Page 146 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 6 of 7 Original Research

factors associated with acceptance levels of medical circumcision tribal elders within non-circumcising communities in order
in the literature. 10,12,16,18 In our study, the perceived costs of to combat some of the negative cultural perceptions and
the procedure had no bearing on respondents’ MC-seeking beliefs about VMMC, which could be preventing some men
behaviours. This finding contrasts with a previous study from undergoing MC.
conducted in Zambia, which found that the majority of
uncircumcised participants reported that unacceptable medical The possibility of suspicion in sexual relationships was
service conditions and concerns about the quality at VMMC reported by some participants in this study. Specifically,
sites were reasons why they did not get circumcised. 15 uncircumcised men believed that if they underwent
circumcision, their partners would perceive them as being
Believing that the MC procedure is safe was associated with more likely to engage in multiple sexual relationships
being medically circumcised. Because this is a cross-sectional because of the protective effect of MC against STIs
study, we cannot say what the temporal relationship is including HIV. This phenomenon is known as ‘behavioural
between believing that the MC procedure is safe and actually disinhibition’. 10
undergoing VMMC. Other studies conducted in Kenya,
Uganda and Zimbabwe found that if men and their parents A study in Zambia noted that almost all male respondents
believed that circumcision leads to high rates of complications, thought that loss of penile sensitivity was beneficial because
then uptake is likely to be low. 9,11,12,14,17 For instance, it was it allowed both men and women to enjoy sex for longer
noted that parents of uncircumcised boys would be willing periods. 10,13 The reported enhanced sexual satisfaction in
to take their sons for circumcision only after the assurance of men, however, could explain the belief that women have a
good treatment and safety of the procedure. 10 preference for circumcised men, hence the perception that
MC promotes promiscuous behaviour among circumcised
The safety of the procedure is of critical importance to a males. 9,19,21 A future study should be conducted to assess
man’s decision to undergo MC because it is a permanent Zambian women’s perceptions of VMMC for their spouses
surgery with potentially significant effects on an individual’s and sons. A study among Kenyan urban women aged 18–35
sexual health. Thus, men’s fears about the safety and quality years found that women who were exposed to positive
of the procedure should be acknowledged and reassured. VMMC messages were able to discuss the procedure with
The Zambian Ministry of Health along with public health their partners, while others made a joint decision for the men
22
partners should continue to educate individuals that to go for VMMC. This suggests that VMMC programmes
safe, high-quality VMMC services are freely available in could involve women as positive motivators for circumcision,
government health facilities. More sensitisation on the safety especially because of the indirect benefits to women,
of procedure could correct the negative perceptions around including reduced risk of human papillomavirus infection,
free MC being of poor medical quality. 5,18 Men considering which is a strong risk factor for cervical cancer.
MC should also be informed about how the procedure is
done, what they need to do to prepare for the surgery and Study limitations
how to ensure proper healing post-surgery. In this study, information bias was a possible limitation
because the circumcision status was self-reported, and
Circumcision is not traditionally practised in the majority respondents might not have reported their true circumcision
of Zambian tribes, which in turn influences societal status for various reasons. The use of convenient sampling
perceptions and an individual’s decision to seek MC. Studies procedures could limit the study’s capacity to appropriately
have documented that men from ethnic communities that estimate the prevalence of MC among respondents. The
do not traditionally circumcise expressed strong feelings study was conducted among college youth, thereby limiting
against MC. This is because MC is not part of their culture, the generalisability to the general population because older
and they did not want to adopt a practice that their forefathers age groups may hold different opinions about VMMC.
never had. 10,19 This could explain the finding in our study As our sample was restricted to men, we could not capture
that some students perceive circumcision to be an ‘unnatural’ women’s opinions and were thus unable to make inferences
modification of the body organ. It can be expected however about the role of women in VMMC uptake. However, these
that such attitudes may perhaps change gradually with anticipated biases were handled by ensuring confidential
access to accurate information about MC and its benefits. 19,20 interviews with male research assistants, and the use of a
‘proportionate to size’ sampling approach to enrol an
Our study found that some students from non-circumcising adequate number of respondents from each of the five
tribes were not concerned about their MC status because campuses. Given the high response rate (77%), our study
they believed that both circumcised and uncircumcised men therefore provides important evidence on the factors
are the same in all aspects, including sexual sensitivity. associated with MC status among college students in
It is possible that the self-reported preference to undergo Ndola, Zambia, and provides essential information for
MC among circumcised students was because of its programme implementers to effect policy adjustments.
protective effect against HIV, and not necessarily whether the The study also offers some baseline information, which is
respondent’s tribe traditionally practised circumcision or necessary for future research on MC using other contextual
not. 10,19 Therefore, VMMC programmes should reach out to approaches.

http://www.sajhivmed.org.za 139 Open Access