Bailey

Authors
  1. Rebecca C. Ngalande
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Judith Levy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chrissie P. N. Kapondo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert C. Bailey
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert C. Bailey.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ngalande, R.C., Levy, J., Kapondo, C.P.N. et al. Acceptability of Male Circumcision for Prevention of HIV Infection in Malawi. AIDS Behav 10, 377–385 (2006). https://doi.org/10.1007/s10461-006-9076-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-006-9076-8

Keywords

Search

Navigation