Communication-related factors influencing the uptake of voluntary medical male circumcision among men in Lilongwe Urban, Malawi

Abstract

Abstract:  Voluntary Medical Male Circumcision (VMMC) has been promoted as an effective biomedical intervention in the reduction of the risk of new HIV and STI infections. The government of Malawi and its stakeholders including the World Health Organization have committed a lot of resources to VMMC programming. However, research shows that its uptake among men is still low in Malawi. This study, therefore, investigated the communication-related factors that influence decision-making in the uptake of VMMC among men in Lilongwe, Malawi. To achieve this aim, twenty-five men, aged between 18 and 35 years old were interviewed on what influenced them to undergo VMMC. The study found that the respondents were influenced to uptake VMMC mostly by peer pressure and the need for conformity; partner/girlfriend demand and considerations; and advice from health personnel. The paper concludes that although the final decision was theirs to make, the men in the study underwent circumcision under duress and/or coercion. It cannot be said to be voluntary. The medical necessity of VMMC can be said to be voluntary if it is negotiated and consented to without duress. Although the respondents mentioned the HIV and STI infection risk reduction properties, hygienic advantages, and cervical cancer reduction properties of VMMC as benefits of VMMC, these had very little influence on their decision. It is recommended that current intervention messages be reviewed and modified to incorporate new ideas that can address the shortcomings that the current crop of messages has with the aim of increasing the uptake of VMMC programmes or other health focused behaviour change programmes.

Keywords:

• circumcision
• decision-making
• HIV/AIDS
• uptake
• voluntary medical male circumcision

PUBLIC INTEREST STATEMENT

Voluntary Male Medical Circumcision (VMMC) is one of the effective strategies for reducing new HIV/AIDS infections. The WHO and UNAIDS recommended the inclusion of male circumcision in HIV-prevention guidelines in countries in Southern Africa, including Malawi, with low circumcision rates and generalized epidemics. VMMC in Malawi was launched in 2012 with the government aiming to achieve 80% coverage among men aged 10–34 by 2020. Considering that there are more barriers than enablers of circumcision, this target of circumcising 80% of the eligible men was quite ambitious. The barriers include social and cultural factors and physical pain, whereas the benefits include improved sex, hygiene, and protection from HIV. However, when the VMMC campaign was scaled up across the country, uptake remained relatively low. It was from this background that the researchers examined the communication-related factors that influence men to uptake VMMC. The findings reported in this paper are part of ongoing studies in Behaviour Change communication being carried out by the department.

Acknowledgements

We would like to thank the following institutions: Center for Disease Control in Malawi, Jhpiego, and Lilongwe District Health Office for allowing us to conduct the study within their jurisdiction and providing the necessary approvals that allowed us to do the study freely.

Competing interests

There are no competing interests to report on.

Informed consent

Informed consent was obtained from all study participants. Ethical approval to conduct the study was also sought from Malawi’s National Commission for Science and Technology (NCST).

Additional information

Funding

The authors received no direct funding for this research.

Notes on contributors

Peter Mhagama

Dr Peter Mhagama is a Senior Lecturer in the Department of Language and Communication at the Polytechnic, a constituent of the University of Malawi. He holds a PhD in Media and Communication obtained in 2015 from the University of Leicester in the UK. His research interests include Media and Development; Communication for Development; Social and Behaviour Change Communication; Citizen Participation and Empowerment; Political Economy of Communication; Media Freedom; and Audience Studies. The research reported in the paper is part of the ongoing research being conducted in the department in the area of Social and Behaviour Change Communication (SBCC). The paper is based on the work of my Master’s student, Patrick Makono, whom I have co-authored with.