AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #268 - “They will think they are protected”: Women university students’ perceptions of the partial efficacy of medical male circumcision (MMC) in KwaZulu-Natal, South Africa
Authors: Presenting Author: Dr. Joanne Mantell - HIV Center for Clinical & Behavioral Studies
Additional Authors: Dr. Jennifer A. Smit, Ms. Jane Saffitz, Ms. Cecilia Milford, Ms. Nzwakie Mosery, Ms. Nonkululeko Tesfay, Mr. Sibusiso Sibiya, Ms. Zonke Mabude, Dr. Tsitsi Masvaure, Dr. Elizabeth Kelvin,
Aim: MMC reduces HIV risk in men by about 50%-60%, but there is no direct evidence that MMC protects women. Endorsement by UNAIDS and roll-out by the governments of several high HIV-prevalence countries, including South Africa, highlight the need to assess how the public understands the concept of partial efficacy (PE) of MMC. This qualitative study explores conceptions of PE to determine the ways in which knowledge, personal beliefs, and degree of trust in partners shape attitudes toward MMC. Of particular importance is how women’s understanding of PE influences their degree of support for partner MMC.
Method / Issue: We conducted 7 focus group discussions (FGDs) with a convenience sample of 77 students (34 women, 43 men) from a university in KwaZulu-Natal Province: 2 were female-only, 3 male-only, and 2, men and women together. Here, we present data on women’s views (4 FGDs). FGDs were conducted in English and addressed understanding of PE in general and specifically to MMC, attitudes toward MMC and how knowledge, personal beliefs and partner trust might influence support for MMC.
Results / Comments: Most participants in all four FGDs communicated a thorough understanding of the PE concept and only a few voiced uncertainty. There was, however, consensus that society-at-large would have difficulty understanding the concept of PE. Women hypothesized that partner MMC could increase women’s risk of contracting HIV. Many participants in the female-only FGDs and in one mixed-gender FGD agreed that male condom use could decrease post-MMC. Women feared that men may view MMC as a license to take more risk. Participants noted the 6-week healing period post-MMC as a risk factor for women. In assessing an appropriate role for women as mothers, partners and community members in regard to MMC, many participants from all groups echoed the sentiment, “You still need to emphasize protection.” In one mixed FGD, participants noted that women have a responsibility to stay faithful to their partners in the recommended 6-week sexual abstinence post-MMC. Groups agreed that women should choose MMC for their sons and were enthusiastic about infant circumcision. While there was also general agreement that women should “encourage,” “motivate”, “support”, and “inform” their male partners, participants noted the ultimate decision rests with men.
Discussion: Women had a good understanding of PE, but thought that others, particularly men, may have difficulty grasping this concept. Doubts about male behavior post-MMC were articulated more clearly in female-only FGDs (e.g., “He will say I am already circumcised so let’s just do it.”), perhaps illustrating a higher level of freedom of expression in same-gender groups. Still, participants from all FGDs consistently predicted high degrees of confusion of PE among men/in the general population and an increase in risky behavior among men post-MMC. Gaining critical insight into the precise nature of individual and societal misconceptions about the efficacy of MMC highlights the need for gender-specific interventions that clarify its protective effect and the consequences of risky sex for circumcised men and their female partners.
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