The acceptability of male circumcision as an HIV intervention among a rural Zulu population, KwaZulu-Natal, South Africa

Abstract

Epidemiological and biological studies provide compelling evidence for the protective effect of male circumcision against the acquisition of HIV. Three randomized controlled trials are currently underway to assess the impact of male circumcision as an HIV intervention in traditionally non-circumcising areas with high levels of heterosexually-transmitted infection. This study explores the acceptability of male circumcision among the rural Zulu around Hlabisa and Mtubatuba, KwaZulu-Natal, South Africa. A cross-sectional convenience sample of 100 men and 44 women was surveyed, and two male focus groups held, to ascertain circumcision preferences within the population. Four in-depth interviews with service providers assessed the feasibility of promoting male circumcision. Fifty-one per cent of uncircumcised men and 68% of women favoured male circumcision of themselves or their partners; while 50% of men and 73% of women would circumcise their sons. For men, the main predictors of circumcision preference pertained to beliefs surrounding sexual pain and pleasure; for women, knowledge about the relationship between male circumcision status and STI acquisition was the key indicator for circumcision preference. Among both sexes the main barrier to circumcision was fear of pain and death. The greatest logistical barrier was that circumcision can presently only be carried out by trained hospital doctors.

Acknowledgments

This study was supported by the London School of Hygiene and Tropical Medicine, the Africa Centre for Health and Population Studies and the Wellcome Trust, to whom we are highly grateful. We would also like to thank Lindelihle Gcabashe, without whose skills as translator and logistics coordinator this study would not have been possible and the Africa Centre Director, Mike Bennish, for his review of the manuscript.