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HCI Sheds Light on Attitudes and Perceptions toward Male Circumcision in Namibia
By Simon Hiltebeitel
Recent studies in sub-Saharan Africa and other regions show that male circumcision has reduced transmission of HIV from women to men by as much as 60%. Male circumcision may prove especially effective in countries with high HIV prevalence and traditionally low rates of male circumcision. In Namibia, where the circumcision rate is only about 20% and HIV prevalence is high (estimated at 20%), the Government is now assessing the feasibility of including a male circumcision component in the country’s HIV/AIDS prevention strategy.
Preliminary results of research recently conducted by the USAID Health Care Improvement Project (HCI), managed by URC, suggest that there may be popular support for the practice as part of AIDS prevention. HCI gathered data from 46 focus group discussions and 34 key informant interviews in 8 regions of Namibia, to access public attitudes toward male circumcision. Focus groups were stratified by gender (some 55% of study participants were male and 45% female), age (18-34 and 35+), and, in areas with circumcision rates above 25%, by circumcision status.
The study assessed perceived benefits and disadvantages, key influences affecting how decisions about circumcision are made, and levels of awareness about how circumcision can prevent the spread of HIV. Preliminary findings suggest that participants are well aware of facts, attitudes, and beliefs surrounding male circumcision, regardless of whether the practice is prevalent in their region or community.
A majority of focus group participants associated male circumcision with cleanliness, although some viewed it as increasing the risk of insect bites or other physical trauma. Some participants from areas with lower circumcision rates thought that it could lead to disfigurement or death or, if conducted by traditional circumcisers, the spread of HIV.
Participants generally agreed that uncircumcised men are more susceptible to infections, although many were uncertain about whether circumcision offered health outcomes significantly superior to good hygiene practices. Many focus group participants were aware that male circumcision had been shown to reduce the risk of HIV, some even citing the 60% reduction rate in transmission. However, because HIV is transmitted through blood and semen, many participants were uncertain as to how circumcision actually reduces the risk of HIV. Some participants said they did not perceive substantial benefits if circumcision did not eliminate the need for condom use.
Male circumcision was strongly associated with groups within Namibia who continue what was once a more widespread tradition of a multi-faceted rite of passage for young men. Participants from areas with lower circumcision rates expressed differing, often strongly held, opinions about whether circumcision was compatible with their cultural or religious beliefs.
Normative pressures were a common topic throughout discussions. Community and family pressures were seen as potentially exerting strong influences, especially in areas where circumcision rates are high. The decision was largely viewed as one that would be made by parents, especially mothers. The attitudes of sexual partners also appeared to have strong potential to influence men’s decisions. Younger participants were more likely to view the decision as an individual choice. Normative pressure was seen as potentially working against the practice as well, with some participants concerned that it might prove difficult to be among the first in their community to elect circumcision. Some participants stated that they would be more likely to choose circumcision if it were more widely accepted as a social norm, while among other groups, the practice was viewed as virtually compulsory.
Participants agreed that health care providers and traditional circumcisers could benefit from additional training and an exchange of ideas. They saw a need for community clinics to specialize in male circumcision in order to increase access to services. It was also agreed that traditional circumcisers would benefit from provision of clean blades and medicines.
Overall, participants expressed generally positive attitudes towards male circumcision, especially in regard to perceived health benefits. Regardless of the prevalence of the practice in their areas, study participants overwhelmingly supported the idea that the government of Namibia had a role to play in dissemination of information on the topic of male circumcision. Participants wanted the government to provide clarification on the relationship between circumcision and health, especially with regard to HIV.
For more information on URC’s work in Namibia, please contact Simon Hiltebeitel at shiltebeitel@urc-chs.com.
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